This case involves a female infant born at forty-one weeks to a healthy mother. The amniotic fluid was stained with meconium at birth; however, the infant did not have 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. The 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 infant’s PDA closed, he suffered from cardiovascular collapse due to coarctation of the aorta. As a result, the patient had a hemorrhagic stroke and now has severe neurological derangements.