This case takes place in Vermont involves a female neonate who was discharged from the hospital and re-admitted within hours with an interrupted aortic arch and other serious heart defects. The infant was born on to a 27-year old G2P2 at 40+3 weeks EGA via uncomplicated SVD with Apgars of 9 and 9. The neonate went to nursery and roomed in with the mother for the duration of 2-days in the hospital prior to discharge. The mother described poor feeding during their hospitalization. A frenulectomy was performed prior to discharge to assist in better feeding. The mother was home only a few hours and grew concerned due to the infant’s poor feeding, listlessness and pallor. At the ED, she was found to be acidotic with a pH of 6.8, hypothermic (temp 96 rectal) and hypoglycemic with BG in the 30s. No pulse was palpated but HR 100 with BMV in the ED. She was resuscitated, intubated (2 attempts) and transferred to the PICU. Fluid resuscitation continued and dopamine initiated with prostaglandins started after initial echocardiogram revealed coarctation or interrupted aortic arch. She was transferred to another facility for interrupted aortic arch repair via approximation of ends and posterior patch, patch closure of VSD, and PDA ligation.