394 - Delivery Room Respiratory Support and Sedation from a Neonatal Congenital Heart Defect Registry at a Single Center

Publication Number: 394.4215

Francisca Chou, Boston Children's Hospital, Boston, MA, United States; Emily Hauser, Brigham & Women's Hospital, Evanston, IL, United States; Alyssa R. Thomas, Brigham & Women's Hospital, Boston, MA, United States; Elisabeth Kaza, Brigham and Women's Hospital, Boston, MA, United States

Background: One in ten newborns require delivery room (DR) resuscitation. Newborns with congenital heart defects (CHD) often require specialized resuscitation beyond the standard Neonatal Resuscitation Program. At our high-volume level III NICU, clinical guidelines for DR management of newborns with CHD were introduced in 2022. We then developed a cardiac delivery database to objectively investigate DR interventions received by newborns prenatally diagnosed with d-transposition of the great vessels (d-TGA) or hypoplastic left heart syndrome (HLHS).

Objective: We aimed to investigate the frequency at which respiratory interventions and sedation medications were received by newborns with CHD during their initial DR stabilization within two distinct time periods. We secondarily hypothesized that clinical guidelines for DR management of this population may have influenced rates of DR intubation and the use of sedation in the later group.

Design/Methods: Baseline characteristics and DR outcomes were abstracted from the electronic medical record for newborns with a prenatal diagnosis of d-TGA or HLHS born between 2018-2024. Means and frequencies of DR outcomes were compared by year group and CHD risk using t-tests and chi-squared analyses, respectively.

Results: A total of 162 newborns with d-TGA or HLHS were analyzed with 62 in the 2018-2020 group and 100 in the 2022-2024 group. Of the 162 newborns, 27% were intubated in the DR and 23% received sedation in the DR. DR needs were compared by CHD risk – 45% of all newborns with d-TGA had an intact ventricular septum (IVS) and 18% of all newborns with HLHS had an intact or restrictive atrial septum (RAS). There were no significant differences in CHD risk by year-group. A significantly higher percentage of newborns with d-TGA-IVS required intubation, supplemental oxygen, and sedation in the DR compared to newborns with d-TGA-VSD (p < 0.0001, p=0.005, p=0.001). Newborns with HLHS-RAS more often required intubation, supplemental oxygen, and sedation in the DR compared to those with HLHS-ASD (p=0.008, p=0.03, p=0.002). Comparing year-groups, significantly more newborns received supplemental oxygen, were intubated in the DR, or received sedation in the DR in the 2022-2024 group compared to the 2018-2020 group (p=0.01, p=0.006, 0.02).

Conclusion(s): Rates of intubation and the use of sedation in the DR for newborns prenatally diagnosed with d-TGA and HLHS vary based on risk status within each diagnosis and also increased following the implementation of new DR guidelines for CHD.

Demographic Characteristics by Year Group
a Transposition of the great arteries; b Hypoplastic left heart syndrome; c Intact ventricular septum; d Intact atrial septum/restrictive atrial septum

Delivery Room (DR) Respiratory Support by CHD Risk


Delivery Room (DR) Sedation for Infants with TGA and HLHS by Year Group