Objective To explore the influence of NRDS on cerebral hemodynamics and its changes with treatment, so as to provide references for early clinical diagnosis and prevention of brain damage secondary to NRDS. Methods From January to June 2019, a total of 123 neonates born in obstetrics department of Tangdu Hospital of the Air Force Military Medical University were prospectively divided into three groups, including 42 NRDS infants (case group), 49 healthy full-term infants (control group), and 32 healthy premature infants (control group). Cerebral ultrasonic examination was performed for all newborns in 24 to 48 hours after birth, measuring the thickness of the frontal lobe and transverse diameter, observing parenchymal hemorrhage or not, recording blood flow spectrum parameters of middle cerebral artery (MCA) including the peak systolic velocity (PSV), end-diastolic velocity (EDV), mean flow velocity (MFV), resistance index (RI) and pulse index (PI). Among the 42 selected neonates with NRDS, 25 patients received exogenous pulmonary surfactant (PS) and craniocerebral ultrasound was re-examined for them after treated with the drug. Results Compared with full-term newborns, EDV and MFV of healthy premature infants decreased and the difference was significant (P < 0.01, P < 0.05), while RI and PI increased (P < 0.01, P < 0.01). Compared with healthy infants, PSV、EDV and MFV of NRDS children were significantly decreased (P < 0.001), while RI and PI showed no significant change. Compared with healthy premature infants, there was no significant change of cerebral blood flow velocity、RI and PI of NRDS neonates (P > 0.05). After application of exogenous PS, PSV and RI in neonates with NRDS were significantly lower than that before treatment (P<0.05), while EDV, MFV and PI showed no significant changes (P>0.05). Conclusions Hypoxemia status of NRDS newborns and the use of exogenous PS could affect cerebral hemodynamics. Two-dimensional and Doppler ultrasound could clearly show the neonatal brain parenchyma, and effectively detect changes of cerebral blood flow velocity, providing a certain reference basis for the clinical prevention and treatment of brain injury in newborns with NRDS.