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

Autor: Niccum M; Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. Electronic address: marianiccum14@gmail.com., Kesman RA Jr; Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania., Ades AM; Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania., Bostwick AL; The Richard D. Wood Jr. Center for Fetal Diagnosis & Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Dombroski M; The Richard D. Wood Jr. Center for Fetal Diagnosis & Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Flohr S; The Richard D. Wood Jr. Center for Fetal Diagnosis & Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Foglia EE; Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania., Mathew L; The Richard D. Wood Jr. Center for Fetal Diagnosis & Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., O'Byrne ML; Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania., Ordonez M; The Richard D. Wood Jr. Center for Fetal Diagnosis & Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Reynolds T; The Richard D. Wood Jr. Center for Fetal Diagnosis & Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania., Rintoul NE; Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania., Rome JJ; Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania., Rychik J; Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania., Shillingford AJ; Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania., Naim MY; Division of Cardiac Critical Care Medicine, Departments of Anesthesiology, Critical Care Medicine and Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
Jazyk: angličtina
Zdroj: The Journal of pediatrics [J Pediatr] 2024 Dec; Vol. 275, pp. 114222. Date of Electronic Publication: 2024 Aug 02.
DOI: 10.1016/j.jpeds.2024.114222
Abstrakt: Objective: To identify delivery room (DR) characteristics of patients with transposition of the great arteries (TGA) who underwent preoperative balloon atrial septostomy (BAS).
Study Design: Retrospective cohort study of all patients with prenatally diagnosed TGA delivered at our center between 2013 and 2023 who underwent arterial switch operation during the newborn admission.
Results: A total of 168 patients were included (median gestational age 39.5 weeks, 64% male, 33% with ventricular septal defect, 8% with aortic arch hypoplasia). BAS was performed in 84 patients (50%). Patients who underwent BAS had higher proportion of intubation in the DR (87% vs 33%, P < .001), lower maximum oxygen saturation in the first 10 minutes (64% vs 74%, P < .001) and 20 minutes (71% vs 81%, P < .001) of life, and lower maximum oxygen saturation at any point in the DR (79% vs 87%, P < .001). Adjusting for confounders (ventricular septal defect, aortic arch anomaly, 5-minute Apgar, birth weight), intubation in the DR (aOR 9.5, 95% CI 3.9, 25.0) and lower maximum oxygen saturation in the DR (aOR 0.9, 95% CI 0.8, 0.9) were independently associated with BAS. By receiver operating characteristic analysis, a maximum oxygen saturation of less than 86% at any time point in the DR discriminated for BAS with a specificity of 0.88, sensitivity of 0.70, and area under the curve of 0.82.
Conclusions: Intubation and lower oxygen saturation in the DR are independently associated with BAS in patients with TGA born at our center. A maximum DR saturation of less than 86% best discriminates patients who undergo BAS in our population.
Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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