title: Congenital heart disease: the impact of delivery in a tertiary care center on SNAP scores (scores for neonatal acute physiology).
abstract: OBJECTIVE
  It has been hypothesized that delivery in a tertiary care center might improve the clinical condition and outcome of infants born with congenital 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 with major structural cardiac defects.
  
  
  METHODS
  This retrospective cohort study included 195 infants with major congenital heart disease admitted to the neonatal intensive care unit at the New England Medical Center between July 1, 1992, and June 30, 1998. SNAP scores were abstracted from the medical record. The values of 97 neonates with major cardiac defects born at the New England Medical Center were compared with those of 98 neonates transferred to our center after delivery in a community setting. A 2-tailed Student t test for independent samples was used to compare the mean SNAP scores between the 2 cohorts.
  
  
  RESULTS
  The SNAP scores for infants with major cardiac defects who were born 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 transferred to our center after birth in community-based hospitals ranged from 0 to 34, with a mean of 11.1 +/- 7.0. There was no significant difference between the 2 populations (P =.646). A comparison of the mean SNAP scores of infants with prenatally diagnosed disease who were delivered at our center versus infants with postnatally diagnosed disease who were delivered in community hospitals was also statistically not significant (P =.824).
  
  
  CONCLUSIONS
  Delivery in a tertiary care center does not improve SNAP scores of infants with major structural cardiac defects.
authors.affiliation: Departments of Obstetrics and Gynecology and Pediatrics, New England Medical Center, Tufts University School of Medicine, Boston, MA 02111, USA.
authors.forename: L L
authors.initials: LL
authors.lastname: Simpson
authors.forename: K
authors.initials: K
authors.lastname: Harvey-Wilkes
authors.forename: M E
authors.initials: ME
authors.lastname: D'Alton
mesh_terms: D000527:Alprostadil / Q000627:therapeutic use; D001724:Birth Weight; D006328:Cardiac Catheterization; D015331:Cohort Studies; D036861:Delivery, Obstetric; D005260:Female; D005865:Gestational Age; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal; D007440:Intubation; D008297:Male; D010808:Physical Examination; D011296:Prenatal Diagnosis; D012121:Respiration, Artificial; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000527:Alprostadil