Critical congenital heart disease manifests in the first few hours/days of life. They can either present with cyanosis or blueness. All babies have blue hands and feet at birth but this should improve and never be associated with a blue tongue or blue lips. This is an important danger sign and should never be ignored. If the blood is obstructed going to the body, the baby may first present with a fast heart beat, fast breathing, clod hands and feet and poor pulses to feel. An abnormal murmur may be not always be present.
Later on, babies who have intermittent blueness of the lips and tongue , again fast breathing and heart beats are concerning as well as those who tire or sweat with feeding. Although many children can have short murmurs, murmurs that are loud or associated with an enlarged heart or any symptoms must be referred to a cardiologist.