168 - Intubation and Lower Saturation in the Delivery Room are Associated with Balloon Atrial Septostomy in Neonates with D-Transposition of the Great Arteries

Poster Number: 168
Publication Number: 168.3211

Background: Patients with D-transposition of the great arteries (D-TGA) and a restrictive atrial communication can develop life-threatening hypoxemia, which can be ameliorated by use of balloon atrial septostomy (BAS). However, data on postnatal predictors of BAS are lacking and necessary to guide appropriate and timely use of this procedure.

Objective: This study sought to identify postnatal clinical predictors of BAS in patients with D-TGA born at our center.

Design/Methods: We conducted a retrospective cohort study of all patients with prenatally diagnosed D-TGA delivered at our center between 2013 and 2023 who underwent arterial switch operation during the newborn admission. Patients with associated ventricular septal defect (VSD) and aortic arch hypoplasia were included. Patients with other cardiac defects, major extracardiac anomalies, and those with prenatal evidence of severely restricted or absent atrial communication were excluded. Independent risk factors for BAS were identified using multiple logistic regression. The ability of delivery room clinical variables to discriminate between patients who did and did not undergo BAS was determined by receiver operating characteristic analysis.

Results: A total of 161 patients were included (median gestational age 39.5 weeks, 36% female, VSD 33%, aortic arch hypoplasia 8%). BAS was performed in 67 (42%) of patients. Patients who underwent BAS had higher rates of intubation in the delivery room (84% vs. 40%, p< 0.001). They also had lower maximum saturation in the first 10 (65% vs. 72%, p< 0.001) and 20 (71% vs. 80%, p< 0.001) minutes of life, as well as lower maximum saturation in the delivery room (79% vs. 87%, p< 0.001). Adjusting for confounders (presence of VSD, presence of hypoplastic aortic arch, 5-minute Apgar, birth weight), intubation in the delivery room (OR 4.5, 95% CI (1.9, 11.25)) and lower maximum saturation in the delivery room (OR 0.92, 95% CI (0.87, 0.97)) were independent predictors of BAS. By receiver operating characteristic analysis, a maximum saturation of 85% in the delivery room predicted BAS with a specificity of 0.61.

Conclusion(s): In a tertiary care center with high rate of prenatal diagnosis of D-TGA, intubation and lower saturation in the delivery room are associated with BAS. A maximum delivery room saturation of greater than 85% may identify infants who do not require BAS. Risk stratification for BAS using delivery room saturation and intubation may be beneficial and merits further study.