Related Experiment Video
Updated: Dec 21, 2025
The Perinatal Asphyxiated Lamb Model: A Model for Newborn Resuscitation
Published on: August 15, 2018
Treating Center Volume and Congenital Diaphragmatic Hernia Outcomes in California
Jordan C Apfeld1, Zachary J Kastenberg2, Alexander T Gibbons3
1Department of Surgery, Stanford University School of Medicine, Palo Alto, CA; Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH.
Insights
Infants with congenital diaphragmatic hernias (CDH) had better outcomes at high-volume treatment centers. Higher surgical and neonatal intensive care unit volumes correlated with reduced mortality and shorter ventilation durations for these complex cases.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Public Health
Background:
- Congenital diaphragmatic hernia (CDH) is a serious condition requiring specialized care.
- Outcomes for infants with CDH can vary significantly based on treatment center expertise.
- Understanding the impact of institutional volume is crucial for optimizing care pathways.
Purpose of the Study:
- To evaluate the association between treatment center volume indicators and outcomes for infants with congenital diaphragmatic hernias (CDH).
- To identify specific institutional experience metrics that correlate with improved infant survival and reduced resource utilization in CDH care.
Main Methods:
- A population-based retrospective cohort study was conducted using data from California neonatal intensive care units.
- Multivariable analysis examined outcomes including mortality, ventilation days, and respiratory support at discharge.
- Covariables included treatment center surgical and overall neonatal intensive care unit volumes.
Main Results:
- In a cohort of 728 infants, overall mortality was 28.3%.
- For a lower-risk subcohort (n=541), higher CDH repair volume was associated with significantly lower mortality (OR, 0.41).
- Higher thoracic surgery volume correlated with fewer ventilator days (OR, 0.56), and higher NICU admission volumes trended towards less respiratory support at discharge (OR, 0.51).
Conclusions:
- Institutional experience, both overall and surgery-specific, is a significant factor in optimizing outcomes for infants with CDH.
- These findings support the need for specialized centers and may inform quality indicators for managing newborns with major surgical anomalies.
- Further research can guide optimal care settings and resource allocation for CDH patients.
Objective:
To examined outcomes for infants born with congenital diaphragmatic hernias (CDH), according to specific treatment center volume indicators.
Study Design:
A population-based retrospective cohort study was conducted involving neonatal intensive care units in California. Multivariable analysis was used to examine the outcomes of infants with CDH including mortality, total days on ventilation, and respiratory support at discharge. Significant covariables of interest included treatment center surgical and overall neonatal intensive care unit volumes.
Results:
There were 728 infants in the overall CDH cohort, and 541 infants (74%) in the lower risk subcohort according to a severity-weighted congenital malformation score and never requiring extracorporeal membrane oxygenation. The overall cohort mortality was 28.3% (n = 206), and 19.8% (n = 107) for the subcohort. For the lower risk subcohort, the adjusted odds of mortality were significantly lower at treatment centers with higher CDH repair volume (OR, 0.41; 95% CI, 0.23-0.75; P = .003), ventilator days were significantly lower at centers with higher thoracic surgery volume (OR, 0.56; 9 5% CI, 0.33-0.95; P = .03), and respiratory support at discharge trended lower at centers with higher neonatal intensive care unit admission volumes (OR, 0.51; 9 5% CI, 0.26-1.02; P = .06).
Conclusions:
Overall and surgery-specific institutional experience significantly contribute to optimized outcomes for infants with CDH. These data and follow-on studies may help inform the ongoing debate over the optimal care setting and relevant quality indicators for newborn infants with major surgical anomalies.
