Purpose of Review <p>To provide the reader with an overview of delivery room management and special considerations for infants with critical congenital heart disease.</p> Recent Findings <p>Infants with critical congenital heart disease may present with cardiovascular compromise requiring life-saving interventions as early as in the delivery room. Advancements in fetal echocardiography have facilitated prenatal diagnosis of congenital heart disease and led to the development of tiered risk-based recommendations to predict postnatal needs. As a result, comprehensive multidisciplinary collaboration starting in the prenatal period has led to improvements in delivery room and postnatal management as well as neonatal outcomes.</p> Summary <p>There is a wide spectrum of clinical manifestations and disease severity in congenital heart disease. Current recommendations for early management are based on fetal echocardiogram findings and must be adapted to local and regional resources. To overcome challenges in providing standardized care, we can consider supplementation with cardiac lesion-specific guidelines. Additional research should evaluate present strategies for risk-assessment, delivery room management, and lesion-specific considerations.</p>