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Timing of Transfer and Mortality in Neonates with Hypoplastic Left Heart Syndrome in California.

CPQCC Publication
TitleTiming of Transfer and Mortality in Neonates with Hypoplastic Left Heart Syndrome in California.
Publication TypeJournal Article
Year of Publication2021
AuthorsPurkey NJ, Ma C, Lee HC, Hintz SR, Shaw GM, McElhinney DB, Carmichael SL
JournalPediatr Cardiol
Date Published2021 Apr
KeywordsAfrican Americans, California, Female, Hispanic or Latino, Humans, Hypoplastic Left Heart Syndrome, Infant, Infant Mortality, Infant, Newborn, Male, Mothers, Patient Transfer, Proportional Hazards Models, Risk Factors, United States

Maternal race/ethnicity is associated with mortality in neonates with hypoplastic left heart syndrome (HLHS). We investigated whether maternal race/ethnicity and other sociodemographic factors affect timing of transfer after birth and whether timing of transfer impacts mortality in infants with HLHS. We linked two statewide databases, the California Perinatal Quality Care Collaborative and records from the Office of Statewide Health Planning and Development, to identify cases of HLHS born between 1/1/06 and 12/31/11. Cases were divided into three groups: birth at destination hospital, transfer on day of life 0-1 ("early transfer"), or transfer on day of life ≥ 2 ("late transfer"). We used log-binomial regression models to estimate relative risks (RR) for timing of transfer and Cox proportional hazard models to estimate hazard ratios (HR) for mortality. We excluded infants who died within 60 days of life without intervention from the main analyses of timing of transfer, since intervention may not have been planned in these infants. Of 556 cases, 107 died without intervention (19%) and another 52 (9%) died within 28 days. Of the 449 included in analyses of timing of transfer, 28% were born at the destination hospital, 49% were transferred early, and 23% were transferred late. Late transfer was more likely for infants of low birthweight (RR 1.74) and infants born to US-born Hispanic (RR 1.69) and black (RR 2.45) mothers. Low birthweight (HR 1.50), low 5-min Apgar score (HR 4.69), and the presence of other major congenital anomalies (HR 3.41), but not timing of transfer, predicted neonatal mortality. Late transfer was more likely in neonates born to US-born Hispanic and black mothers but was not associated with higher mortality.

Alternate JournalPediatr Cardiol
PubMed ID33533967
PubMed Central IDPMC7857096
Grant ListNIH R01 MD007796 / NH / NIH HHS / United States
NIH R01 MD007796 / NH / NIH HHS / United States