O0341 Oct.3: 2:13pm - Birth Location and Timing of Surgical Center ICU Admission in Infants with Prenatally Diagnosed Hypoplastic Left Heart Syndrome: A Report from the National Pediatric Cardiology Quality Improvement Collaborative

Background/Purpose: There is conflicting data on how geographic distance from delivery location to the cardiac surgical center impacts outcomes in neonates with ductal-dependent heart disease. Our goal was to describe national current practices in delivery location of neonates with a prenatal diagnosis of hypoplastic left heart syndrome (HLHS) and evaluate the impact of delivery location and age at admission to the surgical center ICU on post-operative length of hospital stay and transplant-free survival after the Norwood operation.

Methods:
A multicenter cohort study was performed utilizing the National Pediatric Cardiology Quality Improvement Collaborative dataset for infants with prenatally diagnosed HLHS who underwent a Norwood (stage 1) palliation from August 2016 through December 2018. Demographics, clinical and outcome data were collected from the stage 1 hospitalization period. Univariate comparisons of demographic and clinical outcome data were made between groups stratified by distance from surgical center and age at ICU admission. Multivariable logistic regression was performed to assess the impact of distance from center and age at admission controlling for significant differences in preoperative characteristics as well as sites.

Results:
A total of 790 patients from 33 centers were analyzed: 85% were born < 5 miles from the surgical center with 72% of those (486/673) born at the surgical center. Of the 117 infants born > 5 miles from surgical center, they were equally divided among those born 5-19, 20-100 miles and > 100 miles away. Infants born < 5 miles from the surgical center were significantly (p<0.05) more likely to be male, white, full term, have no genetic/chromosomal or extracardiac anomaly and have commercial health insurance. They were significantly more likely to breastfeed pre-operatively and less likely to have pre-operative cardiac catheterizations, pre-operative mechanical ventilation and delayed timing of the Norwood operation (Table 1). Age at surgical center ICU admission was ≤ 1 day in 98% of those born < 5 miles vs 74% born ≥ 5 miles from surgical center (p<0.0001). There was no significant difference in hospital length of stay, 30-day transplant-free survival or survival to hospital discharge based on birth location or age at surgical ICU admission on either univariate analysis or multivariable logistic regression.

Conclusions:
In this contemporary, multicenter dataset, hospital length of stay and survival after Norwood did not differ based on distance from birth location to surgical center or age at ICU admission. However, neonates born > 5 miles from the surgical center had higher rates of modifiable pre-operative risk factors such as mechanical ventilation and delays to surgery. The need for neonatal transport and separation of maternal-infant dyad is common and may contribute to the presence of those risk factors.