Background: Numerous negative outcomes are linked to existence of patent ductus arteriosus (PDA) in neonates. There is a lack of information regarding the proper diagnosis and pathophysiology in relation to long-term outcomes. We aimed to investigate the role of targeted neonatal echocardiography (TNE) in hemodynamically unstable neonates for diagnosis of neonatal PDA that may help in changing the management plan and improving the survival outcome Methods: This cohort study was conducted at the Pediatric Neonatology and Cardiology Units at Pediatrics Department, Faculty of Medicine, Zagazig University on 85 neonates who were clinically suspected to have PDA. We performed TNE for all patients and cases with confirmed PDA were followed up every 3 days to assess changes in management plan till improvement or death. Results: Out of 85 cases examined, 43 were confirmed to have patent ductus arteriosus (PDA). Therapeutic interventions were provided and Post treatment echo revealed that PDA was closed in 34.9% of patients, 25.6% still had PDA, and39.5% died. Comparing pre- to post-echocardiographic analysis, there was statistically significant decrease in the mean of TR pressure gradient, pulmonary artery pressure, LT atrial/aortic ratio and LVESV also there was statistically significant decrease in LV output. Conclusion: We concluded that TNE can help in diagnosis of neonatal PDA. We recommend considering TNE as an early detector of PDA to achieve better outcomes.