Influence of Birth Hospital on Outcomes of Ductal-Dependent Cardiac Lesions

Abstract

OBJECTIVE: The goal was to determine the effect of birth hospital pediatric cardiac specialty center status and neonatal level of care on 90-day mortality for infants with ductal-dependent congenital heart disease. METHODS: A population-based, retrospective, cohort study was conducted in Washington State in 1987–2006. All infants born in Washington with gestational ages of ≥32 weeks and birth weights of ≥1500 g who were admitted to a Washington hospital for the care of a congenital cardiac anomaly likely to be ductal dependent were included. Subjects were required to receive a surgical or interventional cardiac procedure within 30 days after birth. Birth certificate data were linked with death certificate data and hospital administrative records. The exposures of interest were birth hospital pediatric cardiac specialty center status and neonatal level of care. The primary outcome was death within 90 days. RESULTS: A total of 823 infants met the inclusion criteria, 285 born at specialty centers and 538 at other centers. After adjustment for cardiac diagnoses, other congenital anomalies, birth year, maternal income quartile, and definitive-care hospital, there was no significant difference in 90-day mortality for infants born at specialty centers versus other centers (odds ratio: 1.05 [95% confidence interval: 0.65–1.68]). CONCLUSION: For infants with ductal-dependent congenital heart disease, there was no difference in 90-day mortality for infants born at specialty centers versus other centers in the state of Washington.