Survival rate in congenital diaphragmatic hernia: the experience of the Canadian Neonatal Network.
OBJECTIVE
The Canadian Neonatal Network prospectively collects data from 17 pediatric hospitals accounting for 75% of all neonatal intensive care unit beds nationwide. The purpose of this study was to (1) analyze the database to compare actual survival rates of neonates with congenital diaphragmatic hernia (CDH) to predicted outcomes and (2) assess whether institutional CDH volume was associated with improved survival rate.


METHODS
Actual survival rates for CDH patients born during a 22-month period were determined from the registry. Predicted survival rates were calculated using the CDH Study Group logistical regression equation. Actual survival rate was compared with predicted using chi2 analysis. Survival rates were stratified by institutional CDH volume and compared using binomial analysis. P value of less than.05 was deemed statistically significant.


RESULTS
Of approximately 20,500 neonatal admissions, 88 cases of CDH were recorded. Seventy-three of 88 (83%) neonates with CDH survived to discharge, whereas the predicted survival rate was 62% (P <.001). Three centers were considered "high-volume" centers with at least 12 CDH diagnoses, and 11 were considered "low-volume" centers. Actual CDH survival was significantly greater at high-versus low-volume centers (90% v 77%; P <.01).


CONCLUSIONS
From these prospective data, survival rates of Canadian neonates with CDH are significantly better than predicted by the CDH Study Group equation. Further, high-volume centers in Canada have a significantly higher CDH survival rate than low-volume centers.
Javid
Patrick J
PJ
Children's Hospital Boston and Harvard Medical School, Boston, MA 02115, USA.
Jaksic
Tom
T
Skarsgard
Erik D
ED
Lee
Shoo
S
D000206:Actuarial Analysis; D002170:Canada / Q000453:epidemiology; D016009:Chi-Square Distribution; D016208:Databases, Factual; D006548:Hernia, Diaphragmatic / Q000401:mortality*; D065630:Hernias, Diaphragmatic, Congenital; D017052:Hospital Mortality; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D016015:Logistic Models; D017063:Outcome Assessment, Health Care; D011336:Probability; D012042:Registries; D012307:Risk Factors; D015996:Survival Rate