Joyce Woo, MD, on how rapid diagnosis and transfer remain critical in severe heart defects

Newborns with severe congenital heart defects (CHDs) who are transferred to a cardiac surgical center more than 3 days after birth experience longer hospitalizations than those born at surgical centers, according to a study published in The Journal of Pediatrics. While the analysis focused on hospitalization duration, the study's lead author says the findings also highlight how delays in diagnosis and transfer can affect surgical planning and potentially influence outcomes.^1,2

The retrospective study evaluated 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 birth at a surgical center, transfer after 3 days was associated with a longer hospitalization, whereas infants transferred within 1 to 3 days had hospitalization durations similar to those born at cardiac surgical centers.

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 clinicians should recognize that prompt diagnosis remains the first step in timely access to specialized care.

"I think the first thing is to make sure that the diagnosis is accurate," Woo said. "A lot of diagnoses are still being made based on clinical, good, solid clinical exam skills, such as detecting a murmur or detecting early signs of neonatal distress. A lot of CHD diagnoses are being determined by those factors, and those are not things that AI can help us with."

Woo noted that although prostaglandin therapy can stabilize many infants before surgery, delaying definitive treatment is not without consequences.

"I think there is a common misconception that keeping a baby on prostaglandins will maintain patency of the ductus arteriosus... but there are side effects to leaving a baby on prostin, and there are side effects to long-term cyanosis," she said. She cited evidence showing that outcomes for infants with transposition of the great arteries worsen when surgery is delayed beyond the first several days after birth. "Once the diagnosis is made, assuming a postnatal diagnosis, you're on the clock for getting the baby the fastest care possible."

Woo emphasized that transfer decisions should include early communication between referring clinicians and the receiving cardiac surgical center. Factors such as prematurity, comorbidities, and the capabilities of individual surgical centers may influence where an infant should receive care.

"Not all surgical centers are the same," she said. "Some are very, very good at surgery but don't perform neonatal surgery. So a really good idea and a really strong relationship with the potential receiving surgical centers and thoughtful conversations about it, I think, is really, really important."

She added that prenatal planning can also facilitate timely care. At her institution, clinicians work with referring hospitals before delivery when families are unable to travel to a cardiac surgical center, creating contingency plans if an infant is born locally.

The study also highlights that transfer is only one step before definitive treatment. According to Woo, infants often require advanced imaging and multidisciplinary evaluation after arrival at a surgical center before surgery can safely proceed.

"When we receive a patient with critical congenital heart disease, even if we know the diagnosis, it's not nearly as simple as, okay, let's just go to the OR," Woo said. "There's still a lot of preparatory work that needs to happen before the patient, the baby, receives life-saving care."

Woo also pointed to previous research suggesting that hospital systems may influence the timing of surgery. She noted that some higher-level neonatal intensive care units paradoxically experience longer times to surgery than lower-level units, even after accounting for differences in illness severity.

"I think as with many things in medicine, communication and coordination are important," Woo said. "I think it’s the knowledge on both sides, the transferring hospital and the receiving hospital, that timing is actually key. That earlier transfer may lead to earlier surgical planning, may lead to earlier surgery, which leads to better short- and long-term outcomes."

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