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

To identify delivery room (DR) characteristics of patients with transposition of the great arteries (TGA) who underwent preoperative balloon atrial septostomy (BAS). 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. A total of 168 patients were included (median gestational age 39.5 weeks, 64% male, 33% with ventricular septal defect [VSD], 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<0.001), lower maximum oxygen saturation in the first 10 minutes (64% vs. 74%, p<0.001) and 20 minutes (71% vs. 81%, p<0.001) of life, and lower maximum oxygen saturation at any point in the DR (79% vs. 87%, p<0.001). Adjusting for confounders (VSD, aortic arch anomaly, 5-minute Apgar, birth weight), intubation in the DR (adjusted odds ratio [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 timepoint in the DR discriminated for BAS with a specificity of 0.88, sensitivity of 0.70, and area under the curve of 0.82. 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.

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