This case takes place in New Hampshire and involves an infant born at forty weeks to a healthy mother. At birth the patient’s APGARs were nine and nine. The amniotic fluid was stained with meconium at birth; however, the infant was not in respiratory distress at this time. A few hours later, the mother noticed the baby to have labored breathing, tachypnea, and noisy breathing. The baby was then taken to the emergency department and found to have moderate respiratory distress, hypoxia, and audible grunting with some intercostal and subcostal retractions. A precordial exam was normal with the exception of a soft 1/6 systolic murmur likely due to a PDA. No cardiology consult was placed and the patient was admitted to the NICU for four days, and then discharged. Three weeks later after the infants PDA closed, she suffered cardiovascular collapse due to coarctation of the aorta. As a result, the patient suffered a hemorrhagic stroke and now has severe neurological deficits.