Background: Neonatal pneumonia is a common cause of illness, but underlying heart problems can complicate diagnosis and treatment. Structural cardiac anomalies may worsen symptoms or mimic pneumonia, making early detection important.This study aimed to describe echocardiographic findings in neonates previously diagnosed with pneumonia and to assess the prevalence of congenital heart defects in this group.Method: We reviewed 106 NICU cases from 2024 with a prior pneumonia diagnosis. Every 7th neonate from an echocardiography database was included. Clinical data, laboratory results, and imaging findings were analyzed. Echocardiograms were evaluated for isolated, combined, or complex heart defects, and neonates were grouped based on pneumonia type.Results: Most neonates showed echocardiographic abnormalities. Patent foramen ovale (PFO) was the most common (71.7%), appearing alone in 53 cases or with additional defects in 23 cases, including VSD, PDA, fast pulmonary artery flow, and right heart changes. Other findings included atrial septal defects, isolated VSDs, aortic aneurysm, and one case of Tetralogy of Fallot with coronary anomalies. Only 8 neonates (7.5%) had normal echocardiograms.Conclusion: A high number of neonates with a history of pneumonia had structural heart defects, emphasizing the need for routine cardiac evaluation in this population. Early recognition of congenital anomalies can guide appropriate care, improve outcomes, and help differentiate cardiac from pulmonary causes of respiratory distress.Echocardiography should be considered an essential part of neonatal assessment, especially in settings with limited diagnostic resources.
