Jesse A. Weeda, Arjan B. te Pas, Zsuzsanna Nagy, Gábor H. Kovács, Miklós Szabó, Gergo} Leipold, Nariae Baik-Schneditz, Bernhard Schwaberger, Christian Heiring, Emma Louise Malchau Carlsen, Monique C. Haak, Nico A. Blom, Stuart B. Hooper, Janneke Dekker, Roel L.F. van der Palen
Willem-Alexander Children’s Hospital and Leiden University Medical Center. Semmelweis University. Gottsegen National Cardiovascular Centre. Medical University of Graz. Copenhagen University Hospital and University of Copenhagen. Monash Children’s Hospital.
Netherlands, Hungary, Austria, Denmark and Australia
Canadian Journal of Cardiology Pediatric and Congenital Heart Disease
CJC Pediatr Congenit Heart Dis 2025; 5: 136-144
DOI: 10.1016/j.cjcpc.2025.10.005
Abstract
At birth, major circulatory and pulmonary adaptations are required for a successful foetal-to-neonatal transition. In newborns with transposition of the great arteries (TGA), this transition is often impaired, leading to severe hypoxemia. This may also result in persistent pulmonary hypertension of the newborn (PPHN), worsening hypoxemia, and increasing the risk of urgent invasive interventions after birth. Physiological-based cord clamping (PBCC), delaying cord clamping until after lung aeration and ventilation are established, promotes a more stable circulatory transition and has shown benefits in both preterm and term neonates. PBCC may also provide advantages in infants with congenital heart disease. In TGA, combining PBCC with early supplemental oxygen may reduce the incidence and severity of PPHN, decrease related complications, and minimize the need for invasive interventions. To evaluate the feasibility, safety, and clinical outcomes of the stabilisation approach, we have initiated a stepwise quality improvement initiative comprising 2 sequential studies. Study phase 1, a single-centre study at Leiden University Medical Centre will assess feasibility, protocol adherence, and safety. Study phase 2, an observational cohort study across multiple European centres will evaluate clinical outcomes, focusing on incidence and severity of PPHN and the need for urgent interventions. All TGA newborns will be stabilised with an intact umbilical cord while receiving 2 L/min nasal high flow (fraction of inspired oxygen 1.0) as supplemental oxygen. Cord clamping will occur once the infant is considered stable, defined as a heart rate >100 bpm and preductal SpO2 >75% with supplemental oxygen. This study will inform guidelines for delivery room management and early preoperative care in TGA newborns.
Category
Class I. Pulmonary Hypertension Associated with Congenital Cardiovascular Disease
Class I. Persistent Pulmonary Hypertension of the Newborn
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Fresh (PHresh). Less than 1-2 years since publication
Article Access Free PDF File or Full Text Article Available Through PubMed or DOI: Yes