Congenital heart disease: The impact of delivery in a tertiary care center on SNAP scores (scores for neonatal acute physiology),☆☆

https://doi.org/10.1016/S0002-9378(00)70511-4Get rights and content

Abstract

Objective: It has been hypothesized that delivery in a tertiary care center might improve the clinical condition and outcome of infants born with congenital heart disease. The purpose of this study was to determine the effect of delivery in a tertiary care center on SNAP scores (scores for neonatal acute physiology) of infants admitted to the neonatal intensive care unit with major structural cardiac defects. Study Design: This retrospective cohort study included 195 infants with major congenital heart disease admitted to the neonatal intensive care unit at the New England Medical Center between July 1, 1992, and June 30, 1998. SNAP scores were abstracted from the medical record. The values of 97 neonates with major cardiac defects born at the New England Medical Center were compared with those of 98 neonates transferred to our center after delivery in a community setting. A 2-tailed Student t test for independent samples was used to compare the mean SNAP scores between the 2 cohorts. Results: The SNAP scores for infants with major cardiac defects who were born at the New England Medical Center ranged from 0 to 41, with a mean of 10.6 ± 8.8. The values for infants with congenital heart disease who were transferred to our center after birth in community-based hospitals ranged from 0 to 34, with a mean of 11.1 ± 7.0. There was no significant difference between the 2 populations (P = .646). A comparison of the mean SNAP scores of infants with prenatally diagnosed disease who were delivered at our center versus infants with postnatally diagnosed disease who were delivered in community hospitals was also statistically not significant (P = .824). Conclusion: Delivery in a tertiary care center does not improve SNAP scores of infants with major structural cardiac defects. (Am J Obstet Gynecol 2000;182:184-91.)

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.

. Characteristics of study

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

References (15)

  • AC Chang et al.

    Diagnosis, transport, and outcome in fetuses with left ventricular outflow tract obstruction

    J Thorac Cardiovasc Surg

    (1991)
  • RL Williams et al.

    Identifying the sources of the recent decline in perinatal mortality rates in California

    N Engl J Med

    (1982)
  • MC McCormick et al.

    The regionalization of perinatal services: summary of the evaluation of a national demonstration program

    JAMA

    (1985)
  • RJ Ozminkowski et al.

    Inborn/outborn status and neonatal survival: a meta-analysis of non-randomized studies

    Stat Med

    (1988)
  • E Buskens et al.

    Routine screening for congenital heart disease: a prospective study in the Netherlands

  • DK Richardson et al.

    Score for neonatal acute physiology: a physiologic severity index for neonatal intensive care

    Pediatrics

    (1993)
  • TE Arbuckle et al.

    Birth weight percentiles by gestational age in Canada

    Obstet Gynecol

    (1993)
There are more references available in the full text version of this article.

Cited by (14)

  • Obstetric Management of Fetuses with Congenital Heart Disease

    2008, Hemodynamics and Cardiology: Neonatology Questions and Controversies
View all citing articles on Scopus

Reprint requests: Lynn L. Simpson, MD, New England Medical Center, Box 360, 750 Washington St, Boston, MA 02111.

☆☆

0002-9378/2000 $12.00 + 06/1/101827

View full text