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Delivery room oxygen physiology and respiratory interventions for newborns with cyanotic congenital heart disease



To characterize pulse oxygen saturation (SpO2) trajectories and respiratory interventions after birth for newborns with cyanotic congenital heart disease (CCHD).

Study design

Retrospective single-site study of newborns ≥32 weeks gestation with CCHD: single ventricle with critical aortic obstruction (SV-CAO), critical pulmonic obstruction (CPO), transposition of the great arteries (TGA). Minute-to-minute SpO2 values and respiratory interventions were summarized and compared.


Two hundred infants were enrolled. SpO2 at each minute differed across groups (p < 0.01), with the lowest values in TGA. All interventions were most frequent in TGA (p < 0.01). Continuous positive airway pressure was provided in 22% SV-CAO, 23% CPO, and 66% TGA. Positive pressure ventilation occurred in 7% SV-CAO, 14% CPO, and 33% TGA. Intubation occurred in 4% SV-CAO, 10% CPO, and 53% TGA.


We defined SpO2 trajectories and delivery room respiratory interventions for three CCHD phenotypes. These results inform delivery room management of these high-risk populations.

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Fig. 1: The 25th, 50th, and 75th pre-ductal SpO2 percentiles up to 10 minutes after birth for infants within each sub-group of CCHD.


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We acknowledge members of the Children’s Hospital of Philadelphia Fetal Heart Program for assistance in accessing the Fetal Heart Registry for this study. We acknowledge Molly Passarella, MS, for her independent review of the statistical analyses.

Author information




AT conceptualized the study design, collected and analyzed the data, and drafted the manuscript. AM refined the study collection tools, collected data, and reviewed and revised the manuscript. MH and DW analyzed the data, and reviewed and revised the manuscript. AA conceptualized the study design and reviewed and revised the manuscript. JR conceptualized the study design, analyzed the data, and reviewed and revised the manuscript. EF conceptualized the study design, refined the study collection tools, analyzed the data and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Elizabeth E. Foglia.

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The authors declare no competing interests.

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Prior presentation of study data: Accepted for presentation at Pediatric Academic Societies conference and Eastern Society for Pediatric Research in 2020 (presented virtually at ESPR in September 2020).

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Thomas, A.R., Ma, A.L., Weinberg, D.D. et al. Delivery room oxygen physiology and respiratory interventions for newborns with cyanotic congenital heart disease. J Perinatol 41, 2309–2316 (2021).

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