Objective：To explore the value of imaging in the diagnosis of neonatal meconium peritonitis and the selection of treatment methods. Methods：We retrospectively analyzed the clinical，ultrasound and radiological manifestations and treatment results of 83 neonates，which were diagnosed as meconium peritonitis，from January 2018 to December 2022. The children were divided into the surgical group and the non-surgical group，and the manifestations on ultrasound and X-ray examination such as peritoneal calcification，meconium pseudocyst，intestinal obstruction，volvulus，ascites，and pneumoperitoneum were analyzed. Results： Eighty three neonates（48 males and 35 females）were diagnosed as meconium peritonitis in this period. All patients received ultrasound and X-ray examination after admission. Among them，61 cases（73.5%）required surgical treatment，and 22 cases（26.5%） were successfully treated non-surgically. The occurrence rates of three imaging manifestations，including intestinal obstruction （ultrasound 24/61，radiography 32/61），ascites（ultrasound 27/61），and intestinal torsion（ultrasound 13/61），were higher in the surgical group than the non-surgical group（P ＜ 0.05）. The presence of pneumoperitoneum signs in the surgical group was also higher than the non-surgical group，but the number of cases was not enough to show statistical significance. There was no statistical difference in the proportion of multiple calcifications and meconium pseudocysts between two groups. Conclusion：Imaging findings that predicted the need for surgery were intestinal obstruction，ascites，volvulus and pneumoperitoneum. Neonates only with multiple calcifications in the peritoneum can be successfully treated non-operatively. Children with meconium pseudocyst do not need surgery if they do not have the above manifestations.