Joyce Woo, MD, on how hospital factors may influence cardiac transfer timing for newborns

For newborns with severe congenital heart defects (CHDs), transfer to a cardiac surgical center more than 3 days after birth was associated with longer hospitalization than birth at a surgical center, according to a study published in The Journal of Pediatrics. Although the analysis was not designed to determine why some infants experience delayed transfer, the study's lead author says the findings point to opportunities to improve prenatal diagnosis, referral pathways, and hospital systems that facilitate access to specialized care.^1,2

The retrospective study included 1,391 neonates with severe CHDs reported to the Illinois Department of Public Health between 2013 and 2021. Nearly half of the infants were born at hospitals without cardiac surgical capability. Compared with infants born at surgical centers, those transferred after 3 days had longer hospitalization, whereas infants transferred within the first 1 to 3 days had similar hospitalization durations.

Joyce Woo, MD, MS, pediatric and fetal cardiologist at Ann & Robert H. Lurie Children's Hospital of Chicago and assistant professor of pediatrics and medical social sciences at Northwestern University Feinberg School of Medicine, said the findings should be viewed within the broader context of how congenital heart defects are identified before birth and how families access specialty care.

"With regards to prenatal diagnosis, in theory, 99% of these diseases are detectable by prenatal ultrasound," Woo said. "What our team has discovered is that a lot of patients are not getting these prenatal ultrasounds, specifically the second trimester ultrasound, which is probably the real gatekeeper to detecting these defects prenatally." She added that previous research from her group found that "publicly insured patients are far less likely to obtain a second trimester ultrasound. That's a clear disparity and a clear area for intervention, improvement, and policy change."

Woo noted that inaccurate prenatal diagnosis has become less common for most critical CHDs because many lesions are readily identified on fetal ultrasound. However, she said some conditions continue to have lower prenatal detection rates, even as diagnosis has improved over time.

The current study focused on what happens after birth when prenatal diagnosis is missed or unavailable.

"And then the third component is what this paper is really focused on, which is even if someone is not diagnosed prenatally, how do we get them to the right care as soon as possible?" Woo said. "What I think is really encouraging about this paper is that we're seeing that at least for the outcome of hospitalization duration... still transfer between one and three days has a comparable hospitalization duration as being delivered at a cardiac surgical center."

She added that this finding is important because not every family can deliver at a hospital with neonatal cardiac surgery.

"That's really encouraging because not all patients have the access, or the means, or the ability... to wait after mom's water breaks to deliver at a cardiac surgical center," Woo said.

The investigators also highlighted newborn screening as an important contributor to earlier diagnosis after birth.

"Critical congenital heart disease screening has really been a game changer in our field with regards to pulse oximetry screening... in terms of detecting congenital heart diseases sooner, so that patients can be transferred," Woo said.

An unexpected observation from the study was that delayed transfers may not be explained solely by how ill an infant is. According to Woo, later transfers appeared to be associated with hospital-level factors, suggesting that health system processes deserve additional study.

"A lot of the later transfers, the transfers that occur after three days, potentially are not driven by patient-level factors... but appear to be driven by hospital-level factors," she said. "That's really a ripe area for study. I think because that makes you wonder if there's actually a systems-based issue that is driving these later transfers."

Looking ahead, Woo also pointed to advances in artificial intelligence that may improve prenatal detection of congenital heart defects, particularly in rural communities where obstetric ultrasounds are often interpreted remotely.

"So, there are a lot of private groups that are already employing these techniques, which will be extremely useful for rural populations where their obstetric ultrasounds are often being read remotely," Woo said. "These AI techniques will be really useful to increase the total rate of prenatal diagnosis."

References

1. Woo J, Grobman WA, Mongé MC, et al. Time-to-Transfer and Hospitalization Duration for Severe Congenital Heart Defects: Implications for Perinatal Regionalization. J Pediatr. Published online July 3, 2026. doi:10.1016/j.jpeds.2026.115220

2. Ann and Robert H. Lurie Children's Hospital of Chicago. Early Access to a Cardiac Surgical Hospital Linked to Shorter Hospitalization for Newborns with Heart Defects. Newswise. Press Release. July 8, 2026. Accessed July 16, 2026. https://www.newswise.com/articles/early-access-to-a-cardiac-surgical-hospital-linked-to-shorter-hospitalization-for-newborns-with-heart-defects/?sc=dwrecomm&xy=10069478&wt=dw_r_09072026