Congenital heart disease: The impact of delivery in a tertiary care centeron SNAP scores (scores for neonatal acute physiology)

OBJECTIVE: It has been hypothesized that delivery in a tertiary care center might improve the clinical condition and outcome of infants born with cong enital heart disease. The purpose of this study was to determine the effect of delivery in a tertiary care center on SNAP scores (scores for neonatal acute physiology) of infants admitted to the neonatal intensive care unit w ith major structural cardiac defects. STUDY DESIGN: This retrospective cohort study included 195 infants with maj or congenital heart disease admitted to the neonatal intensive care unit at the New England Medical Center between July 1, 1992, and June 30, 1998. SN AP scores were abstracted from the medical record. The values of 97 neonate s with major cardiac defects born at the New England Medical Center were co mpared with those of 98 neonates transferred to our center after delivery i n a community setting. A 2-tailed Student t test for independent samples wa s used to compare the mean SNAP scores between the 2 cohorts. RESULTS: The SNAP scores for infants with major cardiac defects who were bo rn at the New England Medical Center ranged from 0 to 41, with a mean of 10 .6 +/- 8.8. The values for infants with congenital heart disease who were t ransferred to our center after birth in community-based hospitals ranged fr om 0 to 34, with a mean of 11.1 +/- 7.0. There was no significant differenc e between the 2 populations (P =.646). A comparison of the mean SNAP scores of infants with prenatally diagnosed disease who were delivered at our cen ter versus infants with postnatally diagnosed disease who were delivered in community hospitals was also statistically not significant(P=.824). CONCLUSION: Delivery in a tertiary care center does not improve SNAP scores of infants with major structural cardiac defects.