Outcomes of Congenital Heart Disease Deliveries at a Freestanding Children's Hospital.

Special delivery units (SDU) within freestanding pediatric hospitals eliminate transport-associated risks and enable timely subspecialized care for infants with critical congenital heart defects (CCHD). However, outcome data is limited. We conducted a single-center retrospective cohort study of mother-infant dyads with prenatally diagnosed CCHD delivered between 2019 and 2025. We compared outcomes between delivery sites (SDU vs. level III hospitals) and hypothesized that SDU delivery would be associated with improved maternal and infant outcomes. We also assessed how social drivers of health (deprivation index, insurance, race/ethnicity) influenced SDU eligibility. Among 384 dyads evaluated, 91% of the 284 eligible mothers delivered at SDU. SDU infants had higher gestational age, birth weight, and Apgar scores, were more likely to undergo surgery, and underwent earlier cardiac intervention (p < 0.05). In multivariable analysis after adjusting for maternal and infant comorbidities and diagnosis complexity, SDU infants had higher gestational ages, longer length of stay, and lower pH on admission blood gas. SDU mothers were more likely to provide breastmilk (p = 0.01) but had comparable postpartum depression scores. SDU-eligible mothers had lower deprivation index scores (p = 0.04) and higher rates of private insurance (p = 0.02). Maternal race/ethnicity was not associated with eligibility. Overall, this study found SDU delivery is associated with improvement in several early infant outcomes but longer length of stay. Higher breastmilk provision suggests that the dyad interaction may enhance SDU value. SDU eligibility, reflecting maternal delivery risk, is associated with measures of social drivers of health and may contribute to health disparities.