Objective To explore the imaging image and diagnostic value of multislice spiral CT and chest X-ray in neonatal pneumonia. Methods 46 cases of neonatal pneumonia admitted to our hospital from June, 2016 to march, 2018 were selected. To collect the image and clinical data of the patients, summarize the imaging characteristics of multi-slice spiral CT and chest X-ray plain film of neonatal pneumonia, and compare the diagnostic coincidence rate of the two examinations. Results The X-ray plain film correct diagnosis of 38 cases of neonatal pneumonia (82.60%), significantly lower than the multilayer spiral CT in the diagnosis of newborn pneumonia 45 cases (97.82%) (P ＜ 0.05) in 46 cases of patients with chest X-ray plain film is mainly for the increased lung texture fuzzy and lesions, lung door shadow shadow, small lesions characterized by double multiple dot or small patchy shadows, texture distribution along the lungs, to see more lesions fusion situation. The large lesion was a large patchy shadow. In all the 46 patients, the CT images showed small patchy shadows inside the lung, and the central density was higher than the surrounding area, with blurred edges, accompanied by localized emphysema and atelectasis of different degrees, among which 6 patients had lung consolidation. Conclusion Multislice spiral CT and chest X-ray plain images of neonatal pneumonia have various manifestations, and the diagnostic accuracy rate of multislice spiral CT is higher than that of chest X-ray.