Birth Location of Infants with Critical Congenital Heart Disease in California

  • Neha J. PurkeyEmail author
  • David M. Axelrod
  • Doff B. McElhinney
  • Joseph Rigdon
  • FeiFei Qin
  • Manisha Desai
  • Andrew Y. Shin
  • Valerie Y. Chock
  • Henry C. Lee
Original Article


The American Academy of Pediatrics classifies neonatal intensive care units (NICUs) from level I to IV based on the acuity of care each unit can provide. Birth in a higher level center is associated with lower morbidity and mortality in high-risk populations. Congenital heart disease accounts for 25–50% of infant mortality related to birth defects in the U.S., but recent data are lacking on where infants with critical congenital heart disease (CCHD) are born. We used a linked dataset from the Office of Statewide Health Planning and Development to access ICD-9 diagnosis codes for all infants born in California from 2008 to 2012. We compared infants with CCHD to the general population, identified where infants with CCHD were born based on NICU level of care, and predicted level IV birth among infants with CCHD using logistic regression techniques. From 2008 to 2012, 6325 infants with CCHD were born in California, with 23.7% of infants with CCHD born at a level IV NICU compared to 8.4% of the general population. Level IV birth for infants with CCHD was associated with lower gestational age, higher maternal age and education, the presence of other congenital anomalies, and the diagnosis of a single ventricle lesion. More infants with CCHD are born in a level IV NICU compared to the general population. Future studies are needed to determine if birth in a lower level of care center impacts outcomes for infants with CCHD.


Neonatal intensive care Birth location Prevalence Congenital heart disease California 




Compliance with Ethical Standards

Conflict of interest

The authors have no conflicts of interest to disclose. All authors have approved the final version of the manuscript.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors. This study was approved by Stanford University’s Institutional Review Board Panel on Medical Human Subjects and the California Committee for the Protection of Human Subjects.

Supplementary material

246_2018_2019_MOESM1_ESM.docx (89 kb)
Supplementary material 1 (DOCX 88 KB)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Pediatric Cardiology, Department of PediatricsLucile Packard Children’s Hospital at StanfordPalo AltoUSA
  2. 2.Quantitative Sciences Unit, Department of MedicineStanford University School of MedicinePalo AltoUSA
  3. 3.Division of Neonatal and Developmental Medicine, Department of PediatricsLucile Packard Children’s Hospital at StanfordPalo AltoUSA

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