Objective To analyze the MRI and MRS findings of children with bilirubin encephalopathy, to summarize the imaging features, and to follow up the clinical outcomes, and to provide an imaging basis for the diagnosis and prognosis of acute bilirubin encephalopathy. Methods From August 2015 to October 2016 in our hospital 80 cases of children with high bilirubin, according to the severity of the disease is divided into bilirubin encephalopathy group (n=44 cases) and hyperbilirubinemia group (n=36 cases), the application value of axial line T1WI, T2WI, T2FLAIR and DWI series parallel inspection, coronal T1WI, T2WI sequence inspection, MRS scanning wild (VOI) on lenticula regional positioning, positioning as both sides of the maximum level of bilateral globus pallidus. The T1WI signal intensity, T2WI signal intensity and expression diffusion coefficient (ADC) of the globus pallidus, putamen, hippocampus, substantia nigra and dorsal thalamus were measured on the cross sectional images. And analyze the pop data in the lenticular nucleus. Results Bilirubin encephalopathy group bilateral globus pallidus T1WI and T2WI signal intensity was significantly higher than that of hyperbilirubinemia group, the difference was statistically significant (P<0.05), there was no significant difference between the two groups of children with bilateral pallidal eADC, ADC (P>0.05), bilirubin encephalopathy group movement disorder, hearing impairment, mental retardation and other significant higher than the hyperbilirubinemia group, the difference was statistically significant (P<0.05). Conclusion The MRI features of neonatal bilirubin encephalopathy are bilateral globus pallidus, T1WI signal symmetry increases, and prognosis is poor. It is an important basis for clinical diagnosis and evaluation of prognosis of children with bilirubin encephalopathy.