Epidemiology, clinical characteristics, surgical management and outcomes of neonates with congenital heart disease in a tertiary neonatal intensive care unit: a 10-year

Congenital heart disease (CHD) is the most common congenital malformation worldwide and remains a major cause of neonatal morbidity and mortality, particularly in low- and middle-income countries with limited access to specialized cardiovascular care. Early diagnosis and timely multidisciplinary management are essential to improve outcomes. This study aimed to characterize the epidemiology, clinical presentation, management strategies, surgical interventions, and outcomes of neonates with CHD admitted to a tertiary neonatal intensive care unit (NICU) over a 10-year period in northeastern Mexico. A single-center, hospital-based retrospective cohort study was conducted including neonates with echocardiographically confirmed congenital heart disease admitted to the tertiary-level NICU of the Hospital Regional de Alta Especialidad de Ciudad Victoria between January 2015 and December 2024. Demographic, maternal, clinical, echocardiographic, therapeutic, surgical, and outcome-related variables were analyzed using descriptive and comparative statistics. During the study period, 802 neonates were admitted to the NICU, of whom 111 had echocardiographically confirmed CHD, corresponding to a hospital-based prevalence of 13.8% among NICU admissions. This estimate reflects the frequency of CHD within this tertiary referral NICU and should not be interpreted as a population-based prevalence. After exclusion of isolated patent ductus arteriosus (PDA) associated with prematurity, the prevalence of structural CHD decreased to 9.1%. Mean gestational age was 34.8 ± 4.5 weeks, mean birth weight was 2295 ± 1083 g, and 58.6% of patients were preterm. Acyanotic CHD predominated (72.1%), whereas cyanotic defects accounted for 27.9% of cases. The most frequent clinical manifestations were respiratory distress (50.5%), cyanosis (35.1%), cardiac murmur (29.7%), and heart failure (28.8%). PDA, atrial septal defect, and ventricular septal defect were the most common acyanotic lesions, while transposition of the great arteries and tricuspid atresia represented the most frequent complex cyanotic defects. Medical management was implemented in 63.1% of patients, whereas corrective surgery and palliative procedures were performed in 9.9% and 1.8%, respectively. Overall in-hospital mortality was 18.0%. Mortality was significantly higher among neonates with cyanotic CHD than among those with acyanotic defects (35.5% vs. 13.8%; OR 3.91, 95% CI 1.39–11.03; p = 0.010). Among surgically treated patients, mortality reached 50.0% in those requiring cardiopulmonary bypass compared with 8.7% in those undergoing procedures without bypass support (OR 10.50, 95% CI 1.66–66.08; p = 0.011). Prolonged aortic cross-clamp time was also associated with mortality. Congenital heart disease continues to represent a substantial burden of neonatal morbidity and mortality in tertiary care settings. Although acyanotic lesions predominated, cyanotic CHD and the requirement for cardiopulmonary bypass were strongly associated with mortality, likely reflecting greater disease severity and surgical complexity rather than a direct causal effect. These findings provide important regional epidemiological data from northeastern Mexico and underscore the need to strengthen prenatal diagnosis, universal pulse oximetry screening, timely referral pathways, and access to specialized pediatric cardiovascular care to improve neonatal outcomes.