Survival disparities in newborns with congenital diaphragmatic hernia: a national perspective.
OBJECTIVE
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.
Sola
Juan E
JE
Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery University of Miami Miller School of Medicine, Miami, FL 33136, USA. jsola@med.miami.edu
Bronson
Steven N
SN
Cheung
Michael C
MC
Ordonez
Beatriz
B
Neville
Holly L
HL
Koniaris
Leonidas G
LG
D005260:Female; D006548:Hernia, Diaphragmatic / Q000401:mortality* / Q000628:therapy; D065630:Hernias, Diaphragmatic, Congenital; D017052:Hospital Mortality / Q000639:trends; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology