AHA level of care classification in congenital heart disease in a German Heart Center – a single center retrospective observational study

Objectives The aim of this analysis was to clarify, the types of CHD in neonates, which are referred to our heart center prenatally or postnatally? And how do the CHD types differ with regard to place of delivery or mode of delivery are there any differences for the are outcome parameters?

Methods Observation period for this analysis was 10 years (2011-2021). All neonates younger than 28 days treated in our center with CHD were included and divided into 5 groups according to expected hemodynamic instability using the American Heart Association's Level of Care Assignment.

Results Total of 1210 newborns were admitted to our center, of which 852 fitted the inclusion criteria. Out of these, 414 children were delivered in our associated obstetrical department, 438 newborns were transferred from other hospitals. A total of 248 (29,2%) children were assigned to LoC grade 1 (LoC 1), 373 (43,8%) to LoC 2, 112 (13,1%) to LoC 3, 114 (13,3%) to LoC 4 and five LoC P (palliative care) (0,6%). The predominant mode of delivery was a vaginal delivery in 509 (60%), followed by caesarean section of 343 (40%) out of which 184 primary, 120 secondary, 21 emergency caesarean sections and the indication for 18 remain unclear. There was no significant difference regarding the caesarean section rate in the comparison of the Level of Care classes.

Conclusion 73% of our neonates fulfilled the LoC criteria of an increased risk for hemodynamic instability (LoC 2-4). 1/3 of a relevant or high risk (> LoC 2).

Publication History

Article published online:
11 October 2022