Distance from Home to Birth Hospital, Transfer, and Mortality in Neonates with Hypoplastic Left Heart Syndrome in California

Overview

Journal Birth Defects Res

Specialties Reproductive Medicine
Toxicology

Date 2022 Apr 30

PMID 35488460

Authors

Neha J Purkey

Chen Ma

Henry C Lee

Susan R Hintz

Gary M Shaw

Doff B McElhinney

Suzan L Carmichael

Affiliations

Soon will be listed here.

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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References

Tweddell J, Sleeper L, Ohye R, Williams I, Mahony L, Pizarro C . Intermediate-term mortality and cardiac transplantation in infants with single-ventricle lesions: risk factors and their interaction with shunt type. J Thorac Cardiovasc Surg. 2012; 144(1):152-9. PMC: 3359406. DOI: 10.1016/j.jtcvs.2012.01.016. View

Egbe A, Uppu S, Stroustrup A, Lee S, Ho D, Srivastava S . Incidences and sociodemographics of specific congenital heart diseases in the United States of America: an evaluation of hospital discharge diagnoses. Pediatr Cardiol. 2014; 35(6):975-82. DOI: 10.1007/s00246-014-0884-8. View

Frohnert B, Lussky R, Alms M, Mendelsohn N, Symonik D, Falken M . Validity of hospital discharge data for identifying infants with cardiac defects. J Perinatol. 2005; 25(11):737-42. DOI: 10.1038/sj.jp.7211382. View

Donofrio M, Moon-Grady A, Hornberger L, Copel J, Sklansky M, Abuhamad A . Diagnosis and treatment of fetal cardiac disease: a scientific statement from the American Heart Association. Circulation. 2014; 129(21):2183-242. DOI: 10.1161/01.cir.0000437597.44550.5d. View

Nembhard W, Salemi J, Ethen M, Fixler D, Dimaggio A, Canfield M . Racial/Ethnic disparities in risk of early childhood mortality among children with congenital heart defects. Pediatrics. 2011; 127(5):e1128-38. DOI: 10.1542/peds.2010-2702. View

Dean P, McHugh K, Conaway M, Hillman D, Gutgesell H . Effects of race, ethnicity, and gender on surgical mortality in hypoplastic left heart syndrome. Pediatr Cardiol. 2013; 34(8):1829-36. PMC: 4023351. DOI: 10.1007/s00246-013-0723-3. View

Steiner J, Kirkpatrick J, Heckbert S, Habib A, Sibley J, Lober W . Identification of adults with congenital heart disease of moderate or great complexity from administrative data. Congenit Heart Dis. 2017; 13(1):65-71. PMC: 5783801. DOI: 10.1111/chd.12524. View

Mechak J, Edwards E, Morrow K, Swanson J, Vergales J . Effects of Gestational Age on Early Survivability in Neonates With Hypoplastic Left Heart Syndrome. Am J Cardiol. 2018; 122(7):1222-1230. DOI: 10.1016/j.amjcard.2018.06.033. View

Morris S, Ethen M, Penny D, Canfield M, Minard C, Fixler D . Prenatal diagnosis, birth location, surgical center, and neonatal mortality in infants with hypoplastic left heart syndrome. Circulation. 2013; 129(3):285-92. PMC: 7302400. DOI: 10.1161/CIRCULATIONAHA.113.003711. View

10.

Stasik C, Gelehrter S, Goldberg C, Bove E, Devaney E, Ohye R . Current outcomes and risk factors for the Norwood procedure. J Thorac Cardiovasc Surg. 2006; 131(2):412-7. DOI: 10.1016/j.jtcvs.2005.09.030. View

11.

Jacobs J, OBrien S, Chai P, Morell V, Lindberg H, Quintessenza J . Management of 239 patients with hypoplastic left heart syndrome and related malformations from 1993 to 2007. Ann Thorac Surg. 2008; 85(5):1691-6. DOI: 10.1016/j.athoracsur.2008.01.057. View

12.

Campbell M, Lorch S, Rychik J, Quartermain M, Passarella M, Groeneveld P . Socioeconomic barriers to prenatal diagnosis of critical congenital heart disease. Prenat Diagn. 2020; 41(3):341-346. PMC: 7933065. DOI: 10.1002/pd.5864. View

13.

Vandvik I, Forde R . Ethical issues in parental decision-making. An interview study of mothers of children with hypoplastic left heart syndrome. Acta Paediatr. 2000; 89(9):1129-33. DOI: 10.1080/713794571. View

14.

Siffel C, Riehle-Colarusso T, Oster M, Correa A . Survival of Children With Hypoplastic Left Heart Syndrome. Pediatrics. 2015; 136(4):e864-70. PMC: 4663985. DOI: 10.1542/peds.2014-1427. View

15.

. Levels of neonatal care. Pediatrics. 2012; 130(3):587-97. DOI: 10.1542/peds.2012-1999. View

16.

Kaltman J, Burns K, Pearson G, Goff D, Evans F . Disparities in Congenital Heart Disease Mortality Based on Proximity to a Specialized Pediatric Cardiac Center. Circulation. 2020; 141(12):1034-1036. PMC: 7093217. DOI: 10.1161/CIRCULATIONAHA.119.043392. View

17.

Fixler D, Nembhard W, Xu P, Ethen M, Canfield M . Effect of acculturation and distance from cardiac center on congenital heart disease mortality. Pediatrics. 2012; 129(6):1118-24. DOI: 10.1542/peds.2011-3114. View

18.

Kane J, Canar J, Kalinowski V, Johnson T, Hoehn K . Management Options and Outcomes for Neonatal Hypoplastic Left Heart Syndrome in the Early Twenty-First Century. Pediatr Cardiol. 2015; 37(2):419-25. DOI: 10.1007/s00246-015-1294-2. View

19.

Kucik J, Nembhard W, Donohue P, Devine O, Wang Y, Minkovitz C . Community socioeconomic disadvantage and the survival of infants with congenital heart defects. Am J Public Health. 2014; 104(11):e150-7. PMC: 4202971. DOI: 10.2105/AJPH.2014.302099. View

20.

Krishnan A, Jacobs M, Morris S, Peyvandi S, Bhat A, Chelliah A . Impact of Socioeconomic Status, Race and Ethnicity, and Geography on Prenatal Detection of Hypoplastic Left Heart Syndrome and Transposition of the Great Arteries. Circulation. 2021; 143(21):2049-2060. PMC: 8162295. DOI: 10.1161/CIRCULATIONAHA.120.053062. View