Objective. Neonates with congenital heart disease (CHD) frequently require prompt intervention to improve outcomes and limit morbidities. We sought to determine the time to identification for infants with serious CHD admitted to the State of Alabama's neonatal cardiovascular center and to identify types of cardiac lesions associated with an earlier vs. later diagnosis. Design/Setting. Medical record review of all infants admitted to Alabama's cardiovascular referral center over a 3-year period. Patients. Neonates with serious CHD admitted for medical/surgical care. Results. In total, 178 neonates were identified with serious CHD. Of these, 146 (82%) were identified postnatally. Thirty-two (21%) of the postnatally detected infants were identified after initial discharge from the hospital. Neonates with aortic arch anomalies presented at a median age of 7 days. Conclusion. Identification of infants with serious CHD, especially those with aortic arch anomalies is frequently delayed. These findings support the need for improved methods to detect CHD in the newborn. © 2007, the Authors; Journal compilation © 2007, Blackwell Publishing, Inc.