Fetal Anatomic and Physiologic Predictors of Neonatal Hypoxia in D-Transposition of the Great Arteries: A Prospective, Multi-Center Study by the Fetal Heart Society Research Collaborative

Authors

• Joyce T. Johnson, Heart Institute, Johns Hopkins All Children's Hospital. Electronic address: joy.johnson@jhmi.edu.
• David Schidlow, Boston Children's Hospital.
• Jacqueline Shuplock, Advent Health Orlando.
• Mary T. Donofrio, Children's National Hospital.
• Shaine A. Morris, Department of Pediatrics, Division of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston.
• Lisa K. Hornberger, Stollery Children's Hospital, University of Alberta.
• Thomas A. Miller, MaineHealth

Document Type

Article

Publication Date

7-17-2026

Institution/Department

Cardiology

Journal Title

Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography

Abstract

BACKGROUND: Sensitive fetal prediction of acute neonatal compromise at birth following a prenatal diagnosis of dextro-transposition of the great arteries/intact ventricular septum (dTGA/IVS) remains challenging. Using a large multicenter prospectively collected cohort, we aimed to determine if fetal echocardiogram findings could sensitively and specifically predict neonatal hypoxia. METHODS: Twenty-three centers enrolled maternal/infant dyads. Demographics and clinical information were collected. Previously reported fetal predictors were evaluated from the 3 trimester by a core lab blinded to outcome. Primary outcome was preoperative neonatal hypoxia (PaO2 < 30 mmHg or SpO2 < 75% if PaO2 was unavailable). Univariate and multivariate analyses of predictors with the primary outcome were performed. Sensitivity analyses were explored. Incidence of balloon atrial septostomy (BAS) and mortality were calculated. RESULTS: Of the 179 maternal/infant pairs with a fetal diagnosis of dTGA/IVS and postnatal data, 132 had data at all time points and were included in the final cohort, 50 (38%) with neonatal hypoxia and 38/50 (76%) underwent balloon atrial septostomy. Univariate and multivariate analyses showed no significant anatomic or physiologic fetal echocardiography predictors of neonatal hypoxia. Sensitivity analysis showed that an increasing Foramen ovale:Total septal length ratio and increasing atrial septal excursion ratio decreased the likelihood of combined outcome of hypoxia and BAS, but still did not provide useful discrimination to predict outcome. Survival to initial hospital discharge occurred in 131/132(99%). CONCLUSIONS: Our multicenter prospective study did not identify any sensitive prenatal predictors of neonatal hypoxia in infants prenatally diagnosed with TGA/IVS. High risk delivery planning for the possibility of neonatal hypoxia and urgent BAS is needed for all infants with prenatally diagnosed TGA/IVS.

Recommended Citation

Johnson, Joyce T.; Schidlow, David; Shuplock, Jacqueline; Donofrio, Mary T.; Morris, Shaine A.; Hornberger, Lisa K.; and Miller, Thomas A., "Fetal Anatomic and Physiologic Predictors of Neonatal Hypoxia in D-Transposition of the Great Arteries: A Prospective, Multi-Center Study by the Fetal Heart Society Research Collaborative" (2026). MaineHealth Maine Medical Center. 4590.
https://knowledgeconnection.mainehealth.org/mmc/4590