Objective To explore the value of lung high-frequency ultrasound score in the prediction and prognosis evaluation of neonatal respiratory distress syndrome.Methods A total of 107 neonatal respiratory distress syndrome infants admitted to the hospital from February 2020 to January 2022 were selected as the research objects, and recorded as the research group; 48 neonates without pulmonary disease admitted to the hospital during the same period were also selected as the control group, all of whom underwent pulmonary high frequency ultrasonography. The basic data of the children in the study group were collected, and the treatment efficacy was counted after the children were followed up for 7 days after admission. The lung high-frequency ultrasound scores of the study group and the control group were analyzed. The high-frequency ultrasound scores of the lungs of children with different conditions in the study group were recorded. Factors affecting the short-term treatment efficacy of children with neonatal respiratory distress syndrome were analyzed. The predictive value of high-frequency lung ultrasound scores for treatment efficacy in children with neonatal respiratory distress syndrome was analyzed.Results The lung high-frequency ultrasound score in the study group was higher than that in the control group (P < 0.05). The lung high-frequency ultrasound score of the severe disease group was higher than that of the mild and moderate disease groups (P < 0.05), and the lung high-frequency ultrasound score of the moderate disease group was higher than that of the mild disease group (P < 0.05). Logistic multivariate regression analysis showed: gestational age [O^R = 4.968 (95% CI: 2.044, 12.074) ], Δlung high-frequency ultrasound score (the difference between the scores before and 3 days after treatment) [O^R = 4.468 (95% CI: 1.839, 10.859) ], duration of mechanical ventilation [O^R = 5.540 (95% CI: 2.280, 13.464) ] was influential factors in the curative effect of children with neonatal respiratory distress syndrome (P < 0.05). The results of ROC curve analysis showed that the sensitivity of Δlung high-frequency ultrasound score in predicting the treatment efficacy of children with neonatal respiratory distress syndrome was 73.33% (95% CI: 0.448,0.911), and the specificity was 84.78% (95% CI: 0.754,0.911), the AUC was 0.820 (95% CI: 0.725, 0.915).Conclusion The high-frequency lung ultrasound score of children with neonatal respiratory distress syndrome is abnormally increased, and the high-frequency lung ultrasound score is related to the condition and treatment efficacy of children with neonatal respiratory distress syndrome.