Perioperative medicine (London, England) · 2026
RAPID-CHD pathway improves clinical outcomes in neonates with congenital heart disease.
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Li Chenyu, Lu Zhongyuan, Wang Shilin, Li Xia, Wang Xiaofeng, Chen Qinnan, Wang Xu
Аннотация
BACKGROUND: Timely and effective management is crucial for neonates with critical congenital heart disease (CCHD). This study investigated the impact of the RAPID-CHD Pathway, a coordinated referral and transport system, compared with conventional management models.
METHODS: This retrospective study included neonates (≤ 28 days) with CCHD admitted between January 2019 and December 2024. Group 1 comprised neonates enrolled in the RAPID-CHD Pathway: prenatally diagnosed, delivered in designated maternity hospitals, and transferred via a dedicated fast-track pathway. Group 2 included those referred from other hospitals or self-admitted. Major adverse events (MAEs) were defined as in-hospital death or discharge against medical advice. Logistic regression was used to assess associations between management strategies and MAEs.
RESULTS: Among 587 neonates (Group 1: n = 141; Group 2: n = 446), 439 underwent surgery (Group 1: n = 116; Group 2: n = 323). Group 1 had earlier ICU admission (0 vs 6 days, P < 0.001), earlier surgery (7 vs 15 days, P < 0.001), lower rates of low birth weight (< 2.5 kg: 5.7% vs 18.2%, P < 0.001), fewer emergency surgeries (9.5% vs 18.9%, P = 0.028), and higher surgical rates (82.3% vs 72.4%, P = 0.025). MAEs were lower in Group 1 (5.7% vs 12.6%, P = 0.033). Among patients who underwent surgery, the RAPID-CHD pathway remained associated with a trend toward reduced MAEs after adjustment (aOR 0.36; 95% CI, 0.11-1.20).
CONCLUSIONS: The RAPID-CHD Pathway improves early access to care, surgical opportunities, and outcomes in neonates with CCHD. It supports wider adoption in tertiary pediatric cardiac centers.
METHODS: This retrospective study included neonates (≤ 28 days) with CCHD admitted between January 2019 and December 2024. Group 1 comprised neonates enrolled in the RAPID-CHD Pathway: prenatally diagnosed, delivered in designated maternity hospitals, and transferred via a dedicated fast-track pathway. Group 2 included those referred from other hospitals or self-admitted. Major adverse events (MAEs) were defined as in-hospital death or discharge against medical advice. Logistic regression was used to assess associations between management strategies and MAEs.
RESULTS: Among 587 neonates (Group 1: n = 141; Group 2: n = 446), 439 underwent surgery (Group 1: n = 116; Group 2: n = 323). Group 1 had earlier ICU admission (0 vs 6 days, P < 0.001), earlier surgery (7 vs 15 days, P < 0.001), lower rates of low birth weight (< 2.5 kg: 5.7% vs 18.2%, P < 0.001), fewer emergency surgeries (9.5% vs 18.9%, P = 0.028), and higher surgical rates (82.3% vs 72.4%, P = 0.025). MAEs were lower in Group 1 (5.7% vs 12.6%, P = 0.033). Among patients who underwent surgery, the RAPID-CHD pathway remained associated with a trend toward reduced MAEs after adjustment (aOR 0.36; 95% CI, 0.11-1.20).
CONCLUSIONS: The RAPID-CHD Pathway improves early access to care, surgical opportunities, and outcomes in neonates with CCHD. It supports wider adoption in tertiary pediatric cardiac centers.