Importance of clinical practice guidelines for specialized delivery room resuscitation of newborns with prenatally diagnosed critical congenital heart disease.

Perinatal transition is uniquely complex in newborns with critical congenital heart disease (CCHD), whose cardiopulmonary physiology often diverges from the standard neonatal resuscitation framework. We developed lesion-specific clinical practice guidelines (CPGs) for delivery room (DR) management of six high-risk CCHD diagnoses - hypoplastic left heart syndrome, dextro- transposition of the great arteries, Ebstein anomaly, congenital complete heart block, total anomalous pulmonary venous return, and tetralogy of Fallot with absent pulmonary valve. Developed collaboratively between neonatologists, cardiologists, and cardiac intensivists, these guidelines standardize DR stabilization for high-risk, low frequency events, promote a shared mental model among multidisciplinary teams, and provide structured escalation thresholds for oxygen, respiratory support, intubation, and medication use. Beyond clinical standardization, these CPGs enhance provider education, team preparedness, and family counseling. They offer a scalable framework adaptable to centers with or without on-site cardiac care, bridging physiologic principles with practical implementation.