Association between specialist pediatric cardiac transfer and prognosis of neonates with critical congenital heart disease: A cohort study

Abstract Objective: To explore whether specialist pediatric cardiac transfer could improve the prognosis of neonates with critical congenital heart disease (CCHD). Methods: This cohort study retrospectively collected the clinical data of neonates diagnosed with CCHD who underwent treatment at the cardiac intensive care unit of Shanghai Children’s Medical Center between January 2018 and December 2021. The neonates were classified into the specialist pediatric cardiac transfer (SPCT) and non-SPCT groups. Propensity score matching (PSM) was used to match the two groups. The surgical outcome was the postoperative survival of the neonates. Results: During the study period, 357 neonates with CCHD were treated and included, of which 16 died before surgery, all in the non-SPCT group. After PSM, compared with the non-SPCT group, the SPCT group showed a lower rate of inotropic drug use (57.3% vs. 77.5%, P=0.004), a lower rate of unplanned emergent operation (29.2% vs. 53.9%, p =0.001), a higher total survival rate (92.1% vs. 82.0%, p =0.044), and a lower preoperative mortality rate (0% vs. 4.5%, p =0.043). The multivariable analysis showed that body weight at surgery (HR=0.444, 95%CI: 0.273-0.711, p =0.001) and unplanned emergent surgery (HR=5.227, 95%CI: 2.521-10.834, p <0.001) were independently associated with mortality in neonates with CCHD. Conclusion: Low body weight and unplanned emergency surgery are independent risk factors for the death of neonates with CCHD. Although SPCT is unrelated to the surgery mortality rate of newborns with CCHD, it can reduce the incidence of unplanned emergency surgery and increase the total survival rate.