The Journal of pediatrics · 2026
Time to Transfer and Hospitalization Duration for Severe Congenital Heart Defects: Implications for Perinatal Regionalization.
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Woo Joyce L, Grobman William A, Mongé Michael C, Anderson Brett R, Batton Beau, Yee Lynn M, Laternser Christina
Аннотация
OBJECTIVE: To estimate the associations between time to transfer and hospitalization duration among neonates with severe congenital heart defects (CHDs).
STUDY DESIGN: Retrospective, cross-sectional analysis of neonates with severe CHD, 2013-2021, who were reported to the Illinois Department of Public Health. The outcome was hospitalization duration-time from birth to discharge from a surgical center. The exposure was time to transfer (4 categories): birth at a surgical center (referent), not born at a surgical center and transferred at 0, 1-3, or after 3 days. Covariates included clinical and sociodemographic factors. Fine-Gray models estimated subdistribution hazard ratios for discharge, accounting for competing risks. Restricted mean survival time summarized the average hospitalization duration at different timepoint cutoffs.
RESULTS: Among 1391 neonates with severe CHD, 48.1% (669/1391) were not born at a cardiac surgical center. Of those who were transferred, 43.4% (203/468) were transferred at 0 days, 43.8% (205/468) were transferred within 1-3 days, and 12.8% (60/468) were transferred after 3 days. The median hospitalization duration was 23 days (IQR, 12-46 days). Compared with birth at a cardiac surgical center, transfer after 3 days was associated with a slower rate of discharge over time (adjusted subdistribution hazard ratio, 0.71; 95% CI, 0.54-0.94) and longer hospitalization duration.
CONCLUSIONS: For the substantial proportion of neonates with severe CHD who were not born at cardiac surgical centers, late transfer was associated with a longer neonatal hospitalization duration.
STUDY DESIGN: Retrospective, cross-sectional analysis of neonates with severe CHD, 2013-2021, who were reported to the Illinois Department of Public Health. The outcome was hospitalization duration-time from birth to discharge from a surgical center. The exposure was time to transfer (4 categories): birth at a surgical center (referent), not born at a surgical center and transferred at 0, 1-3, or after 3 days. Covariates included clinical and sociodemographic factors. Fine-Gray models estimated subdistribution hazard ratios for discharge, accounting for competing risks. Restricted mean survival time summarized the average hospitalization duration at different timepoint cutoffs.
RESULTS: Among 1391 neonates with severe CHD, 48.1% (669/1391) were not born at a cardiac surgical center. Of those who were transferred, 43.4% (203/468) were transferred at 0 days, 43.8% (205/468) were transferred within 1-3 days, and 12.8% (60/468) were transferred after 3 days. The median hospitalization duration was 23 days (IQR, 12-46 days). Compared with birth at a cardiac surgical center, transfer after 3 days was associated with a slower rate of discharge over time (adjusted subdistribution hazard ratio, 0.71; 95% CI, 0.54-0.94) and longer hospitalization duration.
CONCLUSIONS: For the substantial proportion of neonates with severe CHD who were not born at cardiac surgical centers, late transfer was associated with a longer neonatal hospitalization duration.