What is the clinical evidence from this study?

Study design: Observational. Population: Hypoplastic left heart syndrome (HLHS). Intervention: Born close to home and not transferred vs. Born far from home and not transferred. Primary outcome: Neonatal mortality (HR 1.77, 95% CI 1.17-2.67).

What does this research mean for the field?

Neonates with hypoplastic left heart syndrome (HLHS) who are born close to home and not transferred have a higher risk of neonatal mortality compared to those delivered far from home and not transferred. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

April 29, 2022Open Access

Distance from home to birth hospital, transfer, and mortality in neonates with hypoplastic left heart syndrome in California

Key Result

Neonates with HLHS born close to home and not transferred had a higher risk of neonatal mortality than those delivered far from home and not transferred (HR 1.77; 95% CI 1.17-2.67).

Study Design

Type

Observational

Multicenter

Yes

Structured PICO

Does distance from home to birth hospital and transfer status affect neonatal mortality in neonates with hypoplastic left heart syndrome?

Population

Neonates with hypoplastic left heart syndrome (HLHS) in California from 2006 to 2011

Intervention

Lived close to birth hospital (≤11 miles) and either transferred or not transferred

Comparator

Lived far from birth hospital (>11 miles) and not transferred

Outcome

Neonatal mortalityhard clinical

Infants with HLHS born close to home and not transferred to a cardiac center had a higher risk of neonatal mortality than those delivered far from home and not transferred, highlighting potential disparities related to poverty.

Main Result

Effect estimate: HR 1.77 (95% CI 1.17-2.67)

Abstract

BACKGROUND: Prior studies report a lower risk of mortality among neonates with hypoplastic left heart syndrome (HLHS) who are born at a cardiac surgical center, but many neonates with HLHS are born elsewhere and transferred for repair. We investigated the associations between the distance from maternal home to birth hospital, the need for transfer after birth, sociodemographic factors, and mortality in infants with HLHS in California from 2006 to 2011. METHODS: We used linked data from two statewide databases to identify neonates for this study. Three groups were included in the analysis: "lived close/not transferred," "lived close/transferred," and "lived far/not transferred." We defined "lived close" versus "lived far" as 11 miles, the median distance from maternal residence to birth hospital. Log-binomial regression models were used to identify the association between sociodemographic variables, distance to birth hospital and transfer. Cox proportional hazards models were used to identify the association between mortality and distance to birth hospital and transfer. Models were adjusted for sociodemographic variables. RESULTS: Infants in the lived close/not transferred and the lived close/transferred groups (vs. the lived far/not transferred group) were more likely to live in census tracts above the 75th percentile for poverty with relative risks 1.94 (95% confidence interval CI 1.41-2.68) and 1.21 (95% CI 1.05-1.40), respectively. Neonatal mortality was higher among the lived close/not transferred group compared with the lived far/not transferred group (hazard ratio 1.77, 95% CI 1.17-2.67). CONCLUSIONS: Infants born to mothers experiencing poverty were more likely to be born close to home. Infants with HLHS who were born close to home and not transferred to a cardiac center had a higher risk of neonatal mortality than infants who were delivered far from home and not transferred. Future studies should identify the barriers to delivery at a cardiac center for mothers experiencing poverty.

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