Call to action: prioritizing delivery room care for neonates with critical congenital heart disease

Alyssa R Thomas¹, Philip T Levy², Mary T Donofrio³, Brenda Law⁴, Chloe Joynt⁴, Ruby Gupta⁵, Summer Elshenawy⁶, Danielle Reed⁷, Leeann R Pavlek⁸, Jennifer Shepherd⁹, Sharada H Gowda¹⁰, Beth Ann Johnson¹¹, Elisa Abdulhayoglu¹², Eleonore Valencia¹³, Stephanie Guseh¹⁴, Molly K Ball⁸, Noorjahan Ali¹⁵

Affiliations

¹ Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA. alyssa.thomas@childrens.harvard.edu.
² Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
³ Division of Cardiology, Children's National Hospital, Washington, DC, USA.
⁴ Division of Neonatology, Department of Pediatrics, Stollery Children's Hospital/University of Alberta, Edmonton, AB, Canada.
⁵ Division of Neonatology, Department of Pediatrics, Children's Wisconsin, Milwaukee, WI, USA.
⁶ Division of Neonatology, Department of Pediatrics, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, USA.
⁷ Division of Neonatology, Department of Pediatrics, Children's Mercy-Kansas City, Kansas City, MO, USA.
⁸ Division of Neonatology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH, USA.
⁹ Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
¹⁰ Division of Neonatology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
¹¹ Division of Neonatology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA.
¹² Department of Pediatrics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
¹³ Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
¹⁴ Division of Maternal Fetal Medicine, Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
¹⁵ Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern, Dallas, TX, USA.

PMID: 37980393
PMCID: PMC11891863
DOI: 10.1038/s41372-023-01828-9

Call to action: prioritizing delivery room care for neonates with critical congenital heart disease

Alyssa R Thomas et al. J Perinatol. 2024 Mar.

. 2024 Mar;44(3):321-324.

doi: 10.1038/s41372-023-01828-9. Epub 2023 Nov 18.

Authors

Affiliations

¹ Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA. alyssa.thomas@childrens.harvard.edu.
² Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
³ Division of Cardiology, Children's National Hospital, Washington, DC, USA.
⁴ Division of Neonatology, Department of Pediatrics, Stollery Children's Hospital/University of Alberta, Edmonton, AB, Canada.
⁵ Division of Neonatology, Department of Pediatrics, Children's Wisconsin, Milwaukee, WI, USA.
⁶ Division of Neonatology, Department of Pediatrics, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, USA.
⁷ Division of Neonatology, Department of Pediatrics, Children's Mercy-Kansas City, Kansas City, MO, USA.
⁸ Division of Neonatology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH, USA.
⁹ Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
¹⁰ Division of Neonatology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
¹¹ Division of Neonatology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA.
¹² Department of Pediatrics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
¹³ Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
¹⁴ Division of Maternal Fetal Medicine, Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
¹⁵ Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern, Dallas, TX, USA.

PMID: 37980393
PMCID: PMC11891863
DOI: 10.1038/s41372-023-01828-9

Abstract

Managing high-risk newborns with critical congenital heart disease (CCHD) in the delivery room is a unique challenge, characterized by complex physiology, heightened urgency, the coordinated efforts of multiple medical teams, and depending on the facility, the infrequent occurrence of such cases. Currently, there is a lack of unified guidance for resuscitation of these newborns in the delivery room. In this commentary, we advocate for an integrated approach involving maternal-fetal medicine specialists, fetal cardiologists, neonatologists, and cardiac intensivists. The proposed approach emphasizes collaborative pre-delivery planning, focusing on anticipated risk factors, postnatal physiology, and clinical management plans. We stress the importance of simulation-based education specifically addressing CCHD scenarios and advocate for research collaborations to establish evidence-based guidelines and track outcomes. Ultimately, a comprehensive, collaborative, and standardized approach, involving prenatal coordination, communication, and education, is essential for optimizing the delivery room management of neonates with CCHD.

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Conflict of interest statement

Potential Conflicts of Interest: Authors declare no conflicts of interest.

Figures

**FIGURE 1:**
Stages of multidisciplinary collaboration for neonates with critical congenital heart disease

See this image and copyright information in PMC

References

1. Levy PT, Thomas AR, Wethall A, Perez D, Steurer M, Ball MK. Rethinking Congenital Heart Disease in Preterm Neonates. Neoreviews. 2022;23(6):e373–87. - PubMed
1. Marzec L, Zettler ET, Cua CL, Rivera BK, Pasquali S, Katheria A, et al. Timing of umbilical cord clamping among infants with congenital heart disease. Vol. 59, Progress in Pediatric Cardiology. Elsevier Ireland Ltd; 2020. - PMC - PubMed
1. Thomas AR, Ma AL, Weinberg DD, Huber M, Ades A, Rychik J, et al. Delivery room oxygen physiology and respiratory interventions for newborns with cyanotic congenital heart disease. J Perinatol. 2021. Sep;41(9):2309–16. - PubMed
1. Sethi N, Klugman D, Said M, Hom L, Bowers S, Berger JT, et al. Standardized delivery room management for neonates with a prenatal diagnosis of congenital heart disease: A model for improving interdisciplinary delivery room care. Vol. 14, Journal of Neonatal-Perinatal Medicine. IOS Press BV; 2021. p. 317–29. - PubMed
1. Haxel CS, Johnson JN, Hintz S, Renno MS, Ruano R, Zyblewski SC, et al. Care of the Fetus With Congenital Cardiovascular Disease: From Diagnosis to Delivery. Pediatrics. 2022. Nov 1;150(Suppl 2):e2022056415C. - PubMed

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Call to action: prioritizing delivery room care for neonates with critical congenital heart disease

Affiliations

Call to action: prioritizing delivery room care for neonates with critical congenital heart disease

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous