The study evaluated the modified 12-zone lung ultrasound score (LUS) in the diagnosis and assessment of the severity of neonatal pneumonia in 160 newborns in a multicenter prospective study conducted between January 2023 and February 2024. LUS had a higher diagnostic accuracy than chest X-ray, with an AUC of 0.93, a sensitivity of 78.5%, and a specificity of 88.5% (both P < 0.05). A reduction in the number of B‑lines was correlated with an improvement in the respiratory distress score (r = 0.856, P < 0.001). Reduction in consolidation area correlated with improvement in PaO2/FiO2 ratio (r = 0.801, P < 0.001). Multivariate regression identified the number of B-lines (OR = 1.154), area of consolidation (OR = 2.962), pleural line abnormalities (OR = 6.408), and CRP (OR = 1.102) as independent predictors of severity (P < 0.05). The authors report that modified LUS can be a non-ionizing radiation alternative to X-ray examination in clinical practice in the evaluation of neonatal pneumonia.