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

Journal of Perinatology volume 44, pages 321–324 (2024)Cite this article

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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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Fig. 1: Stages of multidisciplinary collaboration for neonates with critical congenital heart disease.

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Acknowledgements

We thank Kai-ou Tang, M.A., Boston Children’s Hospital, for her illustration of Figure 1.

Funding

Sources of Financial Assistance: This work was supported by T32 HD 098061 and by the Canadian NRP research grant.

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Authors and Affiliations

  1. Division of Newborn Medicine, Department of Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA

    Alyssa R. Thomas & Philip T. Levy

  2. Division of Cardiology, Children’s National Hospital, Washington, DC, USA

    Mary T. Donofrio

  3. Division of Neonatology, Department of Pediatrics, Stollery Children’s Hospital/University of Alberta, Edmonton, AB, Canada

    Brenda Law & Chloe Joynt

  4. Division of Neonatology, Department of Pediatrics, Children’s Wisconsin, Milwaukee, WI, USA

    Ruby Gupta

  5. Division of Neonatology, Department of Pediatrics, Children’s Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, USA

    Summer Elshenawy

  6. Division of Neonatology, Department of Pediatrics, Children’s Mercy-Kansas City, Kansas City, MO, USA

    Danielle Reed

  7. Division of Neonatology, Department of Pediatrics, Nationwide Children’s Hospital and The Ohio State University College of Medicine, Columbus, OH, USA

    Leeann R. Pavlek & Molly K. Ball

  8. 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

    Jennifer Shepherd

  9. Division of Neonatology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA

    Sharada H. Gowda

  10. Division of Neonatology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA

    Beth Ann Johnson

  11. Department of Pediatrics, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Elisa Abdulhayoglu

  12. Department of Cardiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA

    Eleonore Valencia

  13. Division of Maternal Fetal Medicine, Obstetrics and Gynecology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Stephanie Guseh

  14. Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern, Dallas, TX, USA

    Noorjahan Ali

Authors
  1. Alyssa R. Thomas
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  2. Philip T. Levy
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  3. Mary T. Donofrio
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  4. Brenda Law
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  5. Chloe Joynt
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  6. Ruby Gupta
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  7. Summer Elshenawy
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  8. Danielle Reed
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  9. Leeann R. Pavlek
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  10. Jennifer Shepherd
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  12. Beth Ann Johnson
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  13. Elisa Abdulhayoglu
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  14. Eleonore Valencia
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  15. Stephanie Guseh
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  16. Molly K. Ball
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  17. Noorjahan Ali
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Contributions

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.

Corresponding author

Correspondence to Alyssa R. Thomas.

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The authors declare no competing interests.

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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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