title: Predicting death or extended length of stay in infants with congenital diaphragmatic hernia.
abstract: To predict mortality or length of stay (LOS) >109 days (90th percentile) among infants with congenital diaphragmatic hernia (CDH).
  
  
  
  We conducted a retrospective analysis using the Children's Hospital Neonatal Database during 2010 to 2014. Infants born >34 weeks gestation with CDH admitted at 22 participating regional neonatal intensive care units were included; patients who were repaired or were at home before admission were excluded. The primary outcome was death before discharge or LOS >109 days. Factors associated with this outcome were used to develop a multivariable equation using 80% of the cohort. Validation was performed in the remaining 20% of infants.
  
  
  
  The median gestation and age at referral in this cohort (n=677) were 38 weeks and 6 h, respectively. The primary outcome occurred in 242 (35.7%) infants, and was distributed between mortality (n=180, 27%) and LOS >109 days (n=66, 10%). Regression analyses showed that small for gestational age (odds ratio (OR) 2.5, P=0.008), presence of major birth anomalies (OR 5.9, P<0.0001), 5- min Apgar score ⩽3 (OR 7.0, P=0.0002), gradient of acidosis at the time of referral (P<0.001), the receipt of extracorporeal support (OR 8.4, P<0.0001) and bloodstream infections (OR 2.2, P=0.004) were independently associated with death or LOS >109 days. This model performed well in the validation cohort (area under curve (AUC)=0.856, goodness-of-fit (GF) χ(2), P=0.16) and acted similarly even after omitting extracorporeal support (AUC=0.82, GF χ(2), P=0.05).
  
  
  
  Six variables predicted death or LOS ⩾109 days in this large, contemporary cohort with CDH. These results can assist in risk adjustment for comparative benchmarking and for counseling affected families.
authors.affiliation: Ann & Robert H. Lurie Children's Hospital of Chicago, and Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: K
authors.initials: K
authors.lastname: Murthy
authors.affiliation: Children's Mercy - Kansas City, Department of Pediatrics, University of Missouri Kansas City School of Medicine, Kansas City, MO, USA.
authors.forename: E K
authors.initials: EK
authors.lastname: Pallotto
authors.affiliation: Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: J
authors.initials: J
authors.lastname: Gien
authors.affiliation: Children's Hospital of Pittsburgh and the Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: B S
authors.initials: BS
authors.lastname: Brozanski
authors.affiliation: Ann & Robert H. Lurie Children's Hospital of Chicago, and Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: N F M
authors.initials: NF
authors.lastname: Porta
authors.affiliation: Children's Hospital Association, Overland Park, KS, USA.
authors.forename: I
authors.initials: I
authors.lastname: Zaniletti
authors.affiliation: Children's Healthcare of Atlanta at Egleston and the Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Keene
authors.affiliation: Nationwide Children's Hospital and the Department of Pediatrics at The Ohio State University College of Medicine, Columbus, OH, USA.
authors.forename: L G
authors.initials: LG
authors.lastname: Chicoine
authors.affiliation: Children's Hospital of Philadelphia and the Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: N E
authors.initials: NE
authors.lastname: Rintoul
authors.affiliation: Children's Healthcare of Atlanta at Egleston and the Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: F D
authors.initials: FD
authors.lastname: Dykes
authors.affiliation: Department of Pediatrics, Children's Hospital Oakland and Research Center, Neonatal/Pediatric Research, Oakland, CA, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Asselin
authors.affiliation: Children's National Medical Center and the Department of Pediatrics, George Washington University School of Medicine, Washington DC, USA.
authors.forename: B L
authors.initials: BL
authors.lastname: Short
authors.affiliation: Children's Hospital of Philadelphia and the Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Padula
authors.affiliation: Department of Pediatrics, Children's Hospital Oakland and Research Center, Neonatal/Pediatric Research, Oakland, CA, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Durand
authors.affiliation: Nationwide Children's Hospital and the Department of Pediatrics at The Ohio State University College of Medicine, Columbus, OH, USA.
authors.forename: K M
authors.initials: KM
authors.lastname: Reber
authors.affiliation: Children's Hospital of Philadelphia and the Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: J R
authors.initials: JR
authors.lastname: Evans
authors.affiliation: Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: T R
authors.initials: TR
authors.lastname: Grover
mesh_terms: D016208:Databases, Factual; D005260:Female; D005865:Gestational Age; D065630:Hernias, Diaphragmatic, Congenital / Q000401:mortality*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007902:Length of Stay / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D020379:Risk Adjustment / Q000379:methods; D014481:United States / Q000453:epidemiology