Trends in newborn hospitalization transfers for hypoplastic left heart and transposition of the great arteries

Abstract

Neonates with transposition of the great arteries (TGA) and hypoplastic left heart syndrome (HLHS) may benefit from delivery at centers where cardiac surgery can be performed. Prenatal diagnosis may facilitate delivery at referral centers. The primary objective of this study was to analyze trends in newborn transfers for HLHS and TGA. This cross-sectional analysis of newborn hospitalizations in the 2003, 2006, 2009, 2012, and 2019 Kids' Inpatient Database (KID). KID is released approximately every 3 years. Newborn hospitalizations with HLHS and TGA were identified. The proportion of HLHS and TGA deliveries transferred to another hospital for each year of the study was analyzed. Trends in transfers were calculated using joinpoint regression to estimate the average annual percent change (AAPC) with 95% CIs. As a secondary outcome, the proportion of deliveries with HLHS and TGA undergoing the Norwood procedure and arterial switch (respectively) at the hospital of delivery was analyzed by year and trended. Among newborn hospitalizations, 3608 neonates with TGA and 4967 neonates with HLHS were identified. Over the study period, the proportion of transfers for TGA decreased from 69.8% of newborn hospitalizations in 2003 to 44.7% in 2019 (AAPC -3.3%, 95% CI -4.7%, -1.1%). The proportion of transfers for HLHS decreased from 55.5% to 39.7% of newborn hospitalizations (AAPC -2.1%, 95% CI -3.0%, -1.1%) (Figure 1). Over the same period the proportion TGA deliveries undergoing arterial switch at the delivery hospital increased from 10.8% to 29.7% (AAPC 5.9%, 95% CI 3.4%, 8.6%) while the proportion of HLHS deliveries increased from 25.6% to 34.9% (AAPC 1.5%, 95% CI -0.1%, 3.2%) (Figure 2). The proportion of neonates with HLHS and TGA being transferred during a newborn delivery hospitalization decreased over the study period while surgical procedures at the hospital of delivery increased. These findings support that prenatal diagnosis may be increasing likelihood of delivery at referral centers for neonates with these diagnoses.View Large Image Figure ViewerDownload Hi-res image Download (PPT)