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Objective To investigate the pathogenic role of neutrophil extracellular traps （NETs） in the pathogenesis and progression of severe <i>Mycoplasma pneumoniae</i> pneumonia （SMPP） in children and to assess their predictive value for SMPP. Methods Children with <i>Mycoplasma pneumoniae</i> pneumonia （MPP） admitted to the Second Hospital of Lanzhou University from October to December 2023 were selected as the study subjects. They were divided into the non-severe group （MPP group， <i>n = </i>45） and severe group （SMPP group， <i>n = </i>39）. The levels of NETs in the serum and bronchoalveolar lavage fluid （BALF） of all children were measured using ELISA. Additionally， BALF from both the affected and contralateral sides was collected from children in the SMPP group， and the content of NETs in BALF was determined using ELISA. Results A significant difference was observed in the serum concentration of NETs between MPP and SMPP patients （<i>P &lt; </i>0.01）. In the SMPP group， the level of NETs in the BALF of the affected lung was significantly higher than those of the contralateral side （<i>P &lt; </i>0.001）. Serum NETs levels were significantly higher than those in BALF in SMPP group （<i>P &lt; </i>0.001）. The area under the ROC curve （AUC） for predicting SMPP based on serum NETs levels was 0.892 （95%CI 0.810-0.963， <i>P &lt; </i>0.001）， with a sensitivity of 0.821 and specificity of 0.875， and a cut-off value of 17.24 ng/mL，respectively. The AUC of the combination of serum NETs with C-reactive protein （CRP） and lactate dehydrogenase （LDH） levels for predicting SMPP was 0.974 （95%CI 0.946-1.000， <i>P &lt; </i>0.001）， with a sensitivity of 0.923 and specificity of 0.950， respectively. Conclusions Excessive activation of NETs may contribute to the incidence of SMPP and localized lung injury in children with MPP. Monitoring the serum levels of NETs， CRP and LDH can effectively predict the incidence of SMPP. The combination of NETs， CRP， and LDH yields the best predictive performance.