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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Acknowledgements
We thank Kai-ou Tang, M.A., Boston Children’s Hospital, for her illustration of Figure 1.
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Sources of Financial Assistance: This work was supported by T32 HD 098061 and by the Canadian NRP research grant.
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AT and NA conceptualized the manuscript. AT, NA, PL, BL, CJ, RG, SE, DR, LP, JS, SG, BAJ, MB, MD, EA, EV, SG all contributed to the first draft, performed literature review, and revised subsequent drafts. All authors have approved the submitted manuscript and have agreed to be accountable for the contents.
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Thomas, A.R., Levy, P.T., Donofrio, M.T. et al. Call to action: prioritizing delivery room care for neonates with critical congenital heart disease. J Perinatol 44, 321–324 (2024). https://doi.org/10.1038/s41372-023-01828-9
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DOI: https://doi.org/10.1038/s41372-023-01828-9