Maternal hyperoxygenation in congenital heart disease
BACKGROUND: The poor neurodevelopmental outcome of survivors of neonatal CHD surgery has its origins in the fetal period and may be due to reduced oxygen delivery to the fetal brain. GAP: This study will investigate whether maternal hyperoxygenation (MH) results in improved cerebral oxygen delivery in fetuses with CHD and whether chronic inhaled supplemental oxygen is safe and feasible in this population HYPOTHESIS: 1) Cerebral oxygen delivery is increased during MH in fetuses with single ventricles and tetralogy of Fallot but not transposition. 2) The benefits of increasing maternal FiO2 beyond 40% in terms of increments in fetal oxygenation are negligible. 3) Chronic MH is safe and feasible in the setting of fetal CHD. METHODS: Aims 1 and 2 will be investigated using a single center cross-sectional observational study and a pilot interventional study. Aim 3 will employ a single-center pilot cohort study of chronic MH in fetuses with single ventricle hearts. RESULTS: Pending IMPACT: If we can demonstrate a positive impact of MH on fetal brain maturation in fetuses with single ventricle physiology, we would anticipate rapid and widespread adoption of this simple treatment, ensuring a better start in life for children with this most severe form of CHD.