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The application of ultrasound for the evaluation of the newborn possesses the distinct advantage of being non-invasive at a time of life when the patient is fragile because of the combined effects of illness, small body size and physiological immaturity. It is therefore not surprising that echocardiography has found a distinct and unique niche in the evaluation of the newborn suspected of having heart disease. Thus as technological advances such as high resolution high frequency transducers and color flow mapping have been developed, so have the application of these technologies widened the diagnostic capabilities of echocardiography in the neonate. This chapter will outline the contribution of echocardiography and Doppler to the imaging and hemodynamic evaluation of the newborn with structural heart disease or cardiac dysfunction of other etiologies, and indicate those areas which pose particular difficulties for the echocardiographer and require the use of other imaging modalities prior to palliative or corrective newborn cardiac surgery.