Congenital heart disease: The impact of delivery in a tertiary care center on SNAP scores (scores for neonatal acute physiology)☆,☆☆
Section snippets
Study population
All infants admitted to the neonatal intensive care unit at the New England Medical Center with congenital heart disease between July 1, 1992, and June 30, 1998, were considered for the study. Inclusion criteria were the presence of a major cardiac defect, admission to the neonatal intensive care unit by day 2 of life, and the absence of other life-threatening conditions such as multiple organ malformations or lethal chromosomal abnormalities. Patients were excluded if they had cardiac defects
Statistical analyses
The study was designed to detect a 35% difference in the SNAP score between the 2 groups with 80% power with 2-sided tests and an α level of .05. This required a sample size estimated at 90 infants in each cohort. All statistical analyses were performed with SAS (SAS Institute, Inc, Cary, NC) statistical software. Results are reported as mean ± SD or number and percentage of subjects per group. Statistical comparisons were made with Student t tests, χ2 tests, and multivariate linear regression
Population characteristics
Among the 4033 admissions to the neonatal intensive care unit at the New England Medical Center between July 1, 1992, and June 30, 1998, there were 196 infants with congenital heart disease who met the study criteria for inclusion. One patient was excluded because the medical record was incomplete. The demographic characteristics of the remaining 195 infants who were admitted to the neonatal intensive care unit with major structural heart defects are shown in Table II.
Comment
The decline in the perinatal mortality rate in recent decades has been attributed to advances in neonatal intensive care services.1 Improved outcomes have been found for infants born at tertiary level centers compared with infants born at lower level hospitals.2, 3 On the basis of these observations we theorized that the advanced perinatal care available in tertiary referral hospitals might lead to more favorable outcomes for infants with major congenital heart defects.
With a prevalence of 8
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Cited by (14)
Obstetric Management of Fetuses with Congenital Heart Disease
2008, Hemodynamics and Cardiology: Neonatology Questions and ControversiesPregnancy Outcomes After Prenatal Diagnosis of Aneuploidy
2001, Obstetrics and GynecologyNeonatal management and outcomes of prenatally diagnosed CHDs
2017, Cardiology in the YoungWhen, how and where to deliver the fetus with major congenital heart disease
2014, Fetal and Maternal Medicine ReviewImpact of prenatally diagnosed congenital heart defects on outcomes and management
2022, Journal of Clinical Ultrasound
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Reprint requests: Lynn L. Simpson, MD, New England Medical Center, Box 360, 750 Washington St, Boston, MA 02111.
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0002-9378/2000 $12.00 + 06/1/101827