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At Brigham & Women's Hospital (BWH), a high-volume level III neonatal intensive care unit (NICU), delivery room (DR) practice guidelines for newborns with a prenatal diagnosis of dextro-transposition of the great arteries (d-TGA) and hypoplastic left heart syndrome (HLHS) were written in collaboration with cardiac specialists and implemented in 2023 to support clinical decision-making.</p><p>Objective: To investigate the incidence of DR respiratory intervention and medication administration before and after lesion-specific DR guideline implementation for newborns with a prenatal diagnosis of d-TGA and HLHS. Characteristics and DR course were abstracted for newborns with prenatally diagnosed d-TGA or HLHS born at BWH between January 2018 and January 2025, and resuscitation strategies were compared across epochs and sub- diagnoses.</p><p>Results: 221 infants were included in total; 84 d-TGA and 84 HLHS pre- guideline (Jan 2018-Jul 2023) and 31 d-TGA and 22 HLHS post-guideline (Aug 2023-Jan 2025). Among d-TGA infants, incidence of DR intubation increased post-guideline (38% to 58%, p=0.06), as did rocuronium administration (given alongside sedation) after intubation (21% to 66%, p=0.002). d-TGA-intact ventricular septum (IVS) had higher intubation rates than d-TGA-ventricular septal defect (VSD) (60% v 25%, p=0.0002). HLHS with intact/restrictive atrial septum had DR intubation rates of 31% vs. 7% for unrestricted atrial septum (p=0.01). Median time to intubation differed between d-TGA-IVS and d-TGA- VSD (8.5 minutes (IQR 6.75-12 min) vs. 15 min (IQR 11.75-19 min) p=0.0007).</p><p>Conclusion: d-TGA and HLHS newborns, particularly high-risk subtypes, frequently undergo DR interventions. Our findings highlight the need for specialized resuscitation approaches in this population.</p>"},{"label":"Group","value":["Theses & Dissertations"]},{"label":"Digital Origin","value":["born digital"]},{"label":"Discipline","value":["General Scholarship"]},{"label":"Date","value":"April 15, 2025"},{"label":"EDTF Date","value":"D:00 M:00 Y:2025"},{"label":"File Format","value":["application/pdf"]},{"label":"Digital Object Identifier (DOI)","value":"https://doi.org/10.14418/wes01.1.3024"},{"label":"Type","value":["Text"]}],"description":"Neonatal resuscitation in critical congenital heart disease: Assessing the impact of standardized 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