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Survival disparities in newborns with congenital diaphragmatic hernia: a national perspective
Juan E Sola1, Steven N Bronson, Michael C Cheung
1Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery University of Miami Miller School of Medicine, Miami, FL 33136, USA. jsola@med.miami.edu
Insights
National outcomes for congenital diaphragmatic hernia (CDH) show survival is linked to sex, birth weight, race, and socioeconomic status. Black and minority infants face higher mortality risks.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Public Health Outcomes
Background:
- Congenital diaphragmatic hernia (CDH) is a serious birth defect.
- Understanding national outcomes is crucial for improving infant survival rates.
Purpose of the Study:
- To analyze national hospitalization data for congenital diaphragmatic hernia (CDH).
- To identify factors influencing survival outcomes in infants with CDH.
Main Methods:
- Analysis of the Kids' Inpatient Database for infants under 8 days old.
- Inclusion of 2774 hospitalizations for CDH.
- Examination of patient demographics, treatment, and survival to discharge.
Main Results:
- Overall survival to discharge was 66% (excluding transfers).
- Higher survival rates were observed for males, higher birth weight, white race, private insurance, and higher income.
- Extracorporeal membrane oxygenation (ECMO) was associated with lower survival (46%) compared to CDH repair (86%).
Conclusions:
- Survival for congenital diaphragmatic hernia (CDH) is influenced by sex, birth weight, race, and socioeconomic factors.
- Black and other minority infants demonstrate significantly higher mortality rates.
- These findings highlight disparities in CDH outcomes.
Purpose:
The aim of the study was to examine national outcomes for congenital diaphragmatic hernia (CDH).
Methods:
We analyzed the Kids' Inpatient Database for patients admitted at less than 8 days of age.
Results:
Overall, 2774 hospitalizations were identified. Most patients were white and had private insurance. Most patients were treated at urban (96%), teaching (75%), and not identified as children's hospital (NIACH) (50%). Birth was the most common admission source at NIACH (91%) and children's unit in general hospital (CUGH) (59%), compared to hospital transfer at children's general hospital (CGH) (81%). Most CDH were repaired through the abdomen (81%), and 25% required extracorporeal membrane oxygenation (ECMO). Most NIACH patients were transferred to another hospital, whereas most at CGH and CUGH were discharged home. Survival to discharge was 66% after excluding hospital transfers. Univariate analysis revealed higher survival for males, birth weight (BW) of 3 kg or more, whites, patients with private insurance, and those in the highest median household income quartile. Survival was 86% after CDH repair but 46% for ECMO. Multivariate analysis identified black race (hazard ratio [HR], 1.536; P = .03) and other race (HR, 1.515; P = .03) as independent predictors of mortality.
Conclusions:
Hospital survival for CDH is related to sex, BW, race, and socioeconomic status. Blacks and other non-Hispanic minorities have higher mortality rates.
