Congenital heart defects (CHDs) are the most common birth defects, affecting nearly 1% of infants. While detection and survival have improved greatly, complex CHD remains a leading cause of infant mortality and morbidity. Early identification facilitates coordinated delivery and neonatal stabilization until definitive surgery or procedures can be performed. For nurses caring for these vulnerable patients and families during the initial critical phase, specialized knowledge is essential for optimal outcomes. This learning activity will provide an overview of normal fetal cardiac development compared to pathologic development of CHDs. It will discuss common defects, their corresponding physiological effects, implications for medical and nursing management, and best practices for supporting patient and family wellbeing despite difficult diagnoses. Evidence-based care standards for the interdisciplinary team will be reviewed using case examples and care guidelines. Nurses completing this activity will be better prepared to identify neonates with critical CHDs, prioritize developmentally-appropriate interventions, anticipate specialized needs, and assist families coping with initial crises related to complex congenital cardiac anomalies.