To study the diagnostic value of pulmonary ultrasound in the grading of neonatal respiratory distress syndrome (NRDS). Methods A retrospective analysis was performed on 120 children with NRDS and 80 neonates in the control group who were admitted to the Affiliated Hospital of Jiangsu University and the Affiliated People's Hospital of Jiangsu University from January 2019 to July 2021 and confirmed by clinical, chest X-ray. Lung ultrasound (LUS) examination was performed to determine LUS score and lung consolidation area. The LUS score and lung consolidation area were analyzed using receiver operating characteristic (ROC) curve to assess NRDS grading. Results The LUS score of NRDS children was higher than that of non-NRDS children (25.16±3.49 vs 15-06±2.28), and the difference was statistically significant (P＜0.05). The LUS score of children with NRDS increased with the increase of NRDS severity (20.85±0.61 vs 23.66±1.63 vs 29.16±1.51, P＜0.05). In the control group, there was no lung consolidation area, and the number of lung consolidation area in NRDS children also increased with the increase of NRDS severity (0.32±0.29 vs1.73± 0.65 vs4.16±0.69, P＜0.05). LUS score was used to diagnose NRDS. The area under ROC curve was 0.928, the optimal cut-off value was 19.2, and the sensitivity and specificity were 94. 2% and 99. 0%, respectively. LUS score differentiated the diagnosis of severe NRDS from mild/moderate NRDS. The area under the ROC curve was 0.993, the optimal cut-off value was 25.5, and the sensitivity and specificity were 91.7% and 97.5%, respectively. LUS score was used to evaluate mechanical ventilation. The area under ROC curve was 0.955, the optimal cut-off value was 27.5, and the sensitivity and specificity were 83.9% and 97. 6%, respectively.Conclusion LUS score and lung consolidation area can differentiate NRDS from non-NRDs, classify NRDS, predict mechanical ventilation, and provide important information and basis for the treatment and monitoring of children