Pediatric Cardiology

, Volume 38, Issue 7, pp 1350–1358 | Cite as

Transfer of Neonates with Critical Congenital Heart Disease Within a Regionalized Network

  • Michael F. Swartz
  • Jill M. Cholette
  • Jennifer M. Orie
  • Marshall L. Jacobs
  • Jeffrey P. Jacobs
  • George M. Alfieris
Original Article


Regionalization of pediatric cardiac surgical care varies between and within states. In most geographic regions, at least some neonates with critical heart disease are transferred from their birth hospital to a different hospital for surgery. The impact of neonatal transfer for surgery, particularly over a considerable distance (>10 miles), has been largely unexplored. We sought to examine the impact of transferring neonates for cardiac surgery. We queried the New York State Cardiac Surgery database (2005–2014) from a single institution to identify neonates born within the cardiac surgery center and those transferred for surgery. Outcomes were compared between groups, with subgroup analysis of neonates with single ventricle anatomy. 113 surgical neonates were born at the cardiac surgery center, and 268 were transferred to the cardiac surgery center. Median transfer distance was 91 (IQR 73, 94) miles. Age at operation and the need for preoperative ventilation were significantly lower in neonates born at the cardiac surgery center. In addition, single ventricle anatomy was more prevalent among those born at the cardiac surgery center (48.7 vs. 31.3%; p = 0.001). However, postoperative outcomes were the same—30-day survival was similar across groups (birth: 89% vs. transfer: 90%; p = 0.7), and for those with single ventricle palliation (birth: 81% vs. transfer: 81%; p = 0.9). Within our regionalized network, we found no difference in 30-day survival between neonates either born or transferred to a cardiac surgery center, which supports the use of a regionalized network of hospitals to the care of children with congenital heart disease.


Neonate Transfer Regionalization Critical congenital heart disease 



There was no institutional or outside funding used for this study.

Compliance with Ethical Standards

Conflicts of interest

All authors declare that they have no conflict of interest with the following manuscript.

Informed Consent

Following institutional IRB review, informed consent was waived due to the minimal risks associated with this review.

Research Involving Human Participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and or the national research committee and with the 1964 Helsinki declaration and its later amendments or comparable standards.


