Natriuretic atrial peptides are secreted by the heart in response to the distension of the cardiac chambers, and the N-terminal-probrain natriuretic peptide (NT-proBNP) is used frequently by clinician as an indirect measure of cardiac distension. The direct way of getting the same information is echocardiogram which provides a structural and functional assessment of the heart in real time. This paper discusses the value of obtaining both investigations simultaneously. We examined four cases in which the data on simultaneously done NT-proBNP and echocardiogram was available. We concluded that although NT-proBNP used in conjunction with echocardiogram and clinical evaluation can be effective in monitoring neonatal cardiac hemodynamic status, but using NT-proBNP and echocardiogram at the same time is not necessary. Following clinical suspicion and initial echocardiogram, NT-proBNP can be used to trend the infant's status and guide treatment. As our sample size was small, further research using a multicenter trial would be needed to confirm our conclusions, and that could lead to the development of institutional guidelines benefiting both the hospital and patient alike.