**Core Concept**
Hyaline membrane disease, also known as respiratory distress syndrome (RDS), is a condition characterized by the inadequate production of surfactant in the lungs. Surfactant is a complex mixture of phospholipids and proteins that reduces the surface tension in the alveoli, facilitating easier lung expansion and gas exchange.

**Why the Correct Answer is Right**
The clinical sign of hyaline membrane disease generally first appears in the first few hours after birth, particularly in premature infants. This is due to the immaturity of the fetal lungs, which are unable to produce sufficient surfactant to maintain alveolar stability. As a result, the lungs collapse, leading to respiratory distress and the characteristic "grunting" sound. The lack of surfactant also leads to an increase in the surface tension within the alveoli, making it more difficult for the lungs to expand and exchange gases.

**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because hyaline membrane disease is not typically related to congenital heart disease.
**Option B:** This option is incorrect because the clinical sign of hyaline membrane disease does not typically appear immediately at birth, but rather within the first few hours after birth.
**Option C:** This option is incorrect because hyaline membrane disease is not caused by an infection, but rather by the immaturity of the fetal lungs.

**Clinical Pearl / High-Yield Fact**
Premature infants are at a higher risk of developing hyaline membrane disease due to the inadequate production of surfactant in their lungs. This is why surfactant replacement therapy is often administered to high-risk preterm infants to reduce the risk of RDS.

**Correct Answer: C. In the first few hours after birth.**