To evaluate mortality and morbidity among neonates with select critical congenital heart defects (cCHD) delivered and initially managed at a Level-III perinatal center without in-house paediatric cardiac surgery, and to determine how many required immediate cardiac interventions versus stabilization prior to transfer. Retrospective single-center cohort study (2018–2022) at a Level-III perinatal center with neonatologists and paediatric cardiologists on-site but no paediatric cardiac intervention unit. Inclusion of all neonates with prenatally or postnatally suspected cCHD delivered at the center and managed until transfer or discharge. Structured neonatal care including prostaglandin therapy, respiratory support, and coordination with a tertiary cardiac center. Immediate non-surgical cardiac interventions were performed in-house when necessary. Pre- and postnatal diagnosis, neonatal mortality, morbidity, need for immediate cardiac intervention, postnatal bonding, and timing of transfer. A total of 115 neonates were included; 94.0% had a prenatal cCHD diagnosis. Immediate non-surgical cardiac intervention was required in 3 neonates (2.6%) including emergency atrial septostomy performed on-site. The remaining 112 neonates (97.4%) were stabilized without the need for immediate intervention before transfer. Prostaglandin E1 infusion was initiated in 67.0% of neonates to maintain ductal patency. Median time to transfer was 4 days (IQR 3–7). Postnatal bonding occurred in 52.7% of cases despite the complexity of care. No neonates experienced acute in-house mortality during stabilization. Overall mortality was 9.6%, with 81.8% of deaths occurring after transfer and 18.2% following in-house palliative care based on prenatal counselling decisions. Most neonates with cCHD can be safely stabilized at a Level-III perinatal center prior to transfer without the need for immediate surgical cardiac intervention. The model allows for effective care and maternal bonding without increased acute mortality. These findings support collaborative perinatal management outside surgical cardiac centers for selected cases.
Brickmann et al. (Thu,) studied this question.