A baby born at 38 weeks (male) via spontaneous vaginal delivery is seen on the post-natal ward. On examination, he is noted to have upslanting palpebral fissures, a flat facial profile, a single palmar crease, hypotonia and a wide gap between toes 1 and 2 (sandal gap). These are dysmorphic features of Down syndrome. On auscultation of the precordium, a cardiac murmur is found.