Mortality in infants with congenital diaphragmatic hernia: a study of the United States National Database.
OBJECTIVE
To examine the effect of regionalization of care on outcomes of neonates with congenital diaphragmatic hernia (CDH).


METHODS
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.


RESULTS
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).


CONCLUSIONS
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.
Department of Neonatology, George Washington University and Children's National Medical Center, Washington, DC 20037, USA. haly@mfa.gwu.edu
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Aly
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Bianco-Batlles
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Mohamed
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Hammad
D015199:Extracorporeal Membrane Oxygenation / Q000401:mortality / Q000706:statistics & numerical data*; D005260:Female; D006548:Hernia, Diaphragmatic / Q000401:mortality* / Q000628:therapy; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010360:Patient Transfer / Q000706:statistics & numerical data*; D012042:Registries; D014481:United States / Q000453:epidemiology