This chapter focuses on the neurologic outcomes of patients who have undergone congenital heart surgery. It presents a case study of a 3-day-old neonate with a history significant for hypoplastic left heart syndrome. In addition to standard ASA monitors, intraoperative monitoring included an arterial line, central venous line, and near infrared spectroscopy (NIRS). Cerebral injury after cardiac surgery continues to be a significant source of morbidity, and there are numerous pharmacologic and nonpharmacologic modalities that have been implemented to prevent such injury. With many patients surviving very complex congenital heart surgeries, the anesthesiologist should lead the way in preventing, assessing, and treating neurologic injury in order to obtain the highest quality of life possible for these children. While intraoperative neurologic monitoring for pediatric cardiac surgery is still a relatively new science, it shows a great deal of promise for future application in minimizing cerebral injury and optimizing neurodevelopmental outcome.