# Prenatal-postnatal integrated management model improves outcomes of neonatal cardiac surgery in critical congenital heart disease: a retrospective cohort study

## TL;DR

A prenatal-postnatal management model improves survival and reduces risks in neonates with critical heart disease undergoing surgery.

## Contribution

The study introduces a prenatal-postnatal integrated management model that reduces operative mortality in neonates with critical congenital heart disease.

## Key findings

- Neonates in the PPIMM group had lower operative mortality and earlier surgery compared to the non-PPIMM group.
- PPIMM was a protective factor for operative mortality, while preoperative intubation and postoperative ECMO use were risk factors.
- Immediate postnatal surgery in selected neonates was feasible and not associated with increased mortality.

## Abstract

Neonates with CCHD remain at high risk for mortality. This study aimed to evaluate the impact of the prenatal-postnatal integrated management model (PPIMM) on perioperative outcomes and mortality in neonates with CCHD, and to identify factors associated with mortality.

This retrospective cohort study enrolled 274 neonates with CCHD undergoing cardiac surgery from January 2018 to August 2024. Patients were categorized into the PPIMM group (n = 140) and the non-PPIMM group (n = 134). The primary outcome was all-cause mortality, including operative mortality and late mortality. The secondary outcome was unplanned reoperation. Kaplan–Meier survival and Cox regression analyses were performed.

The PPIMM group underwent surgery at a younger age (8.00 vs. 16.00 days, P < 0.001), with lower rates of preoperative intubation (11.43% vs. 20.90%, P = 0.047), emergent procedures (5.71% vs. 14.18%, P = 0.032), and operative mortality (5.71% vs. 13.43%, P = 0.036) compared to the non-PPIMM group. The median follow-up was 20.70 months (IQR 9.00–30.30) in the PPIMM group and 20.40 months (IQR 7.00–37.50) in the non-PPIMM group. Late mortality (3.57% vs. 4.48%, P = 0.702) and unplanned reoperation rates (P>0.05) were comparable between the PPIMM and non-PPIMM groups. Kaplan–Meier analysis showed a significant survival advantage for all-cause mortality in the PPIMM group (log-rank P = 0.038). Twelve neonates underwent immediate postnatal surgery, with no deaths or reoperations during a median follow-up of 13.00 months. PPIMM was a protective factor for operative mortality in the overall cohort, and prenatal diagnosis was protective within the non-PPIMM subgroup, while preoperative intubation, postoperative ECMO use, and elevated lactate level at 24 h postoperatively were risk factors.

PPIMM was associated with earlier surgery, better preoperative status, and lower operative mortality in neonates with CCHD. In selected neonates, immediate postnatal surgery appeared feasible and was not associated with increased mortality. PPIMM and prenatal diagnosis were protective factors, whereas preoperative intubation, postoperative ECMO, and elevated lactate at 24 h postoperatively were risk factors for operative mortality.

Retrospectively registered at ClinicalTrials.gov (NCT06768008), 2025-01-03.

The online version contains supplementary material available at 10.1186/s12887-025-06378-x.