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Mortality in infants with congenital diaphragmatic hernia: a study of the United States National Database
H Aly1, D Bianco-Batlles, M A Mohamed
1Department of Neonatology, George Washington University and Children's National Medical Center, Washington, DC 20037, USA. haly@mfa.gwu.edu
Insights
Neonatal transport for congenital diaphragmatic hernia (CDH) increases mortality and extracorporeal membrane oxygenation (ECMO) use. Regionalizing care and transporting mothers before delivery improves outcomes for CDH newborns.
Area of Science:
- Neonatal surgery
- Pediatric surgery
- Healthcare management
Background:
- Congenital diaphragmatic hernia (CDH) is a serious condition requiring specialized care.
- Outcomes for neonates with CDH can vary significantly based on the healthcare setting.
- Regionalization of care aims to centralize complex pediatric cases in expert centers.
Purpose of the Study:
- To evaluate the impact of regionalized care on outcomes for neonates with congenital diaphragmatic hernia (CDH).
- To compare outcomes for CDH infants treated at their birth hospital versus those transferred to another facility for surgery.
- To identify factors associated with increased mortality and need for advanced life support in CDH patients.
Main Methods:
- Analysis of the National Inpatient Sample and 'Kids' database (1997-2004).
- Inclusion of 2140 neonates diagnosed with congenital diaphragmatic hernia (CDH).
- Comparison of outcomes between infants repaired at the hospital of birth versus those transported for surgical repair, using statistical tests including logistic regression.
Main Results:
- Overall mortality for CDH infants was 33%, with 79% undergoing operative repair.
- Transported infants showed higher utilization of extracorporeal membrane oxygenation (ECMO) (25% vs. 15%) and increased post-operative mortality (16% vs. 13%).
- Survival after surgery for transported infants was lower compared to non-transported infants, with statistically significant adjusted odds ratios for ECMO use and mortality.
Conclusions:
- Neonatal transport for congenital diaphragmatic hernia (CDH) patients is linked to increased mortality and greater reliance on ECMO.
- The findings support the implementation of regionalized care models for CDH.
- Maternal transport prior to delivery of newborns with CDH is recommended to optimize outcomes.
Objective:
To examine the effect of regionalization of care on outcomes of neonates with congenital diaphragmatic hernia (CDH).
Study Design:
We analyzed the National Inpatient Sample and the 'Kids' database for the years 1997 to 2004. Infants with CDH were grouped based on whether they underwent surgical repair at the hospital of birth, or at another facility. Groups were compared using chi-square, t-test and logistic regression.
Result:
A total of 2140 infants were included: 41% were females, 42% were Caucasians, 48% were transported, 20% reported the use of extracorporeal membrane oxygenation (ECMO)and 33% died. Only 79% underwent operative repair, in which 85% survived after surgery. Survival among operated patients who used ECMO was 40%. Transported infants used more ECMO than non-transported ones (25 vs 15%; adjusted odds ratio (OR) 1.46; confidence interval 1.1 to 1.9, P=0.007), and had higher mortality after surgery (16 vs 13%; adjusted OR 1.46; confidence interval 1.1 to 2, P=0.02).
Conclusion:
The utilization of neonatal transport of CDH patients is associated with increased mortality and increased need for ECMO. This study supports the need for regionalization of care, and favors maternal transport before delivery of CDH newborns.
