Later transfer linked to longer hospitalization in severe congenital heart defects

For newborns with severe congenital heart defects (CHDs), reaching a cardiac surgical center more than 3 days after birth was associated with longer hospitalization compared with being born at a surgical center, according to a study published in The Journal of Pediatrics.¹ Although the findings do not establish a causal relationship, investigators say they underscore the importance of understanding how infants with critical heart disease access specialized care and whether delays can be reduced.²

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 study shifts attention beyond surgical care itself to the process of getting patients to centers capable of providing it.

"We looked at all babies born with severe congenital heart defects between 2013 and 2021 in our state, Illinois, through an administrative database provided by the Illinois Department of Public Health," Woo said. "We looked at the relationship between the time to transfer to a cardiac surgical center—that's a hospital that has capabilities for neonatal cardiac surgery—and the outcome was the total hospitalization duration."

The retrospective analysis included 1,391 neonates with severe CHDs reported to the Illinois Department of Public Health between 2013 and 2021. Nearly half (48.1%) were born at hospitals without cardiac surgical capability. Among transferred infants, 43.4% arrived at a surgical center on the day of birth, 43.8% transferred within 1 to 3 days, and 12.8% transferred after 3 days.

The median hospitalization duration was 23 days. Compared with infants born at cardiac surgical centers, transfer after 3 days was associated with a slower rate of discharge over time (adjusted subdistribution hazard ratio, 0.71; 95% CI, 0.54-0.94) and longer hospitalization. By contrast, infants transferred within 1 to 3 days had hospitalization durations that were not significantly different from those born at surgical centers.

Summarizing the findings, Woo said, "What we found was that compared to those newborns that were born at a cardiac surgical center, those that were transferred to a cardiac surgical center between 1 and 3 days actually had similar hospitalization durations, but those who transferred after 3 days tended to have anywhere between a 4-day longer to 30-day longer hospitalization duration."

The investigators emphasized that the study was not designed to determine why some newborns experienced later transfer. Woo noted that the available administrative data lacked the level of detail needed to identify the underlying causes.

"I think the short answer is that we don't know for sure because our data wasn't granular enough to really get down to the driving factors for what causes later transfer," she said. Potential explanations, she added, include delayed prenatal or postnatal diagnosis, infants being too medically unstable for immediate transport, planned delays before surgery, or socioeconomic factors that could affect access to care.

The findings build on prior research showing that prolonged hospitalization in newborns with severe CHDs is associated with higher 1-year mortality and less favorable long-term neurodevelopmental outcomes. Although this study cannot determine whether earlier transfer would directly shorten hospitalization, it identifies an area that may warrant additional investigation.

According to Woo, improving outcomes for infants with complex heart disease requires attention not only to the care delivered after arrival at a surgical center but also to the systems that connect patients with specialized services.

"So, we can't really figure out the mechanism based on our data, but what I think is really important is that it's really opening a door for more research into this area of how babies with critical heart disease access care," Woo said. "As cardiologists and cardiac surgeons and subspecialists in these big surgical centers, we try to do our very, very best to provide the highest quality care for babies once they arrive to us. But the point of this manuscript is to really point out that there's actually a whole process of accessing these surgical hospitals, and whether it's being done equitably or efficiently requires a little bit more investigation."

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