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Background <p>Timely and effective management is crucial for neonates with critical congenital heart disease (CCHD). This study investigated the impact of the RAPID-CHD Pathway, a coordinated referral and transport system, compared with conventional management models.</p> Methods <p>This retrospective study included neonates (≤ 28&#xa0;days) with CCHD admitted between January 2019 and December 2024. Group 1 comprised neonates enrolled in the RAPID-CHD Pathway: prenatally diagnosed, delivered in designated maternity hospitals, and transferred via a dedicated fast-track pathway. Group 2 included those referred from other hospitals or self-admitted. Major adverse events (MAEs) were defined as in-hospital death or discharge against medical advice. Logistic regression was used to assess associations between management strategies and MAEs.</p> Results <p>Among 587 neonates (Group 1: <i>n</i> = 141; Group 2: <i>n</i> = 446), 439 underwent surgery (Group 1: <i>n</i> = 116; Group 2: <i>n</i> = 323). Group 1 had earlier ICU admission (0 vs 6&#xa0;days, <i>P</i> &lt; 0.001), earlier surgery (7 vs 15&#xa0;days, <i>P</i> &lt; 0.001), lower rates of low birth weight (&lt; 2.5&#xa0;kg: 5.7% vs 18.2%, <i>P</i> &lt; 0.001), fewer emergency surgeries (9.5% vs 18.9%, <i>P</i> = 0.028), and higher surgical rates (82.3% vs 72.4%, <i>P</i> = 0.025). MAEs were lower in Group 1 (5.7% vs 12.6%, <i>P</i> = 0.033). Among patients who underwent surgery, the RAPID-CHD pathway remained associated with a trend toward reduced MAEs after adjustment (aOR 0.36; 95% CI, 0.11–1.20).</p> Conclusions <p>The RAPID-CHD Pathway improves early access to care, surgical opportunities, and outcomes in neonates with CCHD. It supports wider adoption in tertiary pediatric cardiac centers.</p>

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RAPID-CHD pathway improves clinical outcomes in neonates with congenital heart disease

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月18日

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  • Chenyu Li,
  • Zhongyuan Lu,
  • Shilin Wang,
  • Xia Li,
  • Xiaofeng Wang,
  • Qinnan Chen,
  • Xu Wang

摘要

Background

Timely and effective management is crucial for neonates with critical congenital heart disease (CCHD). This study investigated the impact of the RAPID-CHD Pathway, a coordinated referral and transport system, compared with conventional management models.

Methods

This retrospective study included neonates (≤ 28 days) with CCHD admitted between January 2019 and December 2024. Group 1 comprised neonates enrolled in the RAPID-CHD Pathway: prenatally diagnosed, delivered in designated maternity hospitals, and transferred via a dedicated fast-track pathway. Group 2 included those referred from other hospitals or self-admitted. Major adverse events (MAEs) were defined as in-hospital death or discharge against medical advice. Logistic regression was used to assess associations between management strategies and MAEs.

Results

Among 587 neonates (Group 1: n = 141; Group 2: n = 446), 439 underwent surgery (Group 1: n = 116; Group 2: n = 323). Group 1 had earlier ICU admission (0 vs 6 days, P < 0.001), earlier surgery (7 vs 15 days, P < 0.001), lower rates of low birth weight (< 2.5 kg: 5.7% vs 18.2%, P < 0.001), fewer emergency surgeries (9.5% vs 18.9%, P = 0.028), and higher surgical rates (82.3% vs 72.4%, P = 0.025). MAEs were lower in Group 1 (5.7% vs 12.6%, P = 0.033). Among patients who underwent surgery, the RAPID-CHD pathway remained associated with a trend toward reduced MAEs after adjustment (aOR 0.36; 95% CI, 0.11–1.20).

Conclusions

The RAPID-CHD Pathway improves early access to care, surgical opportunities, and outcomes in neonates with CCHD. It supports wider adoption in tertiary pediatric cardiac centers.