Critical congenital heart defects outside a paediatric cardiology center – combined expertise and resources from a cohort study

Objective To assess whether neonates with critical congenital heart defects (cCHD) can be safely delivered and stabilized at a Level-III perinatal center lacking a dedicated paediatric cardiology unit. Methods Retrospective single-center cohort study (2018–2022) at a tertiary perinatal center with paediatric cardiologists on staff but no dedicated cardiology unit. Inclusion of all neonates with prenatally or postnatally diagnosed cCHD delivered at the center and followed until transfer or discharge. Main outcome measures Integrated prenatal and neonatal care prior to transfer for cardiac intervention. Neonatal mortality, morbidity, diagnostic confirmation, functional cCHD classification, delivery mode, postnatal bonding, and admission site. Results Among 115 neonates, 94.0% had prenatal cCHD diagnosis. Vaginal delivery occurred in 50.4%; 52.7% achieved postnatal bonding. Initial care was provided at NICU (87.0%), intermediate care (5.2%), and maternity ward (7.8%). Functional cCHD classification was: Univentricular diseases (29%), Systemic Outflow Tract Obstruction (17%), Transposition of the Great Arteries (11%), Left-to-right Shunt Lesion (12%), Tetralogy of Fallot (8%), Ebstein Anomaly (5%), Heterotaxy Syndrome (1%), Arrhythmia (1%) and Other Defects (9%) with a significant difference in the postnatal confirmation of the prenatal diagnosis. (OR 2.1; CI 1.3–3.4). Neonatal thriving was significant for head circumference (p < 0.01), but not for weight gain (p = 0.22). Mortality was 9.5%; notably no acute deaths occurred in-house. Conclusions Contrary to current practice emphasizing delivery at specified centers, our findings show that neonates with cCHD can be safely managed in non-cardiac centers with expert neonatal and cardiologic collaboration. This model optimizes maternal bonding and resource allocation without compromising early survival.