RAPID-CHD pathway improves clinical outcomes in neonates with congenital heart disease

Timely and effective management is crucial for neonates with critical congenital heart disease (CCHD). This study investigated the impact of the RAPID-CHD Pathway, a coordinated referral and transport system, compared with conventional management models.

This retrospective study included neonates (≤ 28 days) with CCHD admitted between January 2019 and December 2024. Group 1 comprised neonates enrolled in the RAPID-CHD Pathway: prenatally diagnosed, delivered in designated maternity hospitals, and transferred via a dedicated fast-track pathway. Group 2 included those referred from other hospitals or self-admitted. Major adverse events (MAEs) were defined as in-hospital death or discharge against medical advice. Logistic regression was used to assess associations between management strategies and MAEs.

Among 587 neonates (Group 1: n = 141; Group 2: n = 446), 439 underwent surgery (Group 1: n = 116; Group 2: n = 323). Group 1 had earlier ICU admission (0 vs 6 days, P < 0.001), earlier surgery (7 vs 15 days, P < 0.001), lower rates of low birth weight (< 2.5 kg: 5.7% vs 18.2%, P < 0.001), fewer emergency surgeries (9.5% vs 18.9%, P = 0.028), and higher surgical rates (82.3% vs 72.4%, P = 0.025). MAEs were lower in Group 1 (5.7% vs 12.6%, P = 0.033). Among patients who underwent surgery, the RAPID-CHD pathway remained associated with a trend toward reduced MAEs after adjustment (aOR 0.36; 95% CI, 0.11-1.20).

The RAPID-CHD Pathway improves early access to care, surgical opportunities, and outcomes in neonates with CCHD. It supports wider adoption in tertiary pediatric cardiac centers.