Association Between Prenatal Risk Stratification and Access to Care for Neonatal d-Transposition of the Great Arteries

To evaluate how prenatal risk stratification impacts transfer times to the cardiac unit for newborns with d-transposition of the great arteries (d-TGA) in a high-volume, free-standing children’s center. This is a retrospective study examining all prenatally diagnosed d-TGA newborns at a single center without in-house delivery capacity from 1/1/2013 to 3/1/2026. We evaluated two time periods based on implementation of level of care (LOC) assignments at our center (2013–2018 versus 2018–2026). The primary outcome was time from birth to arrival in the cardiac intensive care unit (CICU). Univariable and multivariable models were performed to include fetal echocardiographic and clinical covariates. Of 106 d-TGA newborns, 52 (49%) had a BAS within 24 h of arrival to the CICU, of which 24 (23%) required an emergent BAS within 2 h of CICU arrival. The multivariable model demonstrates that LOC implementation led to shorter median times from birth to CICU after adjusting for fetal echocardiographic markers and clinical covariates such as birthweight, gestational age and PaO2 on initial arterial blood gas (-180.7 min, 95% CI -351.9 to -9.5, p = 0.039). Risk stratification by LOC assignment is critical in access to life-saving care and shortening transport times for prenatally diagnosed d-TGA newborns, especially for free-standing children’s hospitals.