  1. 1.
    Tworetzky W, McElhinney D, Reddy V, Brook M, Hanley F, Silverman N (2001) Improved surgical outcome after fetal diagnosis of hypoplastic left heart syndrome. Circulation 103:1269–1273CrossRefPubMedGoogle Scholar
  2. 2.
    Zhao QM, Ma XJ, Ge XL et al (2014) Pulse oximetry with clinical assessment to screen for congenital heart disease in neonates in China: a prospective study. Lancet 384:747–754CrossRefPubMedGoogle Scholar
  3. 3.
    Levey A, Glickstein JS, Kleinman CS et al (2010) The impact of prenatal diagnosis of complex congenital heart disease on neonatal oucomes. Pediatr Cardiol 31:587–597CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Sivarajan V, Penny DJ, Filan P, Brizard C, Shekerdemian LS (2009) Impact of antenatal diagnosis of hypoplastic left heart syndrome on the clinical presentation and clinical outcomes: the Australian experience. J Paediatr Child Health 45:112–117CrossRefPubMedGoogle Scholar
  5. 5.
    Savoie KB, Huang EY, Aziz SK et al (2014) Improving gastroschisis outcomes: does birth place matter? J Ped Surg 49:1771–1775CrossRefGoogle Scholar
  6. 6.
    Longhini F, Jourdain G, Ammar F et al (2015) Outcomes of preterm neonates transferred between tertiary perinatal centers. Pediatr Crit Care Med 16:733–738CrossRefPubMedGoogle Scholar
  7. 7.
    Anagnostou K, Messenger L, Yates R, Kelsall W (2013) Outcome of infants with prenatally diagnosed congenital heart disease delivered outside specialist paediatric cardiac centres. Arch Dis Child Fetal Neonat Ed 98:F218–F221CrossRefGoogle Scholar
  8. 8.
    Bennett TD, Klein MB, Sorensen MD, DeRoos AJ, Rivara FP (2010) Influence of birth hospital on outcomes of ductal-dependent cardiac lesions. Pediatrics 126:1156–1164CrossRefPubMedGoogle Scholar
  9. 9.
    Gupta N, Leven L, Stewart M, Cheung M, Patel N (2014) Transport of infants with congenital heart disease: benefits of antenatal diagnosis. Eur J Pediatr 173:655–660CrossRefPubMedGoogle Scholar
  10. 10.
    Peake LK, Draper ES, Budd JLS, Field D (2015) Outcomes when congenital heart disease is diagnosed antenatally versus postnatally in the UK: a retrospective population based study. BMC Pediatr 15:58CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Morris SA, Ethen MK, Penny DJ et al (2014) Prenatal diagnosis, birth location, surgical center, and neonatal mortality in infants with hypoplastic left heart syndrome. Circulation 129:285–292CrossRefPubMedGoogle Scholar
  12. 12.
    Nasr A, Langer JC (2011) Influence of location of delivery on outcome in neonates with congenital diaphragmatic hernia. J Ped Surg 46:814–816CrossRefGoogle Scholar
  13. 13.
    Lang A, Brun H, Kaaresen PI, Klingenberg C (2007) A population based 10-year study of neonatal air transport in North Norway. Acta Paediatr 7:995–999CrossRefGoogle Scholar
  14. 14.
    New York 2010 (2012) Census of population and housing. In: Robert M Groves (ed)Google Scholar
  15. 15.
    Doran DR, Roark CS, Hannan EL (2003) Improving quality of care for pediatric cardiac surgery in New York State. Prog Ped Cardiol 18:13–25CrossRefGoogle Scholar
  16. 16.
    Hannan EL, Cozzens K, King SB, Walford G, Shah NR (2012) The New York State cardiac registries. J Am Coll Cardiol 59:2309–2316CrossRefPubMedGoogle Scholar
  17. 17.
    Pediatric Congenital Cardiac Surgery in New York State 1997-1999 (2004) New York State Department of HealthGoogle Scholar
  18. 18.
    Pediatric Congenital Cardiac Surgery in New York State 2002-2005 (2007) New York State Department of HealthGoogle Scholar
  19. 19.
    Pediatric Congenital Cardiac Surgery in New York State 2006-2009 (2011) New York State Department of HealthGoogle Scholar
  20. 20.
  21. 21.
    Lundstrom NR, Berggren H, Bjorkhem G, Joig P, Sunnegardh S (2000) Centralization of pediatric heart surgery in Sweden. Pediatr Cardiol 21:353–357CrossRefPubMedGoogle Scholar
  22. 22.
    Chang RKR, Klitzner TS (2002) Can regionalization decrease the number of deaths for children who undergo cardiac surgery? A theoretical analysis. Pediatrics 109:173–181CrossRefPubMedGoogle Scholar
  23. 23.
    Kumar TK, Charpie JR, Ohye RG et al (2014) Timing of neonatal cardiac surgery is not associated with perioperative outcomes. J Thorac Cardiovasc Surg 147:1573–1579CrossRefPubMedGoogle Scholar
  24. 24.
    Mulholland HC, Casey F, Brown D et al (1999) Application of a low cost telemedicine link to the diagnosis of neonatal congenital heart defects by remote consultation. Heart 82:217–221CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Grant B, Morgan GJ, McCrossan BA et al (2010) Remote diagnosis of congenital heart disease: the impact of telemedicine. Arch Dis Child 95:276–280CrossRefPubMedGoogle Scholar
  26. 26.
    Carvalho JS (2016) Antenatal diagnosis of critical congenital heart disease. Optimal place of delivery is where appropriate care can be delivered. Arch Dis Child 101:505–507CrossRefPubMedGoogle Scholar
  27. 27.
    Lorch SA, Baiocchi M, Ahlberg CE, Small DS (2012) The differential impact of delivery hospital on the outcomes of premature infants. Pediatrics 130:270–278CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Jensen EA, Lorch SA (2015) Effects of a birth hospitals neonatal intensive care unit level and annual volume of very-low birth—weight infant deliveries on morbidity and mortality. JAMA Pediatr 169:1–9CrossRefGoogle Scholar
  29. 29.
    Pilkington H, Blondel B, Drewniak N, Zeitlin J (2014) Where does distance matter? Distance to the closest maternity unit and risk of foetal and neonatal mortality in France. Eur J Pub Health 14:905–910CrossRefGoogle Scholar
  30. 30.
    Paranjoyhy S, Watkins WJ, Rolfe K et al (2014) Perinatal outcomes and travel time from home to hospital: welsh data from 1995-2009. Acta Paediatr 103:e522–e527CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Pediatric Cardiac Consortium of Upstate New YorkNew YorkUSA
  2. 2.University of Rochester Medical CenterRochesterUSA
  3. 3.Division of Cardiac SurgeryJohns Hopkins UniversityBaltimoreUSA
  4. 4.Division of Cardiac SurgeryJohns Hopkins All Children’s Heart InstituteSt. PetersburgUSA
  5. 5.Strong Memorial HospitalRochesterUSA

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