Perinatal management and delivery-room stabilization in congenital complete heart block: an 11-year experience at a tertiary center

Congenital complete heart block (CCHB) is a rare condition associated with significant perinatal hemodynamic instability. Although advances in prenatal diagnosis and pacing have improved survival, evidence guiding delivery-room stabilization remains limited. To describe our institutional experience in the perinatal management of CCHB, focusing on delivery-room stabilization and neonatal outcomes. We conducted a retrospective study at a tertiary center including newborns with CCHB over an 11-year period (2009-2020). Fetal characteristics, delivery-room interventions, and neonatal outcomes were analyzed. In 2014, a structured delivery-room stabilization protocol was introduced, incorporating ECG monitoring, anticipatory preparation for respiratory support and intravenous isoproterenol, and immediate availability of transcutaneous pacing (TCP) when indicated. Fourteen newborns were diagnosed with CCHB, with prenatal diagnosis in 13/14. Major congenital heart defects (CHD) were present in 3/14 newborns, and nine cases were immune-mediated. Prematurity occurred in 9/14. Respiratory support in the delivery room was required in 10/14 infants. Two infants with severe cardiorespiratory instability required intubation, TCP, and isoproterenol in the delivery room. Following NICU admission, invasive mechanical ventilation was required in 5/14 infants and inotropic support in 6/14. Invasive pacing was required in 9/14 infants, including 3/14 within the first 24 h of life. One patient required ECMO support. Survival to neonatal discharge was 13/14.Conclusion: Newborns with CCHB may require advanced stabilization at birth. A structured delivery-room strategy may incorporate anticipatory respiratory and hemodynamic support, including TCP in selected unstable newborns. Multidisciplinary coordination and CCHB-specific delivery-room planning provide a framework for anticipating potential stabilization needs. What is Known • Congenital complete heart block is associated with significant perinatal morbidity and may require early pacing. • Standard neonatal resuscitation algorithms may be insufficient in these patients. What is New • This study describes an 11-year experience with perinatal management and delivery-room stabilization of newborns with CCHB. • A CCHB-specific strategy integrating anticipatory cardiorespiratory support and transcutaneous pacing in selected unstable newborns is proposed as a pragmatic framework for delivery-room stabilization.