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Readmission and Late Mortality Among Children With Congenital Diaphragmatic Hernia
Marine Jouannin1, Pierre Pinson2, Mathis Collier2
1Assistance Publique-Hopitaux de Paris, Hôpital Necker-Enfants malades, Neonatal Intensive Care Unit, Paris, France.
Insights
Nearly three-quarters of infants with congenital diaphragmatic hernia (CDH) were readmitted within three years. Enteral feeding at discharge was linked to higher readmission and mortality risks, suggesting a potential target for improving outcomes.
Area of Science:
- Pediatric Surgery
- Neonatology
- Public Health
Background:
- Congenital diaphragmatic hernia (CDH) is a severe condition with high neonatal mortality.
- Despite improved survival, long-term morbidity and healthcare system impact, especially hospital readmissions, are not well understood.
Purpose of the Study:
- To determine the incidence, causes, and associated factors of hospital readmission and late mortality in children with CDH after primary discharge.
- To analyze the long-term health outcomes and healthcare utilization for CDH survivors.
Main Methods:
- A nationwide retrospective cohort study using French National Health Data System from 2012-2024.
- Included 1028 infants surgically treated for CDH within 6 months of life, discharged alive.
- Follow-up data analyzed for readmissions and mortality up to 3 years post-discharge.
Main Results:
- 72.5% of children experienced at least one readmission within 3 years.
- Common readmission reasons included respiratory issues (38.0%), gastrointestinal/nutritional problems (20.5%), and surgical complications (23.3%).
- Preterm birth, congenital anomalies, prolonged initial stay, oxygen, and enteral feeding at discharge were linked to readmission; enteral feeding also predicted late mortality.
Conclusions:
- Congenital diaphragmatic hernia survivors face a high rate of readmission within three years, though late mortality is low.
- Enteral feeding at discharge, while reflecting CDH severity, may be a modifiable factor to target for improved long-term outcomes.
Importance:
Congenital diaphragmatic hernia (CDH) is a rare malformation with high neonatal mortality. Although advances in management have improved survival rates, long-term morbidity remains substantial, and its impact on the health care system, particularly hospital readmissions, remains poorly described.
Objective:
To describe the incidence, causes, and factors associated with hospital readmission and late mortality after discharge from the primary stay.
Design, Setting, And Participants:
This nationwide retrospective cohort study was conducted from 2012 to 2024 and used data from the French National Health Data System, capturing nationwide health insurance claims and hospital discharge records in France. Participants were children with CDH who underwent surgical repair within the first 6 months of life, and were discharged alive from the primary stay. Data were analyzed from January to October 2025.
Main Outcomes And Measures:
The main outcomes were readmission to an acute care facility within 3 years after discharge and death during follow-up. Factors associated with readmission were identified using multivariable analysis.
Results:
Of the 1028 included infants (median [IQR] birth weight, 3050 [2720-3410] g; 849 [82.6%] with full-term birth; 630 [61.3%] male infants), 753 had at least 3 years of follow-up (median [IQR] time of follow-up, 6.2 [2.6-9.1] years), constituting the overall sample size for the primary analysis. Of them, 546 children (72.5%) were readmitted at least once, and 182 (24.2%) required intensive care. At 3 years, 208 (38.0%), 112 (20.5%), and 127 (23.3%) children had experienced at least 1 readmission for respiratory causes, gastrointestinal and/or nutritional issues, and CDH-related surgical complications, respectively. Preterm birth (incidence rate ratio [IRR], 1.32; 95% CI, 1.10-1.60), associated congenital anomalies (IRR, 1.31; 95% CI, 1.13-1.53), a primary stay longer than 1 month (IRR, 1.50; 95% CI, 1.27-1.76), oxygen therapy at discharge (IRR, 2.14; 95% CI, 1.55-2.99), and enteral feeding at discharge (IRR, 2.21; 95% CI, 1.83-2.68) were independently associated with readmission. Fourteen late deaths (14 of 1028 infants [1.4%]) were recorded, attributable to CDH-related complications or associated comorbidities in half of cases. Enteral feeding at discharge was also independently associated with late mortality (hazard ratio, 5.09; 95% CI, 1.33-19.48).
Conclusions And Relevance:
In this cohort study of 1028 children with CDH, nearly three-quarters were readmitted within 3 years, but late mortality was low. Although enteral feeding at discharge likely reflected CDH severity, it may also represent a potentially modifiable target that warrants further investigation to improve outcomes.
