Objective To explore the prognostic value of magnetic resonance imaging (MRI) examination combined with Gesell score for neurodevelopment in infants with brain injury. Methods 93 infants with brain injury born in our hospital from July 2022 to July 2023 were selected as the research subjects. According to the results of cranial MRI, the 93 infants with brain injury were divided into mild group (n=21), moderate group (n=47), and severe group (n=25). According to the Bayley Infant Development Scale, they were divided into a good prognosis group of 65 cases and a poor prognosis group of 28 cases. Comparisons were made between different degrees of brain injury in infants (MRI parameters such as T1 value, T2 value, DWI value, and Gesell score), as well as clinical indicators of infants with different prognoses of brain injury, and Pearson correlation analysis, logistic multifactor analysis, and ROC curve analysis were conducted. Results The MRI parameters (T₁ value, T₂ value, DWI value) of children in the severe group were significantly higher than those in the moderate and mild groups, Gesell score in severe group was significantly lower than that in moderate group and mild group. There were no statistical differences in gender, birth weight, 1 min Apgar score, mode of delivery, and whether there was anemia during pregnancy between the good prognosis and poor prognosis groups; however, there were statistical differences in 5 min Apgar score, T1 value, T2 value, DWI value, Bayley score, and Gesell score between the good prognosis and poor prognosis groups. Pearson correlation analysis showed that the MRI parameters (T1 value, T2 value, DWI value) of infants with brain injury were negatively correlated with MDI and PDI, while the Gesell score was positively correlated with MDI and PDI (P<0.05). Logistic multifactor analysis results showed that 5 min Apgar score, T₁ value, T₂ value, DWI value, and Gesell score were independent influencing factors of the neurodevelopment prognosis of infants with brain injury. The ROC curve showed that the combined prediction of MRI parameters and Gesell score for the prognosis of neurodevelopment in infants with brain injury had significantly higher AUC and sensitivity than individual indicators. Conclusion The combined value of MRI parameters and Gesell score has a high predictive value for the prognosis of neurodevelopment in infants with brain injury.