title: [Does the regional health care organization impact the outcome of infants born with congenital diaphragmatic hernia?].
abstract: BACKGROUND
  Congenital diaphragmatic hernia (CDH) is a serious pathology that requires optimal management in very specialized health centers. French medical care organization is regionally based. Hence, evaluating local practices may help deliver clear information to parents before delivery. The aim of this study was to analyze the neonatal characteristics and the postnatal outcome of infants affected with CDH, treated within two different French perinatal health care networks.
  
  
  METHODS
  Retrospective cohort study of infants with CDH, cared for in the Lorraine perinatal health care network (Réseau Périnatal Lorrain [RPL]) or at Édouard-Herriot Hospital (HEH) in Lyon, between 1997 and 2007.
  
  
  RESULTS
  One hundred and twenty-seven newborns were included, 44 in the RPL and 83 in Lyon. Prenatal diagnosis of CDH was similar in RPL and at HEH; 47.7% of infants with CDH died in RPL vs 36.1% in HEH (P=0.2). Surgery delayed for more than 24h was more frequent in RPL (68.6% vs 31.7%; P<0.001), with a postoperative mortality rate of 31.4% vs 15.9%; P=0.08. In RPL, specialized medical follow-up was rare (33.3% vs 100%; P<0.001), while psychomotor retardation was more frequent (33.3% vs 5.7%; P=0.002).
  
  
  CONCLUSIONS
  This study brings to light the diversity of care and outcome for infants affected with CDH in two French perinatal health care networks. These results may help improve both centers' practices. In Lorraine for instance, the follow-up of these vulnerable children can be improved.
authors.affiliation: Service de néonatalogie, soins intensifs et réanimation néonatale, maternité régionale universitaire de Nancy, 10, rue du Docteur-Heydenreich, 54042 Nancy cedex, France.
authors.forename: A
authors.initials: A
authors.lastname: Roussel
authors.forename: J-M
authors.initials: JM
authors.lastname: Hascoet
authors.forename: R
authors.initials: R
authors.lastname: Desandes
authors.forename: O
authors.initials: O
authors.lastname: Claris
authors.forename: R
authors.initials: R
authors.lastname: Vieux
mesh_terms: D000465:Algorithms; D015331:Cohort Studies; D005602:France / Q000453:epidemiology; D006296:Health Services; D006548:Hernia, Diaphragmatic / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000175:diagnosis* / Q000601:surgery*; D015931:Intensive Care, Neonatal; D018743:Perinatal Care; D011184:Postoperative Period; D011596:Psychomotor Disorders / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal