Association between specialist pediatric cardiac transfer and prognosis of neonates with critical congenital heart disease: A cohort study

Association between specialist pediatric cardiac transfer and prognosis of neonates with critical congenital heart disease: A cohort study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Association between specialist pediatric cardiac transfer and prognosis of neonates with critical congenital heart disease: A cohort study Chunxiang Li, Xiaolei Gong, Zhuoming Xu, Jinlong Liu, Haibo Zhang, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2987865/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: To explore whether specialist pediatric cardiac transfer could improve the prognosis of neonates with critical congenital heart disease (CCHD). Methods: This cohort study retrospectively collected the clinical data of neonates diagnosed with CCHD who underwent treatment at the cardiac intensive care unit of Shanghai Children’s Medical Center between January 2018 and December 2021. The neonates were classified into the specialist pediatric cardiac transfer (SPCT) and non-SPCT groups. Propensity score matching (PSM) was used to match the two groups. The surgical outcome was the postoperative survival of the neonates. Results: During the study period, 357 neonates with CCHD were treated and included, of which 16 died before surgery, all in the non-SPCT group. After PSM, compared with the non-SPCT group, the SPCT group showed a lower rate of inotropic drug use (57.3% vs. 77.5%, P=0.004), a lower rate of unplanned emergent operation (29.2% vs. 53.9%, p =0.001), a higher total survival rate (92.1% vs. 82.0%, p =0.044), and a lower preoperative mortality rate (0% vs. 4.5%, p =0.043). The multivariable analysis showed that body weight at surgery (HR=0.444, 95%CI: 0.273-0.711, p =0.001) and unplanned emergent surgery (HR=5.227, 95%CI: 2.521-10.834, p <0.001) were independently associated with mortality in neonates with CCHD. Conclusion: Low body weight and unplanned emergency surgery are independent risk factors for the death of neonates with CCHD. Although SPCT is unrelated to the surgery mortality rate of newborns with CCHD, it can reduce the incidence of unplanned emergency surgery and increase the total survival rate. critical congenital heart disease pediatric cardiac transfer neonates intensive care units surgery Figures Figure 1 Introduction Critical congenital heart disease (CCHD) is a congenital heart disease (CHD) for which the neonates require early surgical intervention to survive; otherwise, extremely high rates of mortality and survival with significant disability are observed [ 1 , 2 ]. CCHD represents approximately 25% of CHD cases [ 3 ]. The main screening methods include fetal echocardiograms and pulse oximetry [ 1 , 4 , 5 ]. Surgery is mandatory in all cases of CCHD to improve prognosis [ 6 , 7 ]. The burden of CHD has been increasing in China from 1990 to 2017 [ 8 ]. Treating neonates with CCHD is challenging in China under the current medical environment and uneven medical resource distribution [ 9 , 10 ] and is associated with high costs and burdens to families and society [ 11 ]. A prenatal diagnosis of CCHD will improve the prognosis [ 12 ]. All cases of CCHD should be detected early and promptly discussed with a pediatric cardiologist to improve prognosis [ 3 ]. Transfer to the neonatal intensive care unit (NICU) or cardiac intensive care unit (CICU) can be lifesaving [ 3 ]. Studies in developed countries showed that CHD diagnosis at maternity hospitals was associated with lower healthcare costs and better prognosis [ 13 , 14 ]. Prenatal diagnosis is crucial to the prognosis of CCHD [ 15 ]. The transfer mode to the hospital and preoperative medical department is important in managing CCHD. Among the 12,000 emergency admissions in the pediatric intensive care unit (PICU) in the United Kingdom every year, inter-hospital transfer accounts for almost 50%, most of which are undertaken by professional pediatric intensive care transfer teams [ 16 ]. The transportation team in the United States of America has developed a mobile ICU model that can provide the most advanced critical care in pediatric and neonatal transportation [ 17 ]. Still, the mortality of children is higher with inter-hospital transport with direct admission [ 18 ]; therefore, it is necessary to improve the inter-hospital transport process to improve the prognosis of the children. In a small-sample study in China, an integrated approach to transferring CHD patients to the NICU was reported, and encouraging outcomes were observed compared with the non-integrated approach [ 19 ]. The success rate of surgery for CCHD in neonates in China is still lower than in developed countries [ 20 ], and the management of neonates with CCHD in China remains to be optimized. Therefore, this study explored whether cardiac specialist transfer could improve the prognosis of neonates with CCHD. The results could help optimize the prognosis of neonates with CCHD in China. Methods Study Design and Patients This cohort study retrospectively collected the clinical data of neonates diagnosed with CCHD who underwent treatment at Shanghai Children’s Medical Center between January 2018 and December 2021. This study was approved by the Ethics Committee of Shanghai Children’s Medical Center (SCMCIRB-K2023026-1). The requirement for informed consent was waived as this study was retrospective. The inclusion criteria were 1) neonates diagnosed with CCHD and 2) aged 0–28 days. Neonates with incomplete clinical data were excluded. The neonates were classified into the specialist pediatric cardiac transfer (SPCT) and non-SPCT groups according to the transfer mode to the hospital. Data Collection Preoperative data, interventional data, and outcomes of the neonates were collected from the electronic medical record system. The preoperative data of the neonates included age, body weight, diagnosis, preoperative Risk Adjusted classification for Congenital Heart Surgery (RACHS-1) and biochemical data after hospital admission. Interventional data mainly included surgical data and perioperative treatment. The outcome was the postoperative survival, overall survival and ICU complications of the neonates. Statistical Analysis SPSS 18.0 (SPSS, Chicago, USA) was used for the statistical analysis. For all neonates included in this study, 1:1 propensity score matching (PSM) was performed for the non-SPCT and SPCT groups. Specifically, the factors matched between the two groups included age, body weight, extracorporeal membrane oxygenation (ECMO) transfer, and preoperative cardiopulmonary resuscitation (CPR). For the neonates who underwent surgery, 1:1 PSM was performed for the non-SPCT and SPCT groups. Specifically, the factors matched between the two groups included age, body weight, ECMO transfer, and preoperative CPR. The caliper value was 0.02, and 89 pairs of neonates were acquired after fuzzy matching. Continuous data were tested for normal distribution using the Kolmogorov-Smirnov test. Continuous data with a normal distribution were described as means ± standard deviations and analyzed using the independent t-test. Continuous data with skew distribution were described as medians (ranges) and analyzed using the Mann-Whitney U-test. Categorical data were described as n (%) and analyzed using the chi-square test. For the multivariable analysis, the survival of the neonates was used as the dependent variable, and variables with statistical significance in the univariable analysis, as well as variables without statistical significance in the univariable analysis but that could possibly be closely associated with the outcome according to clinical practice and the literature, were included as the independent variable for binary Cox regression. Kaplan-Meier curves were used for the survival analysis. Two-sided p -values < 0.05 were considered statistically significant. Results During the study period, 357 neonates with CCHD were included and treated, of which 16 died before surgery, all in the non-SPCT group. All 16 patients who were initially screened as CCHD in the local hospital were transferred to Shanghai for emergency treatment from other locations, 13 by their parents and 3 by common Ordinary ambulance transshipment. The age, diagnosis, condition after admission, and cause of death of 16 patients were analyzed. From the diagnosis perspective, most of them are arterial duct-dependent systemic circulation or pulmonary circulation CCHD. The condition of 16 children transferred to the hospital has been very poor (Table 1 ). The characteristics of the neonates are shown in Table 2 . Before PSM, compared with the non-SPCT group, the neonates in the SPCT group were younger, had a higher incidence of transfer with invasive ventilation, had a higher rate of fetal ultrasound abnormalities, had a lower rate of RACHS-1 score ≥ 3, acidosis at ICU admission, preoperative CPR, and unplanned emergent operation, and had a higher total survival rate (all p 0.05). Compared with the non-SPCT group, the SPCT group showed a lower rate of inotropic drug use (57.3% vs. 77.5%, p = 0.004), a lower rate of intubation before operation(49.4% vs. 62.9%, p = 0.07), a lower rate of unplanned emergent operation (29.2% vs. 53.9%, p = 0.001), a higher survival rate (92.1% vs. 82.0%, p = 0.044), and a lower preoperative mortality rate (0% vs. 4.5%, p = 0.043). Table 1 Characteristics of the neonates who died before surgery. No. Diagnosis Age (d) Weight (kg) Emergency Admission Y/N Emergency Intubation, Y/N CPR Y/N Death time Po-admission (h) Major issues Death cause 1 D-TGA/PFO/PDA/PH 5d 2.5 Y Y Y 2h Insufficiency confluence of systemic circulation and pulmonary circulation Hypoxia, severe metabolic acidosis, NDR 2 Taussig-Bing/ COA/PDA/PH 1 3 Y Y Y 3h Aortic arch hypoplasia Heart failure, severe metabolic acidosis 3 AS/ASD/PDA/PH 1 3.2 Y Y Y 10h Severe obstruction of blood flow through aortic valve Heart failure 4 PA/IVS/PDA/PFO/TR 28 5 Y Y N 5h Ductal-dependent pulmonary circulation, Insufficiency of systemic perfusion Hypoxia, severe metabolic acidosis, NDR 5 TAPVC (Infracardiac) 1 2.6 Y Y Y 6h Severe pulmonary vein obstruction Hypoxia left heart failure, pulmonary edema 6 IAA/VSD/ASD/ PDA/PH 4 3.2 Y Y Y 3h Ductal-dependent systemic circulation, Insufficiency of systemic perfusion Heart failure, severe metabolic acidosis 7 SV/TAPVC/MGA/CAVC/PDA/PH 1 3.8 Y Y Y 3h Pulmonary vein obstruction, atrio-ventricular valve regurgitation Hypoxia, severe metabolic acidosis Heart failure 8 COA/VSD/ASD/PDA 6 3.4 Y Y N 48h Large PDA with congestive heart failure, Insufficiency of systemic perfusion NEC, sepsis shock NDR 9 PA/VSD/ PDA 12 2.8 Y Y Y 5h Ductal-dependent pulmonary circulation, Insufficiency of pulmonary blood flow Hypoxia, severe metabolic acidosis 10 HLHS/ MA/AS 15 2.3 Y Y Y 3h Insufficiency of systemic perfusion Heart failure, severe metabolic acidosis 11 SA/PA/CAVC/ TAPVC/PDA 2 2.6 Y Y Y 4h Ductal-dependent pulmonary circulation, Insufficiency of pulmonary blood flow Hypoxia, severe metabolic acidosis 12 TAPVC (Supracardiac) 1 3 Y Y Y 4h Severe pulmonary vein obstruction Hypoxia, severe metabolic acidosis, NDR 13 Hemi-Truncus 16 3 Y Y Y 6h Congestive heart failure Heart failure, severe metabolic acidosis 14 DORV(Taussig-Bing)/COA/PDA/PH 15 4.1 Y Y Y 5h Congestive heart failure Heart failure, severe metabolic acidosis 15 IAA/VSD/ASD/ PDA/PH 27 3.5 Y Y Y 4h Ductal-dependent systemic circulation, Insufficiency of systemic perfusion heart failure, severe metabolic acidosis 16 D-TGA/VSD (restrictive)/ASD/PDA/PH 27 3.6 Y Y Y 6h Insufficiency confluence of systemic circulation and pulmonary circulation Hypoxia, severe metabolic acidosis, NDR Abbreviations: No., Number; CPR, cardiopulmonary resuscitation; Y/N, Yes/No; NDR, do not resuscitate ;D-TGA,D-transposition of the great arteries; PFO, patent foramen ovale; ASD, Atrial septal defect; PDA, patent ductus arteriosus; PH, pulmonary hypertension; AS, aortic stenosis; PA/IVS, pulmonary atresia and intact ventricular septum; TR, tricuspid regurgitation; TAPVC; total anomalous pulmonary venous connection; IAA, interrupted aortic arch; VSD, ventricular septal defect; COA, Coarctation of aorta; SA single atrium; SV, single ventricle; MGA, malposition great arteries; CAVC, complete atrioventricular canal; HLHS, Hypoplastic Left Heart Syndrome; MA, mitral atresia Table 2 Baseline characteristics and clinical data of neonates before and after PSM. Before PSM After PSM Non-SPCT group (n = 263) SPCT group (n = 94) p Non-SPCT group (n = 89) SPCT group (n = 89) p Age (days) 12 (0–29) 10 (0–28) 0.007 10 (0–29) 10 (0–28) 0.929 Body weight (kg) 3.30 (1.83–4.70) 3.20 (1.05–4.20) 0.349 3.19 (1.83–4.60) 3.30 (1.64–4.20) 0.272 Transfer with invasive ventilation, n (%) 28 (10.6) 20 (21.3) 0.010 23 (25.8) 16 (18.0) 0.205 Preterm birth, n (%) 38 (14.4) 15 (16.0) 0.724 13 (14.6) 12 (13.5) 0.829 Twin pregnancy, n (%) 19 (7.2) 10 (10.6) 0.298 9 (10.1) 8 (9.0) 0.799 Prenatal diagnosis, n (%) 109 (41.4) 50 (53.2) 0.049 55 (61.8) 47 (52.8) 0.225 RACHS-1 score ≥ 3, n (%) 217 (82.5) 68 (72.3) 0.035 72 (80.9) 65 (73.0) 0.213 Ductal dependent CHD, n (%) 145 (55.1) 61 (64.9) 0.206 55 (61.8) 57 (64.0) 0.756 High carbon acid on ICU arrival, n (%) 31 (11.8) 4 (4.3) 0.453 9 (10.1) 4 (4.5) 0.150 Hypoxia on ICU arrival, n (%) 122 (46.4) 37 (39.4) 0.239 36 (40.4) 35 (39.3) 0.878 Acidosis on ICU arrival, n (%) 101 (38.4) 32 (34.0) 0.035 40 (44.9) 30 (33.7) 0.125 Preoperative high carbon acid, n (%) 28 (10.6) 9 (9.6) 0.770 8 (9.0) 8 (9.0) > 0.999 Preoperative hypoxia, n (%) 97 (36.9) 34 (36.2) 0.902 27 (30.3) 31 (34.8) 0.522 Preoperative acidosis, n (%) 57 (21.7) 14 (14.9) 0.158 17 (19.1) 12 (13.5) 0.310 Intubation before surgery, n (%) 122 (46.4) 47 (50.0) 0.547 56 (62.9) 44 (49.4) 0.070 Preoperative CPR, n (%) 42 (16.0) 6 (6.4) 0.019 12 (13.5) 6 (6.7) 0.136 Preoperative use of inotropic drug, n (%) 134 (51) 53 (56.4) 0.571 69 (77.5) 51 (57.3) 0.004 CHF before surgery, n (%) 82 (31.2) 29 (29.8) 0.802 25 (28.1) 28 (31.5) 0.623 Unplanned emergent operation, n (%) 145 (55.1) 29 (30.9) 0.0001 48 (53.9) 26 (29.2) 0.001 Survival, n (%) 211 (80.2) 84 (89.4) 0.045 73 (82.0) 82 (92.1) 0.044 Died before surgery 16 (6.1) 0 0.014 4 (4.5) 0 0.043 Died after surgery 36 (14.6) 10 (10.6) 0.342 12 (14.1) 7 (7.9) 0.186 PSM: propensity score matching; SPCT: cardiac intensive care unit; RACHS-1: Risk Adjusted classification for Congenital Heart Surgery; ICU: intensive care unit; ECMO: extracorporeal membrane oxygenation; CPR: cardiopulmonary resuscitation; CHF: chronic heart failure. According to the univariable analyses (Table 3 ), age ( p = 0.013), body weight at surgery ( p = 0.001), preterm birth ( p = 0.002), twin pregnancy ( p = 0.004), preoperative CPR ( p = 0.013), unplanned emergent surgery ( p = 0.0001), preoperative acid-base imbalance ( p = 0.001), preoperative acidosis ( p = 0.0001), and preoperative lactic acid levels ( p = 0.0001) were associated with mortality. The multivariable analysis showed that body weight at surgery (HR = 0.444, 95%CI: 0.273–0.711, p = 0.001) and unplanned emergent surgery (HR = 5.227, 95%CI: 2.521–10.834, p < 0.001) were independently associated with mortality in neonates with CCHD (Table 4 ). Table 3 Comparison of baseline and clinical data of neonates with different prognosis who underwent surgery. Variable Total (n = 341) Survival (n = 305) Mortality (n = 36) p Age at surgery (days) 12 (0–28) 12 (0–28) 10 (0–27) 0.013 Body weight at surgery (kg) 3.3 (1.05–4.70) 3.30 (1.64–4.60) 3.10 (1.05–4.70) 0.001 Premature, n (%) 48 (14.1) 34 (11.5) 14 (30.4) 0.002 Twin pregnancy, n (%) 26 (7.6) 17 (5.8) 9 (19.6) 0.004 Prenatal diagnosis, n (%) 147 (43.1) 122 (41.4) 25 (54.3) 0.107 RACHS-1 score ≥ 3, n (%) 269 (78.9) 234 (79.3) 35 (76.1) 0.639 Ductal dependence, n (%) 193 (56.6) 166 (56.3) 27 (58.7) 0.765 CHF before surgery, n (%) 105 (30.8) 92 (31.2) 13 (28.3) 0.656 Transfer with invasive ventilation, n (%) 43 (12.6) 37 (12.5) 6 (13.0) 0.975 Intubation before surgery, n (%) 153 (44.9) 128 (43.4) 25 (54.3) 0.171 Preoperative use of inotropic drug, n (%) 171 (50.1) 142 (48.1) 29 (63.0) 0.271 Preoperative CPR, n (%) 32 (9.4) 23 (7.8) 9 (19.6) 0.013 Unplanned emergent surgery, n (%) 158 (46.3) 121 (41.0) 37 (80.4) 0.0001 Acidosis on ICU arrival, n (%) 122 (35.8) 101 (34.2) 21 (45.7) 0.126 Hypoxia on ICU arrival, n (%) 146 (42.8) 122 (41.4) 24 (52.2) 0.169 High carbon acid on ICU arrival, n (%) 33 (9.7) 26 (8.8) 7 (15.2) 0.178 Lactic acid on ICU arrival (mmol/L) 2.7 (0.3–26.0) 2.6 (0.3–26.0) 3.4 (0.8–11.2) 0.084 Preoperative hypercapnia, n (%) 34 (10.0) 23 (7.8) 11 (23.9) 0.001 Preoperative hypoxia, n (%) 119 (34.9) 100 (33.9) 19 (41.3) 0.330 Preoperative acidosis, n (%) 55 (16.1) 39 (13.2) 16 (34.8) 0.0001 Preoperative lactic acid (mmol/L) 1.8 (0.3–28.0) 1.7 (0.3–26.0) 2.8 (0.7–28.0) 0.0001 SPCT transfer, n (%) 94 (27.6) 84 (28.5) 10 (21.7) 0.342 ICU: intensive care unit; ECMO: extracorporeal membrane oxygenation; CPR: cardiopulmonary resuscitation; CHF: chronic heart failure; SPCT: specialist pediatric cardiac transfer. Table 4 Analysis of factors influencing the postoperative outcomes of patients (before PSM). HR 95%CI p Body weight 0.444 0.273,0.711 0.001 Unplanned emergent surgery 5.227 2.521,10.834 < 0.001 HR: hazard ratio; CI: confidence interval. Survival analysis was performed for the neonates who underwent surgery, of which the median follow-up time was 411 days. There were no statistically significant differences in survival between the two groups (Fig. 1 ). For patients who underwent surgery, we compared the prognostic indicators of the two groups and found no significant differences in the main complications between the two groups. Nevertheless, the mechanical ventilation time and length of ICU stay (LOS) of children in the SPCT transport group were higher than in the non-SPCT transport group (Table 5 ). Table 5 Comparison of prognostic indicators between the two groups who underwent surgery. Non-SPCT group SPCT group P CPB 109 (16–535) 133 (17–515) 0.004 AOC 63 (3-285) 75 (4-218) 0.021 Failure to separate from CPB 1 (0.5%) 2 (2.4%) > 0.99 ECPR 4 (1.9%) 1 (1.2%) 0.53 Selective ECMO 1 (0.5%) 4 (4.8%) 0.08 LCOS 153 (72.5%) 62 (73.8%) 0.90 Arrhythmia 25 (11.8%) 13 (15.5%) 0.49 Infection 68 (32.2%) 26 (31.0%) 0.73 Pneumonia 54 (25.6%) 20 (23.8%) 0.71 Bloodstream infection 24 (11.4%) 7 (8.3%) 0.48 Incision infection 7 (3.3%) 3 (3.6%) > 0.99 Mediastinal infection 5 (2.4%) 3 (3.6%) 0.45 Multiple infections 17 (8.1%) 3 (3.6%) 0.27 Brain complications 5 (2.4%) 3 (3.6%) > 0.99 DIC 13 (6.2%) 8 (9.5%) 0.63 Liver lesion 28 (13.3%) 18 (21.4%) 0.18 AKI 83 (39.3%) 41 (48.8%) 0.25 Ventilator time 115 (0-648) 126 (0-1224) 0.008 Reintubation 29 19 0.06 Non-invasive ventilator 133 52 0.86 Postoperative ICU duration, days 15 (0–69) 19 (0–67) 0.001 Length of hospital stay, days 21 (1–72) 21 (0–73) 0.036 Survival time, months 12.13 (0-43.73) 17.47 (0.03–49.97) 0.18 SPCT: specialist pediatric cardiac transfer; CPB: cardiopulmonary bypass; AOC: aortic clamp; ECPR: extracorporeal cardiopulmonary resuscitation; ECMO: extracorporeal membrane oxygenation; LCOS: low cardiac output syndrome; DIC: disseminated intravascular coagulopathy; AKI: acute kidney injury. Discussion The results suggest that low body weight and unplanned emergency surgery are independent risk factors for the death of neonates with CCHD. SPCT is unrelated to the survival rate of neonates with CCHD underwent surgery, but can reduce the incidence of unplanned emergency surgery. Previous studies showed that a prenatal diagnosis improves the prognosis of infants with CCHD [ 12 , 21 , 22 ]. Indeed, a prenatal diagnosis of CCHD will allow time for discussion with the parents, discussion among specialists [ 3 ], and planning the surgery, and the infant will be closely monitored immediately after birth. In this study, fetal ultrasound cardiac abnormality was not independently associated with survival. Still, the available prenatal ultrasound data were not necessarily specific for heart abnormalities, and not all prenatal screenings were performed at the study hospital. In addition, even for children with a prenatal diagnosis, many other factors affect their prognosis, and not all children with a prenatal diagnosis were transferred to our center, and such children were not included in the present study. Nevertheless, some children with CHD diagnosed before delivery have not been referred to our center, especially those far away, and have been treated at a local hospital. All infants with high complexity, who were diagnosed with and treated for CCHD, were ultimately referred to our center, which probably contributed to this study’s relatively high mortality rate. In addition, a missed diagnosis of CCHD will lead to death a few days after birth [ 23 ]. In a review by Singh et al. [ 3 ], it was suggested that timely treatment with cardiotonic drugs (e.g., prostaglandin E1) and discussion with a pediatric cardiologist could be lifesaving. Wang et al. [ 19 ] recently reported an integrated approach for NICU transfer for patients with CCHD that led to shorter diagnosis and hospitalization intervals; surgery could be performed with a lower mortality risk, especially in infants with transposition of great arteries. Peterson et al. [ 13 ] and Jegatheeswaran et al. [ 14 ] reported that the prognosis of infants with CHD was better in mother and child hospitals than in general hospitals, probably owing to better access to a pediatric cardiologist and experience in CCHD surgery in specialized hospitals. It has been reported that about 20% of infants with CCHD are diagnosed after being discharged from maternity units and that 43% of these infants are in circulatory shock when admitted to a cardiology department [ 24 ]. Brown et al. [ 25 ] reported that heart failure and end-organ dysfunction were more common in infants with CCHD discharged from obstetrics units than those discharged from cardiology units. Fixler et al. [ 26 ] reported that the non-referral of infants with CCHD to cardiac specialty centers led to significant mortality rates. Accordingly, in the present study, all infants who died prior to surgery were in the non-SPCT group, but there were no significant differences after surgery. The transport of children with CCHD is very important to maintain the stability of these children, especially in the case of remote transport distance. All the children who died before the operation occurred in the non-SPCT group, which might be related to the lack of professional cardiac specialist management before or during the transport, leading to life-threatening complications and the loss of surgical opportunities. Non-SPCT transportation, inadequate evaluation of the condition before transportation, and inadequate monitoring and care measures during transportation are all risk factors that lead to the death of children. The transportation process involves the movement of the child and the handling and fixation of the required instruments and equipment, which may lead to the instability of the child’s respiratory system and circulatory system, as well as the occurrence of accidents, thus having a negative impact on the prognosis of the child, Therefore, “transfer” should be started systematically [ 27 ]. The basis for the safe development of all transport modes is to stabilize vital signs, provide a safe airway and venous access, ensure the safety of all catheters, and provide appropriate monitoring before departure. As recommended by the American College of Intensive Care Medicine, each hospital should develop its intra-hospital and inter-hospital transfer plans for critically ill patients [ 28 ]. Clinical medical staff should develop more accurate transfer strategies based on fully considering the actual clinical environmental factors and the latest evidence and establish specialized transfer teams to benefit children. In addition, SPCT referral was not independently associated with patient outcomes. This lack of association can be due to factors such as age at referral, prematurity, perinatal conditions, and screening. The present study identified low body weight at surgery and unplanned emergent surgery as factors associated with a poor prognosis in infants with CCHD. Mehmood et al. [ 29 ] reported that infants < 2.2 kg undergoing cardiac surgery were at high risk of ICU morbidity and mortality. Oster et al. [ 30 ] reported that low birth weight was associated with higher 1-year mortality in infants with CHD and CCHD. Emergent surgery has to be performed in infants with a suddenly deteriorating condition, indicating a more severe condition and a poorer prognosis. Still, the present study showed that SPCT could reduce the incidence of unplanned emergency surgery, which can support the use of SPCT. This study shows that the transport of CCHD critically ill neonates does not affect the survival rate of neonates after surgery. However, the study showed that the safe and effective implementation of transportation could reduce preoperative mortality and emergency surgery, thus providing a reference basis for the transportation of neonates with CCHD and further improving the appropriate surgical opportunity for them. Regarding the 16 dead neonates, the parents transferred them to our hospital alone, including 3 common Ordinary ambulance transshipment. Some patients with CCHD were in poor condition, had been in cardiogenic shock when they arrived the hospital. Some parents chose to give up DNR (do not resuscitate). Most of the neonates died after rescue and lost the surgical opportunity. The neonates with CCHD were transported by our professional pediatric cardiology specialist, and safe and effective transportation was carried out for these neonates, providing appropriate operation status and timely mechanism. This study had some limitations. It was a retrospective study limited to the data available in the charts, introducing bias. The patients were from only one center, resulting in a relatively small sample size and possibly leading to bias due to local practices. The exact physician’s line of thought that led to an individual neonate being transferred or not to the SPCT was not always clearly indicated in the charts and could not be analyzed. Prospective multicenter studies with large sample sizes are needed to provide higher-grade evidence. Conclusion In conclusion, low body weight and unplanned emergency surgery are independent risk factors for the death of neonates with CCHD. Although SPCT is unrelated to the surgery mortality rate of newborns with CCHD, it can reduce the incidence of unplanned emergency surgery and increase the total survival rate. Neonates with CCHD transported by professional pediatric cardiology specialist ensures transportation safety and effectiveness, reducing preoperative death and unplanned emergency operations. Medical staff should formulate transportation specifications for neonate with CCHD based on the actual clinical situation to ensure transportation safety. Declarations Acknowledgments We highly acknowledge the contribution of the participating researchers: Ming-Jie Zhang, Yu-Jie Liu, and Li-Ping Liu. Ethical approval The study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of Shanghai Children’s Medical Center affiliated with Shanghai Jiaotong University School of Medicine (SCMCIRB-K2023026-1). Competing interests The authors declare that they have no competing interests. Funding This study was funded by National Natural Science Foundation of China (Grant No. 81970439), the Development Fund for Shanghai Talents (Grant No. 2020114). Author contributions Li-Min Zhu and Hai-Bo Zhang contributed to the conception and design of this study. Chun-Xiang and Li-Min Zhu designed the study, performed the statistical analysis, and drafted the manuscript. Xiao-Lei Gong, Zhuo-Ming Xu, and Jin-Long Liu collected the clinical data. All authors read and approved the final manuscript. Availability of data and materials The datasets used or analyzed during the current study are available from the corresponding author upon reasonable request. References Chamsi-Pasha MA, Chamsi-Pasha H. Critical congenital heart disease screening. Avicenna J Med. 2016;6(3):65–8. Gilboa SM, Salemi JL, Nembhard WN, Fixler DE, Correa A. Mortality resulting from congenital heart disease among children and adults in the United States, 1999 to 2006. Circulation. 2010;122(22):2254–63. 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Hospitalizations, costs, and mortality among infants with critical congenital heart disease: how important is timely detection? Birth Defects Res A Clin Mol Teratol. 2013;97(10):664–72. Jegatheeswaran A, Oliveira C, Batsos C, Moon-Grady AJ, Silverman NH, Hornberger LK, et al. Costs of prenatal detection of congenital heart disease. Am J Cardiol. 2011;108(12):1808–14. Oster ME, Kim CH, Kusano AS, Cragan JD, Dressler P, Hales AR, et al. A population-based study of the association of prenatal diagnosis with survival rate for infants with congenital heart defects. Am J Cardiol. 2014;113(6):1036–40. Swickard S, Winkelman C, Hustey FM, Kerr M, Reimer AP. Patient Safety Events during Critical Care Transport. Air Med J. 2018;37(4):253–8. Stroud MH, Trautman MS, Meyer K, Moss MM, Schwartz HP, Bigham MT, et al. Pediatric and neonatal interfacility transport: results from a national consensus conference. Pediatrics. 2013;132(2):359 – 66. Kawaguchi A, Saunders LD, Yasui Y, DeCaen A. Effects of Medical Transport on Outcomes in Children Requiring Intensive Care. J Intensive Care Med. 2020;35(9):889–95. Wang GX, Ma K, Pang KJ, Wang X, Qi L, Yang Y, et al. Two approaches for newborns with critical congenital heart disease: a comparative study. World J Pediatr. 2022;18(1):59–66. Yan H, Zhai B, Feng R, Wang P, Zhang Y, Wang Y, et al. Prevalence of Congenital Heart Disease in Chinese Children With Different Birth Weights and Its Relationship to the Neonatal Birth Weight. Front Pediatr. 2022;10:828300. Han B, Tang Y, Qu X, Deng C, Wang X, Li J. Comparison of the 1-year survival rate in infants with congenital heart disease diagnosed by prenatal and postnatal ultrasound: A retrospective study. Medicine (Baltimore). 2021;100(4):e23325. Bakker MK, Bergman JEH, Krikov S, Amar E, Cocchi G, Cragan J, et al. Prenatal diagnosis and prevalence of critical congenital heart defects: an international retrospective cohort study. BMJ Open. 2019;9(7):e028139. Chang RK, Gurvitz M, Rodriguez S. Missed diagnosis of critical congenital heart disease. Arch Pediatr Adolesc Med. 2008;162(10):969–74. Mellander M, Sunnegardh J. Failure to diagnose critical heart malformations in newborns before discharge–an increasing problem? Acta Paediatr. 2006;95(4):407–13. Brown KL, Ridout DA, Hoskote A, Verhulst L, Ricci M, Bull C. Delayed diagnosis of congenital heart disease worsens preoperative condition and outcome of surgery in neonates. Heart. 2006;92(9):1298–302. Fixler DE, Xu P, Nembhard WN, Ethen MK, Canfield MA. Age at referral and mortality from critical congenital heart disease. Pediatrics. 2014;134(1):e98-105. Kulshrestha A, Singh J. Inter-hospital and intra-hospital patient transfer: Recent concepts. Indian J Anaesth. 2016;60(7):451–7. Warren J, Fromm RE, Jr., Orr RA, Rotello LC, Horst HM, American College of Critical Care M. Guidelines for the inter- and intrahospital transport of critically ill patients. Crit Care Med. 2004;32(1):256–62. Mehmood A, Ismail SR, Kabbani MS, Abu-Sulaiman RM, Najm HK. Outcome of low body weight (< 2.2 kg) infants undergoing cardiac surgery. J Saudi Heart Assoc. 2014;26(3):132–7. Oster ME, Lee KA, Honein MA, Riehle-Colarusso T, Shin M, Correa A. Temporal trends in survival among infants with critical congenital heart defects. Pediatrics. 2013;131(5):e1502-8. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2987865","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":204843859,"identity":"2dcee6d1-e30f-422b-b661-a70feb90cc88","order_by":0,"name":"Chunxiang Li","email":"","orcid":"","institution":"Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Chunxiang","middleName":"","lastName":"Li","suffix":""},{"id":204843860,"identity":"33aee9f6-e54a-4849-b474-df11cc109bf2","order_by":1,"name":"Xiaolei Gong","email":"","orcid":"","institution":"Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Xiaolei","middleName":"","lastName":"Gong","suffix":""},{"id":204843861,"identity":"e41212d2-8c9c-41aa-b5f4-2a9629f372cc","order_by":2,"name":"Zhuoming Xu","email":"","orcid":"","institution":"Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Zhuoming","middleName":"","lastName":"Xu","suffix":""},{"id":204843862,"identity":"103c99ed-e0af-44f5-b226-75da5d8c6465","order_by":3,"name":"Jinlong Liu","email":"","orcid":"","institution":"Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Jinlong","middleName":"","lastName":"Liu","suffix":""},{"id":204843863,"identity":"209f3082-0f4e-4514-b4c5-ca0853e92486","order_by":4,"name":"Haibo Zhang","email":"","orcid":"","institution":"Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Haibo","middleName":"","lastName":"Zhang","suffix":""},{"id":204843864,"identity":"def29272-6db5-40b6-897c-d9fe1bc319ee","order_by":5,"name":"Limin Zhu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAArUlEQVRIiWNgGAWjYBACPgbGBjCDn5n58AOitLDBtEi2s6UZEKkFCgzO8yhIEKdF7HDbY54/NvnGh3kYDBhqbKIJa5FObDfmbUuz3HaY98ADhmNpuQ1EaGmT5m04bGB2mC/BgLHhMJFaeP78NzBu5jGQIEEL2wEDA2ZStEjObUs2kDgMDOQEYvzCL53+TOLNHzsD/v7Dhx98qLEhrAUVJJCmfBSMglEwCkYBLgAAj/Y1w9ArrT0AAAAASUVORK5CYII=","orcid":"","institution":"Shanghai Children’s Medical Center, Shanghai Jiaotong University School of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Limin","middleName":"","lastName":"Zhu","suffix":""}],"badges":[],"createdAt":"2023-05-27 05:29:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2987865/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2987865/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":37769398,"identity":"37e21fc8-6e13-4365-9dd0-7779a5cc5c09","added_by":"auto","created_at":"2023-05-31 14:09:39","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":625442,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of the postoperative survival curves of neonates in the cardiac intensive care unit (SPCT) and non-SPCT groups. (A) Before propensity score matching (PSM). (B) After PSM.\u003c/p\u003e","description":"","filename":"OnlineFig..png","url":"https://assets-eu.researchsquare.com/files/rs-2987865/v1/fd0b2c7e9a2cc62c31092379.png"},{"id":37900041,"identity":"ec898f55-5780-4157-bd63-0d8f12af217a","added_by":"auto","created_at":"2023-06-02 09:30:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":552733,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2987865/v1/304c7064-93a9-47b0-8995-c77dfb1c1148.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Association between specialist pediatric cardiac transfer and prognosis of neonates with critical congenital heart disease: A cohort study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCritical congenital heart disease (CCHD) is a congenital heart disease (CHD) for which the neonates require early surgical intervention to survive; otherwise, extremely high rates of mortality and survival with significant disability are observed [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. CCHD represents approximately 25% of CHD cases [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The main screening methods include fetal echocardiograms and pulse oximetry [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Surgery is mandatory in all cases of CCHD to improve prognosis [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe burden of CHD has been increasing in China from 1990 to 2017 [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Treating neonates with CCHD is challenging in China under the current medical environment and uneven medical resource distribution [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] and is associated with high costs and burdens to families and society [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. A prenatal diagnosis of CCHD will improve the prognosis [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. All cases of CCHD should be detected early and promptly discussed with a pediatric cardiologist to improve prognosis [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Transfer to the neonatal intensive care unit (NICU) or cardiac intensive care unit (CICU) can be lifesaving [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Studies in developed countries showed that CHD diagnosis at maternity hospitals was associated with lower healthcare costs and better prognosis [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Prenatal diagnosis is crucial to the prognosis of CCHD [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe transfer mode to the hospital and preoperative medical department is important in managing CCHD. Among the 12,000 emergency admissions in the pediatric intensive care unit (PICU) in the United Kingdom every year, inter-hospital transfer accounts for almost 50%, most of which are undertaken by professional pediatric intensive care transfer teams [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The transportation team in the United States of America has developed a mobile ICU model that can provide the most advanced critical care in pediatric and neonatal transportation [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Still, the mortality of children is higher with inter-hospital transport with direct admission [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]; therefore, it is necessary to improve the inter-hospital transport process to improve the prognosis of the children. In a small-sample study in China, an integrated approach to transferring CHD patients to the NICU was reported, and encouraging outcomes were observed compared with the non-integrated approach [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The success rate of surgery for CCHD in neonates in China is still lower than in developed countries [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], and the management of neonates with CCHD in China remains to be optimized.\u003c/p\u003e \u003cp\u003eTherefore, this study explored whether cardiac specialist transfer could improve the prognosis of neonates with CCHD. The results could help optimize the prognosis of neonates with CCHD in China.\u003c/p\u003e "},{"header":"Methods","content":"\u003cp\u003e \u003cem\u003eStudy Design and Patients\u003c/em\u003e \u003c/p\u003e\u003cp\u003eThis cohort study retrospectively collected the clinical data of neonates diagnosed with CCHD who underwent treatment at Shanghai Children’s Medical Center between January 2018 and December 2021. This study was approved by the Ethics Committee of Shanghai Children’s Medical Center (SCMCIRB-K2023026-1). The requirement for informed consent was waived as this study was retrospective.\u003c/p\u003e\u003cp\u003eThe inclusion criteria were 1) neonates diagnosed with CCHD and 2) aged 0–28 days. Neonates with incomplete clinical data were excluded. The neonates were classified into the specialist pediatric cardiac transfer (SPCT) and non-SPCT groups according to the transfer mode to the hospital.\u003c/p\u003e\u003cp\u003e \u003cem\u003eData Collection\u003c/em\u003e \u003c/p\u003e\u003cp\u003ePreoperative data, interventional data, and outcomes of the neonates were collected from the electronic medical record system. The preoperative data of the neonates included age, body weight, diagnosis, preoperative Risk Adjusted classification for Congenital Heart Surgery (RACHS-1) and biochemical data after hospital admission. Interventional data mainly included surgical data and perioperative treatment. The outcome was the postoperative survival, overall survival and ICU complications of the neonates.\u003c/p\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eSPSS 18.0 (SPSS, Chicago, USA) was used for the statistical analysis. For all neonates included in this study, 1:1 propensity score matching (PSM) was performed for the non-SPCT and SPCT groups. Specifically, the factors matched between the two groups included age, body weight, extracorporeal membrane oxygenation (ECMO) transfer, and preoperative cardiopulmonary resuscitation (CPR). For the neonates who underwent surgery, 1:1 PSM was performed for the non-SPCT and SPCT groups. Specifically, the factors matched between the two groups included age, body weight, ECMO transfer, and preoperative CPR. The caliper value was 0.02, and 89 pairs of neonates were acquired after fuzzy matching.\u003c/p\u003e\u003cp\u003eContinuous data were tested for normal distribution using the Kolmogorov-Smirnov test. Continuous data with a normal distribution were described as means ± standard deviations and analyzed using the independent t-test. Continuous data with skew distribution were described as medians (ranges) and analyzed using the Mann-Whitney U-test. Categorical data were described as n (%) and analyzed using the chi-square test. For the multivariable analysis, the survival of the neonates was used as the dependent variable, and variables with statistical significance in the univariable analysis, as well as variables without statistical significance in the univariable analysis but that could possibly be closely associated with the outcome according to clinical practice and the literature, were included as the independent variable for binary Cox regression. Kaplan-Meier curves were used for the survival analysis. Two-sided \u003cem\u003ep\u003c/em\u003e -values \u0026lt; 0.05 were considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eDuring the study period, 357 neonates with CCHD were included and treated, of which 16 died before surgery, all in the non-SPCT group. All 16 patients who were initially screened as CCHD in the local hospital were transferred to Shanghai for emergency treatment from other locations, 13 by their parents and 3 by common Ordinary ambulance transshipment. The age, diagnosis, condition after admission, and cause of death of 16 patients were analyzed. From the diagnosis perspective, most of them are arterial duct-dependent systemic circulation or pulmonary circulation CCHD. The condition of 16 children transferred to the hospital has been very poor (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The characteristics of the neonates are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Before PSM, compared with the non-SPCT group, the neonates in the SPCT group were younger, had a higher incidence of transfer with invasive ventilation, had a higher rate of fetal ultrasound abnormalities, had a lower rate of RACHS-1 score\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;3, acidosis at ICU admission, preoperative CPR, and unplanned emergent operation, and had a higher total survival rate (all \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). After PSM, the two groups\u0026rsquo; demographic and clinical characteristics were similar (all \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Compared with the non-SPCT group, the SPCT group showed a lower rate of inotropic drug use (57.3% vs. 77.5%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004), a lower rate of intubation before operation(49.4% vs. 62.9%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.07), a lower rate of unplanned emergent operation (29.2% vs. 53.9%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001), a higher survival rate (92.1% vs. 82.0%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.044), and a lower preoperative mortality rate (0% vs. 4.5%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.043).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of the neonates who died before surgery.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiagnosis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003cp\u003e(d)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWeight\u003c/p\u003e \u003cp\u003e(kg)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEmergency\u003c/p\u003e \u003cp\u003eAdmission\u003c/p\u003e \u003cp\u003eY/N\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEmergency\u003c/p\u003e \u003cp\u003eIntubation, Y/N\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCPR\u003c/p\u003e \u003cp\u003eY/N\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eDeath time\u003c/p\u003e \u003cp\u003ePo-admission\u003c/p\u003e \u003cp\u003e(h)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMajor issues\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eDeath cause\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eD-TGA/PFO/PDA/PH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eInsufficiency confluence of systemic circulation and pulmonary circulation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eHypoxia, severe metabolic acidosis,\u003c/p\u003e \u003cp\u003eNDR\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTaussig-Bing/\u003c/p\u003e \u003cp\u003eCOA/PDA/PH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eAortic arch hypoplasia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eHeart failure,\u003c/p\u003e \u003cp\u003esevere metabolic acidosis\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAS/ASD/PDA/PH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e10h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSevere obstruction of blood flow through aortic valve\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eHeart failure\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePA/IVS/PDA/PFO/TR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eDuctal-dependent pulmonary circulation,\u003c/p\u003e \u003cp\u003eInsufficiency of systemic perfusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eHypoxia, severe metabolic acidosis,\u003c/p\u003e \u003cp\u003eNDR\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTAPVC (Infracardiac)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSevere pulmonary vein obstruction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eHypoxia\u003c/p\u003e \u003cp\u003eleft heart failure, pulmonary edema\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIAA/VSD/ASD/\u003c/p\u003e \u003cp\u003ePDA/PH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eDuctal-dependent systemic circulation,\u003c/p\u003e \u003cp\u003eInsufficiency of systemic perfusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eHeart failure,\u003c/p\u003e \u003cp\u003esevere metabolic acidosis\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSV/TAPVC/MGA/CAVC/PDA/PH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003ePulmonary vein obstruction, atrio-ventricular valve regurgitation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eHypoxia, severe metabolic acidosis\u003c/p\u003e \u003cp\u003eHeart failure\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCOA/VSD/ASD/PDA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e48h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eLarge PDA with congestive heart failure,\u003c/p\u003e \u003cp\u003eInsufficiency of systemic perfusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNEC, sepsis shock\u003c/p\u003e \u003cp\u003eNDR\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePA/VSD/\u003c/p\u003e \u003cp\u003ePDA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eDuctal-dependent pulmonary circulation,\u003c/p\u003e \u003cp\u003eInsufficiency of pulmonary blood flow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eHypoxia, severe metabolic acidosis\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHLHS/\u003c/p\u003e \u003cp\u003eMA/AS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eInsufficiency of systemic perfusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eHeart failure,\u003c/p\u003e \u003cp\u003esevere metabolic acidosis\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSA/PA/CAVC/\u003c/p\u003e \u003cp\u003eTAPVC/PDA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eDuctal-dependent pulmonary circulation,\u003c/p\u003e \u003cp\u003eInsufficiency of pulmonary blood flow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eHypoxia,\u003c/p\u003e \u003cp\u003esevere metabolic acidosis\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTAPVC (Supracardiac)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSevere pulmonary vein obstruction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eHypoxia,\u003c/p\u003e \u003cp\u003esevere metabolic acidosis,\u003c/p\u003e \u003cp\u003eNDR\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHemi-Truncus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCongestive heart failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eHeart failure,\u003c/p\u003e \u003cp\u003esevere metabolic acidosis\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDORV(Taussig-Bing)/COA/PDA/PH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCongestive heart failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eHeart failure,\u003c/p\u003e \u003cp\u003esevere metabolic acidosis\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIAA/VSD/ASD/\u003c/p\u003e \u003cp\u003ePDA/PH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eDuctal-dependent systemic circulation,\u003c/p\u003e \u003cp\u003eInsufficiency of systemic perfusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eheart failure,\u003c/p\u003e \u003cp\u003esevere metabolic acidosis\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eD-TGA/VSD (restrictive)/ASD/PDA/PH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eInsufficiency confluence of systemic circulation and pulmonary circulation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eHypoxia,\u003c/p\u003e \u003cp\u003esevere metabolic acidosis,\u003c/p\u003e \u003cp\u003eNDR\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003eAbbreviations: No., Number; CPR, cardiopulmonary resuscitation; Y/N, Yes/No; NDR, do not resuscitate ;D-TGA,D-transposition of the great arteries; PFO, patent foramen ovale; ASD, Atrial septal defect; PDA, patent ductus arteriosus; PH, pulmonary hypertension; AS, aortic stenosis; PA/IVS, pulmonary atresia and intact ventricular septum; TR, tricuspid regurgitation; TAPVC; total anomalous pulmonary venous connection; IAA, interrupted aortic arch; VSD, ventricular septal defect; COA, Coarctation of aorta; SA single atrium; SV, single ventricle; MGA, malposition great arteries; CAVC, complete atrioventricular canal; HLHS, Hypoplastic Left Heart Syndrome; MA, mitral atresia\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics and clinical data of neonates before and after PSM.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eBefore PSM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eAfter PSM\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-SPCT group (n\u0026thinsp;=\u0026thinsp;263)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSPCT group (n\u0026thinsp;=\u0026thinsp;94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNon-SPCT group (n\u0026thinsp;=\u0026thinsp;89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSPCT group (n\u0026thinsp;=\u0026thinsp;89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (0\u0026ndash;29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (0\u0026ndash;28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 (0\u0026ndash;29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10 (0\u0026ndash;28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.929\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody weight (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.30 (1.83\u0026ndash;4.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.20 (1.05\u0026ndash;4.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.349\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.19 (1.83\u0026ndash;4.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.30 (1.64\u0026ndash;4.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.272\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransfer with invasive ventilation, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 (10.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (21.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23 (25.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16 (18.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.205\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreterm birth, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38 (14.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (16.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.724\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13 (14.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12 (13.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.829\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTwin pregnancy, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (7.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (10.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.298\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (10.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8 (9.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.799\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrenatal diagnosis, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e109 (41.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50 (53.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e55 (61.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e47 (52.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.225\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRACHS-1 score\u0026thinsp;\u0026ge;\u0026thinsp;3, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e217 (82.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68 (72.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e72 (80.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e65 (73.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.213\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuctal dependent CHD, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e145 (55.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61 (64.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.206\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e55 (61.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e57 (64.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.756\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh carbon acid on ICU arrival, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31 (11.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.453\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (10.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 (4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.150\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypoxia on ICU arrival, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e122 (46.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37 (39.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.239\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36 (40.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e35 (39.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.878\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcidosis on ICU arrival, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e101 (38.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (34.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40 (44.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e30 (33.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.125\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative high carbon acid, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 (10.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (9.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.770\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (9.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8 (9.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative hypoxia, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e97 (36.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (36.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.902\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27 (30.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e31 (34.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.522\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative acidosis, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57 (21.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (14.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.158\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17 (19.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12 (13.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.310\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntubation before surgery, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e122 (46.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.547\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e56 (62.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e44 (49.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.070\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative CPR, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42 (16.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (6.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12 (13.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6 (6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.136\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative use of inotropic drug, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e134 (51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53 (56.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.571\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e69 (77.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e51 (57.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCHF before surgery, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82 (31.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (29.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.802\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25 (28.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e28 (31.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.623\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnplanned emergent operation, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e145 (55.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (30.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e48 (53.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26 (29.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurvival, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e211 (80.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84 (89.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e73 (82.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e82 (92.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.044\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDied before surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.043\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDied after surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 (14.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (10.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.342\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12 (14.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7 (7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.186\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003ePSM: propensity score matching; SPCT: cardiac intensive care unit; RACHS-1: Risk Adjusted classification for Congenital Heart Surgery; ICU: intensive care unit; ECMO: extracorporeal membrane oxygenation; CPR: cardiopulmonary resuscitation; CHF: chronic heart failure.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAccording to the univariable analyses (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), age (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.013), body weight at surgery (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001), preterm birth (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002), twin pregnancy (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004), preoperative CPR (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.013), unplanned emergent surgery (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.0001), preoperative acid-base imbalance (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001), preoperative acidosis (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.0001), and preoperative lactic acid levels (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.0001) were associated with mortality. The multivariable analysis showed that body weight at surgery (HR\u0026thinsp;=\u0026thinsp;0.444, 95%CI: 0.273\u0026ndash;0.711, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001) and unplanned emergent surgery (HR\u0026thinsp;=\u0026thinsp;5.227, 95%CI: 2.521\u0026ndash;10.834, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were independently associated with mortality in neonates with CCHD (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of baseline and clinical data of neonates with different prognosis who underwent surgery.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal (n\u0026thinsp;=\u0026thinsp;341)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSurvival (n\u0026thinsp;=\u0026thinsp;305)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMortality (n\u0026thinsp;=\u0026thinsp;36)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge at surgery (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (0\u0026ndash;28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (0\u0026ndash;28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (0\u0026ndash;27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody weight at surgery (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.3 (1.05\u0026ndash;4.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.30 (1.64\u0026ndash;4.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.10 (1.05\u0026ndash;4.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePremature, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48 (14.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (11.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (30.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTwin pregnancy, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (7.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (5.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (19.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrenatal diagnosis, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e147 (43.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e122 (41.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25 (54.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.107\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRACHS-1 score\u0026thinsp;\u0026ge;\u0026thinsp;3, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e269 (78.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e234 (79.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35 (76.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.639\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuctal dependence, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e193 (56.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e166 (56.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27 (58.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.765\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCHF before surgery, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e105 (30.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e92 (31.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (28.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.656\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransfer with invasive ventilation, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43 (12.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (13.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.975\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntubation before surgery, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e153 (44.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e128 (43.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25 (54.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.171\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative use of inotropic drug, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e171 (50.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e142 (48.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29 (63.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.271\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative CPR, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32 (9.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (7.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (19.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnplanned emergent surgery, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e158 (46.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e121 (41.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37 (80.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcidosis on ICU arrival, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e122 (35.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e101 (34.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21 (45.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.126\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypoxia on ICU arrival, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e146 (42.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e122 (41.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (52.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.169\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh carbon acid on ICU arrival, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33 (9.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (15.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.178\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLactic acid on ICU arrival (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.7 (0.3\u0026ndash;26.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.6 (0.3\u0026ndash;26.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.4 (0.8\u0026ndash;11.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.084\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative hypercapnia, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34 (10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (7.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (23.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative hypoxia, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e119 (34.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100 (33.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19 (41.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.330\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative acidosis, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55 (16.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39 (13.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (34.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative lactic acid (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.8 (0.3\u0026ndash;28.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.7 (0.3\u0026ndash;26.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.8 (0.7\u0026ndash;28.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSPCT transfer, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e94 (27.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84 (28.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (21.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.342\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eICU: intensive care unit; ECMO: extracorporeal membrane oxygenation; CPR: cardiopulmonary resuscitation; CHF: chronic heart failure; SPCT: specialist pediatric cardiac transfer.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAnalysis of factors influencing the postoperative outcomes of patients (before PSM).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.444\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.273,0.711\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnplanned emergent surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5.227\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.521,10.834\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eHR: hazard ratio; CI: confidence interval.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSurvival analysis was performed for the neonates who underwent surgery, of which the median follow-up time was 411 days. There were no statistically significant differences in survival between the two groups (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFor patients who underwent surgery, we compared the prognostic indicators of the two groups and found no significant differences in the main complications between the two groups. Nevertheless, the mechanical ventilation time and length of ICU stay (LOS) of children in the SPCT transport group were higher than in the non-SPCT transport group (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of prognostic indicators between the two groups who underwent surgery.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-SPCT group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSPCT group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCPB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e109 (16\u0026ndash;535)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e133 (17\u0026ndash;515)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAOC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e63 (3-285)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75 (4-218)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFailure to separate from CPB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (2.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eECPR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (1.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelective ECMO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (4.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLCOS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e153 (72.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62 (73.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArrhythmia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (11.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (15.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68 (32.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (31.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePneumonia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54 (25.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (23.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBloodstream infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (11.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (8.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncision infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (3.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (3.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMediastinal infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (2.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (3.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMultiple infections\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (8.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (3.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrain complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (2.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (3.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDIC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (6.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (9.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.63\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiver lesion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 (13.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (21.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAKI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e83 (39.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41 (48.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVentilator time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e115 (0-648)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e126 (0-1224)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReintubation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-invasive ventilator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e133\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative ICU duration, days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (0\u0026ndash;69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (0\u0026ndash;67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of hospital stay, days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (1\u0026ndash;72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (0\u0026ndash;73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.036\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurvival time, months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.13 (0-43.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.47 (0.03\u0026ndash;49.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eSPCT: specialist pediatric cardiac transfer; CPB: cardiopulmonary bypass; AOC: aortic clamp; ECPR: extracorporeal cardiopulmonary resuscitation; ECMO: extracorporeal membrane oxygenation; LCOS: low cardiac output syndrome; DIC: disseminated intravascular coagulopathy; AKI: acute kidney injury.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe results suggest that low body weight and unplanned emergency surgery are independent risk factors for the death of neonates with CCHD. SPCT is unrelated to the survival rate of neonates with CCHD underwent surgery, but can reduce the incidence of unplanned emergency surgery.\u003c/p\u003e \u003cp\u003ePrevious studies showed that a prenatal diagnosis improves the prognosis of infants with CCHD [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Indeed, a prenatal diagnosis of CCHD will allow time for discussion with the parents, discussion among specialists [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], and planning the surgery, and the infant will be closely monitored immediately after birth. In this study, fetal ultrasound cardiac abnormality was not independently associated with survival. Still, the available prenatal ultrasound data were not necessarily specific for heart abnormalities, and not all prenatal screenings were performed at the study hospital. In addition, even for children with a prenatal diagnosis, many other factors affect their prognosis, and not all children with a prenatal diagnosis were transferred to our center, and such children were not included in the present study. Nevertheless, some children with CHD diagnosed before delivery have not been referred to our center, especially those far away, and have been treated at a local hospital. All infants with high complexity, who were diagnosed with and treated for CCHD, were ultimately referred to our center, which probably contributed to this study\u0026rsquo;s relatively high mortality rate. In addition, a missed diagnosis of CCHD will lead to death a few days after birth [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn a review by Singh et al. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], it was suggested that timely treatment with cardiotonic drugs (e.g., prostaglandin E1) and discussion with a pediatric cardiologist could be lifesaving. Wang et al. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] recently reported an integrated approach for NICU transfer for patients with CCHD that led to shorter diagnosis and hospitalization intervals; surgery could be performed with a lower mortality risk, especially in infants with transposition of great arteries. Peterson et al. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] and Jegatheeswaran et al. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] reported that the prognosis of infants with CHD was better in mother and child hospitals than in general hospitals, probably owing to better access to a pediatric cardiologist and experience in CCHD surgery in specialized hospitals. It has been reported that about 20% of infants with CCHD are diagnosed after being discharged from maternity units and that 43% of these infants are in circulatory shock when admitted to a cardiology department [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Brown et al. [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] reported that heart failure and end-organ dysfunction were more common in infants with CCHD discharged from obstetrics units than those discharged from cardiology units. Fixler et al. [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] reported that the non-referral of infants with CCHD to cardiac specialty centers led to significant mortality rates. Accordingly, in the present study, all infants who died prior to surgery were in the non-SPCT group, but there were no significant differences after surgery. The transport of children with CCHD is very important to maintain the stability of these children, especially in the case of remote transport distance. All the children who died before the operation occurred in the non-SPCT group, which might be related to the lack of professional cardiac specialist management before or during the transport, leading to life-threatening complications and the loss of surgical opportunities. Non-SPCT transportation, inadequate evaluation of the condition before transportation, and inadequate monitoring and care measures during transportation are all risk factors that lead to the death of children. The transportation process involves the movement of the child and the handling and fixation of the required instruments and equipment, which may lead to the instability of the child\u0026rsquo;s respiratory system and circulatory system, as well as the occurrence of accidents, thus having a negative impact on the prognosis of the child, Therefore, \u0026ldquo;transfer\u0026rdquo; should be started systematically [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The basis for the safe development of all transport modes is to stabilize vital signs, provide a safe airway and venous access, ensure the safety of all catheters, and provide appropriate monitoring before departure. As recommended by the American College of Intensive Care Medicine, each hospital should develop its intra-hospital and inter-hospital transfer plans for critically ill patients [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Clinical medical staff should develop more accurate transfer strategies based on fully considering the actual clinical environmental factors and the latest evidence and establish specialized transfer teams to benefit children. In addition, SPCT referral was not independently associated with patient outcomes. This lack of association can be due to factors such as age at referral, prematurity, perinatal conditions, and screening.\u003c/p\u003e \u003cp\u003eThe present study identified low body weight at surgery and unplanned emergent surgery as factors associated with a poor prognosis in infants with CCHD. Mehmood et al. [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] reported that infants\u0026thinsp;\u0026lt;\u0026thinsp;2.2 kg undergoing cardiac surgery were at high risk of ICU morbidity and mortality. Oster et al. [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] reported that low birth weight was associated with higher 1-year mortality in infants with CHD and CCHD. Emergent surgery has to be performed in infants with a suddenly deteriorating condition, indicating a more severe condition and a poorer prognosis. Still, the present study showed that SPCT could reduce the incidence of unplanned emergency surgery, which can support the use of SPCT. This study shows that the transport of CCHD critically ill neonates does not affect the survival rate of neonates after surgery. However, the study showed that the safe and effective implementation of transportation could reduce preoperative mortality and emergency surgery, thus providing a reference basis for the transportation of neonates with CCHD and further improving the appropriate surgical opportunity for them.\u003c/p\u003e \u003cp\u003eRegarding the 16 dead neonates, the parents transferred them to our hospital alone, including 3 common Ordinary ambulance transshipment. Some patients with CCHD were in poor condition, had been in cardiogenic shock when they arrived the hospital. Some parents chose to give up DNR (do not resuscitate). Most of the neonates died after rescue and lost the surgical opportunity. The neonates with CCHD were transported by our professional pediatric cardiology specialist, and safe and effective transportation was carried out for these neonates, providing appropriate operation status and timely mechanism.\u003c/p\u003e \u003cp\u003eThis study had some limitations. It was a retrospective study limited to the data available in the charts, introducing bias. The patients were from only one center, resulting in a relatively small sample size and possibly leading to bias due to local practices. The exact physician\u0026rsquo;s line of thought that led to an individual neonate being transferred or not to the SPCT was not always clearly indicated in the charts and could not be analyzed. Prospective multicenter studies with large sample sizes are needed to provide higher-grade evidence.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, low body weight and unplanned emergency surgery are independent risk factors for the death of neonates with CCHD. Although SPCT is unrelated to the surgery mortality rate of newborns with CCHD, it can reduce the incidence of unplanned emergency surgery and increase the total survival rate. Neonates with CCHD transported by professional pediatric cardiology specialist ensures transportation safety and effectiveness, reducing preoperative death and unplanned emergency operations. Medical staff should formulate transportation specifications for neonate with CCHD based on the actual clinical situation to ensure transportation safety.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe highly acknowledge the contribution of the participating researchers: Ming-Jie Zhang, Yu-Jie Liu, and Li-Ping Liu.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of Shanghai Children\u0026rsquo;s Medical Center affiliated with Shanghai Jiaotong University School of Medicine (SCMCIRB-K2023026-1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by National Natural Science Foundation of China (Grant No. 81970439), the Development Fund for Shanghai Talents (Grant No. 2020114).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLi-Min Zhu and Hai-Bo Zhang contributed to the conception and design of this study. Chun-Xiang and Li-Min Zhu designed the study, performed the statistical analysis, and drafted the manuscript. Xiao-Lei Gong, Zhuo-Ming Xu, and Jin-Long Liu collected the clinical data. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used or analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eChamsi-Pasha MA, Chamsi-Pasha H. Critical congenital heart disease screening. Avicenna J Med. 2016;6(3):65\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGilboa SM, Salemi JL, Nembhard WN, Fixler DE, Correa A. Mortality resulting from congenital heart disease among children and adults in the United States, 1999 to 2006. 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Air Med J. 2018;37(4):253\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStroud MH, Trautman MS, Meyer K, Moss MM, Schwartz HP, Bigham MT, et al. Pediatric and neonatal interfacility transport: results from a national consensus conference. Pediatrics. 2013;132(2):359 \u0026ndash; 66.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKawaguchi A, Saunders LD, Yasui Y, DeCaen A. Effects of Medical Transport on Outcomes in Children Requiring Intensive Care. J Intensive Care Med. 2020;35(9):889\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang GX, Ma K, Pang KJ, Wang X, Qi L, Yang Y, et al. Two approaches for newborns with critical congenital heart disease: a comparative study. World J Pediatr. 2022;18(1):59\u0026ndash;66.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYan H, Zhai B, Feng R, Wang P, Zhang Y, Wang Y, et al. Prevalence of Congenital Heart Disease in Chinese Children With Different Birth Weights and Its Relationship to the Neonatal Birth Weight. Front Pediatr. 2022;10:828300.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHan B, Tang Y, Qu X, Deng C, Wang X, Li J. Comparison of the 1-year survival rate in infants with congenital heart disease diagnosed by prenatal and postnatal ultrasound: A retrospective study. Medicine (Baltimore). 2021;100(4):e23325.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBakker MK, Bergman JEH, Krikov S, Amar E, Cocchi G, Cragan J, et al. Prenatal diagnosis and prevalence of critical congenital heart defects: an international retrospective cohort study. BMJ Open. 2019;9(7):e028139.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChang RK, Gurvitz M, Rodriguez S. Missed diagnosis of critical congenital heart disease. 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Indian J Anaesth. 2016;60(7):451\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWarren J, Fromm RE, Jr., Orr RA, Rotello LC, Horst HM, American College of Critical Care M. Guidelines for the inter- and intrahospital transport of critically ill patients. Crit Care Med. 2004;32(1):256\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMehmood A, Ismail SR, Kabbani MS, Abu-Sulaiman RM, Najm HK. Outcome of low body weight (\u0026lt; 2.2 kg) infants undergoing cardiac surgery. J Saudi Heart Assoc. 2014;26(3):132\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOster ME, Lee KA, Honein MA, Riehle-Colarusso T, Shin M, Correa A. Temporal trends in survival among infants with critical congenital heart defects. Pediatrics. 2013;131(5):e1502-8.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"critical congenital heart disease, pediatric cardiac transfer, neonates, intensive care units, surgery","lastPublishedDoi":"10.21203/rs.3.rs-2987865/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2987865/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eTo explore whether specialist pediatric cardiac transfer could improve the prognosis of neonates with critical congenital heart disease (CCHD).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis cohort study retrospectively collected the clinical data of neonates diagnosed with CCHD who underwent treatment at the cardiac intensive care unit of Shanghai Children’s Medical Center between January 2018 and December 2021. The neonates were classified into the specialist pediatric cardiac transfer (SPCT) and non-SPCT groups. Propensity score matching (PSM) was used to match the two groups. The surgical outcome was the postoperative survival of the neonates.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eDuring the study period, 357 neonates with CCHD were treated and included, of which 16 died before surgery, all in the non-SPCT group. After PSM, compared with the non-SPCT group, the SPCT group showed a lower rate of inotropic drug use (57.3% vs. 77.5%, P=0.004), a lower rate of unplanned emergent operation (29.2% vs. 53.9%, \u003cem\u003ep\u003c/em\u003e=0.001), a higher\u003cstrong\u003e \u003c/strong\u003etotal survival rate (92.1% vs. 82.0%, \u003cem\u003ep\u003c/em\u003e =0.044), and a lower preoperative mortality rate (0% vs. 4.5%, \u003cem\u003ep\u003c/em\u003e =0.043). The multivariable analysis showed that body weight at surgery (HR=0.444, 95%CI: 0.273-0.711, \u003cem\u003ep\u003c/em\u003e=0.001) and unplanned emergent surgery (HR=5.227, 95%CI: 2.521-10.834, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001) were independently associated with mortality in neonates with CCHD.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003eLow body weight and unplanned emergency surgery are independent risk factors for the death of neonates with CCHD. Although SPCT is unrelated to the surgery mortality rate of newborns with CCHD, it can reduce the incidence of unplanned emergency surgery and increase the total survival rate.\u003c/p\u003e","manuscriptTitle":"Association between specialist pediatric cardiac transfer and prognosis of neonates with critical congenital heart disease: A cohort study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-05-31 14:09:34","doi":"10.21203/rs.3.rs-2987865/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8cd2cf2a-5558-454d-bd68-d1b217f8232f","owner":[],"postedDate":"May 31st, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-06-02T09:29:55+00:00","versionOfRecord":[],"versionCreatedAt":"2023-05-31 14:09:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2987865","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2987865","identity":"rs-2987865","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}