Background: Transient tachypnea of the newborn (TTN) is one of the commonest causes of respiratory distress in newborns in late preterm and term infants. TTN occurs due to delay in clearance of fetal alveolar fluid after birth. Objective: The aim of our study was to detect cardiac changes in neonates with TTN and correlating the presence of cardiac changes to the severity of the condition. Patients and methods: Twenty-five neonates were included in this study (15 males and 10 females) with a mean gestational age of 37.76 ± 0.72 weeks and a mean weight of 3.10 ± 0.33 Kg. All cases were subjected to full history and clinical examination and detailed maternal history, laboratory and radiological investigations. Echocardiography was done in all cases as a diagnostic noninvasive tool to assess the cardiac changes in neonates with TTN. Results: About 32% of TTN cases were associated with pulmonary hypertension. 25% showed mild persistent pulmonary hypertension (PPHT), 12.5% showed moderated PPHT and 62.5% showed sever PPHT. The present results showed 13 patients required nasal support, 9 patients required continuous positive airway pressure (CPAP) and 3 patients required advanced respiratory support in the form of mechanical ventilation (SIMV). There was a significant relation between elective cesarean section and occurrence of pulmonary hypertension. 24 neonates included in this study survived and one died. None of our patients developed neonatal sepsis. Conclusion: Echocardiography represents an important non-invasive tool for assessment of cardiac changes and determination of the severity of the condition in neonates suffering from TTN.