Neha J Purkey1, Chen Ma2, Henry C Lee2, Susan R Hintz2, Gary M Shaw2, Doff B McElhinney1,3, Suzan L Carmichael2,4. 1. Division of Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA. 2. Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA. 3. Division of Pediatric Cardiac Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California, USA. 4. Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA.
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.
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.
Authors: Chad N Stasik; S Gelehrter; Caren S Goldberg; Edward L Bove; Eric J Devaney; Richard G Ohye Journal: J Thorac Cardiovasc Surg Date: 2006-01-18 Impact factor: 5.209
Authors: Mary T Donofrio; Anita J Moon-Grady; Lisa K Hornberger; Joshua A Copel; Mark S Sklansky; Alfred Abuhamad; Bettina F Cuneo; James C Huhta; Richard A Jonas; Anita Krishnan; Stephanie Lacey; Wesley Lee; Erik C Michelfelder; Gwen R Rempel; Norman H Silverman; Thomas L Spray; Janette F Strasburger; Wayne Tworetzky; Jack Rychik Journal: Circulation Date: 2014-04-24 Impact factor: 29.690
Authors: Jill M Steiner; James N Kirkpatrick; Susan R Heckbert; Asma Habib; James Sibley; William Lober; J Randall Curtis Journal: Congenit Heart Dis Date: 2017-07-24 Impact factor: 2.007
Authors: James S Tweddell; Lynn A Sleeper; Richard G Ohye; Ismee A Williams; Lynn Mahony; Christian Pizarro; Victoria L Pemberton; Peter C Frommelt; Scott M Bradley; James F Cnota; Jennifer Hirsch; Paul M Kirshbom; Jennifer S Li; Nancy Pike; Michael Puchalski; Chitra Ravishankar; Jeffrey P Jacobs; Peter C Laussen; Brian W McCrindle Journal: J Thorac Cardiovasc Surg Date: 2012-02-15 Impact factor: 5.209
Authors: Barbara Kathleen Frohnert; Richard Charles Lussky; Maureen Anne Alms; Nancy J Mendelsohn; Daniel Michael Symonik; Myron Clifford Falken Journal: J Perinatol Date: 2005-11 Impact factor: 2.521
Authors: Wendy N Nembhard; Jason L Salemi; Mary K Ethen; David E Fixler; Angela Dimaggio; Mark A Canfield Journal: Pediatrics Date: 2011-04-18 Impact factor: 7.124
Authors: Peter N Dean; Kimberly E McHugh; Mark R Conaway; Diane G Hillman; Howard P Gutgesell Journal: Pediatr Cardiol Date: 2013-05-31 Impact factor: 1.655
Authors: Joseph T Mechak; Erika M Edwards; Kate A Morrow; Jonathan R Swanson; Jeffrey Vergales Journal: Am J Cardiol Date: 2018-07-21 Impact factor: 2.778
Authors: Shaine A Morris; Mary K Ethen; Daniel J Penny; Mark A Canfield; Charles G Minard; David E Fixler; Wendy N Nembhard Journal: Circulation Date: 2013-10-17 Impact factor: 29.690