Managing CHD in Tertiary NICU in Collaboration with a Cardiothoracic Center

Area of Science:

• Neonatal Medicine
• Pediatric Cardiology
• Healthcare Management

Background:

• Non-cardiac tertiary neonatal intensive care units (NCTNs) increasingly manage newborns with congenital heart disease (CHD) before transfer to specialist cardiac surgical centers (SCSCs).
• This model of care aims to improve SCSC patient flow, keep families closer to home, and enhance psychological well-being.
• The decreasing number of SCSCs has led to an expansion of this practice in NCTNs.

Purpose of the Study:

• To examine the effectiveness of managing newborns with CHD in a NCTN prior to transfer to an SCSC.
• To describe the management, length of stay, and outcomes for neonates with CHD in a UK NCTN.
• To evaluate the feasibility of this care model for complex neonatal cardiac cases.

Main Methods:

• A retrospective observational study was conducted.
• Data were collected on cardiac-related admissions to a UK NCTN between January 2010 and December 2019.
• 190 neonates with various forms of CHD were identified and analyzed.

Main Results:

• Of 190 neonates with CHD, 41 had critical CHD and 64 had major CHD.
• 23.7% (n=45) required transfer to a specialist center after stabilization, with stays ranging from hours to 132 days.
• 68% (n=130) were discharged home or repatriated to a local NICU; 8.9% (n=17) died before age 2.

Conclusions:

• A complex neonatal cohort with CHD can be effectively managed in a NCTN.
• The findings support the current model of care where NCTNs manage these patients before transfer.
• The NCTN demonstrated successful management with support from pediatricians with cardiology expertise and visiting cardiologists.