Abstract This article aims to comprehensively investigate the epidemiology, pathophysiology, diagnostic methods, therapeutic strategies, and prognosis of Ductus Arteriosus Aneurysm (DAA) in neonates, and to analyze the clinical management highlights through specific case studies. DAA is a rare congenital cardiovascular anomaly that can present with subtle symptoms or be misdiagnosed as common neonatal infections. This paper presents a case study of a 22-day-old male neonate diagnosed with a DAA complicated by left pulmonary artery and bronchial compression, which led to respiratory distress and persistent fever failure to respond to conventional anti-infective treatment. The diagnostic process, clinical management, and the outcome of surgical intervention are discussed, with a review of the relevant literature on the pathophysiology, diagnostic criteria, and management strategies for DAA in neonates. This case emphasizes the need for careful differential diagnosis in neonates presenting with persistent fever and respiratory symptoms, particularly when infection markers are elevated but infection etiology remains unclear.