The Golden Hour for Infants with Congenital Anomalies: Experience of the Special Delivery Unit.

OBJECTIVE: To summarize the frequency and intensity of delivery room resuscitation for infants with congenital anomalies. STUDY DESIGN: This was a retrospective, single-center cohort study of infants born in the Garbose Family Special Delivery Unit at the Children's Hospital of Philadelphia from 2013-2024. We assessed the frequency and intensity of delivery room resuscitation interventions. Main outcome measures included hospital survival and length of stay. RESULTS: There were 4,437 infants who met the study inclusion criteria including 2,670 with surgical/medical diagnoses and 1,767 with congenital heart disease. Median gestational age at delivery was 38.1 weeks. Advanced respiratory interventions were common, with intubation occurring in >5% across most diagnoses. Cardiopulmonary resuscitation (CPR) and epinephrine use were rare overall but occurred in >3% of infants with select diagnoses. Differences in advanced respiratory interventions and CPR were seen across diagnosis groups. Despite high rates of delivery room interventions, golden hour survival was 99.8% overall and survival to discharge was >80% across most diagnoses. CONCLUSIONS: Infants with congenital anomalies experience relatively high rates of delivery room resuscitation, including advanced airway interventions. Need and intensity of resuscitation vary based on underlying anomaly. These results may inform delivery room preparation and planning for infants with prenatally diagnosed congenital anomalies.