Neonatal Outcomes in Transposition of the Great Arteries by Mode and Timing of Delivery

We aimed to assess neonatal outcomes by mode of delivery and to evaluate the value of achieving daytime delivery among neonates undergoing a planned induction of labor (IOL).This was a retrospective study of pregnancies with prenatally diagnosed d-TGA with an IVS receiving care at a single tertiary care referral center from 2020 to 2023. Inclusion required prenatal diagnosis of d-TGA with an IVS and surgical care at the referral center. The primary outcome was a composite of neonatal outcomes, including preoperative inhaled nitric oxide use, inotrope use, preoperative mortality, reoperation, readmission, delayed sternal closure, diaphragmatic paralysis, and postoperative mortality. Secondary surgical outcomes and composite neurological morbidity, including hypoxic-ischemic encephalopathy, seizures, intraventricular hemorrhage, or stroke, were collected. Pearson's chi-square or Fisher's exact test was performed as appropriate.We identified 90 cases of prenatally diagnosed d-TGA, of which 68 (76%) underwent timed IOL and 46 (68%) achieved vaginal delivery. The primary outcome occurred in 16 neonates (89%) who were delivered by cesarean and 47 neonates (78%) who underwent a planned timed IOL (p = 0.26). Among individuals undergoing IOL, the primary outcome occurred in 29 neonates (73%) who delivered during the daytime and 18 (90%) who delivered after-hours (p = 0.19).We found that in cases of prenatally diagnosed d-TGA with an IVS, IOL is feasible. Neonates with d-TGA with an IVS had similar surgical outcomes when induced and delivered at this single tertiary care center, regardless of delivery time. · Induction is feasible, and daytime delivery was achieved in the majority of cases of TGA.. · Neonates with d-TGA with an IVS have similar surgical outcomes regardless of delivery time.. · There was no clear benefit to achieving strict daytime delivery in cases of TGA..