title: Epidemiology and Outcomes of Congenital Diaphragmatic Hernia in Croatia: A Population-Based Study.
abstract: Outcomes of neonates with congenital diaphragmatic hernia (CDH) are variable; reports are frequently limited to the experience of single tertiary care centres-a possible source of bias. Population-based studies decrease survivor bias and provide additional insight into this high-mortality condition. The objective of this study was to examine the incidence and outcomes of CDH in Croatia.
  
  
  
  All cases of CDH in Croatia from 2001 through 2013 were ascertained from public health records. Overall and sex- and region-specific incidence rates were calculated, and characteristics associated with 1-year survival were assessed.
  
  
  
  We identified 145 cases of CDH during the study period, for an incidence of 2.67 per 10 000 total births. The incidence did not differ by calendar year (P = 0.38) or geographic region (P = 0.67). There was a slightly higher incidence among males (rate ratio, 1.37, 95% CI 0.99, 1.91). The 1-year survival rate was 33.1% for the entire cohort and 47.9% for liveborns who received any treatment at an intensive care unit. From multivariable analysis, survival was decreased in neonates with left CDH, liver up (odds ratio 0.1, 95% CI, 0.03, 0.4) and increased when treated in a centre with higher case volume (odds ratio 12.8, 95% CI, 2.2, 72.1).
  
  
  
  The incidence of CDH in Croatia is within the range of previous reports. Survival was substantially higher in neonates treated in a centre with higher case volume, which suggests that centralisation of medical care for CDH may be warranted in Croatia.
authors.affiliation: Department of Pediatrics, School of Medicine, University of Zagreb, University Hospital Centre Zagreb, Zagreb, Croatia.
authors.forename: Ruža
authors.initials: R
authors.lastname: Grizelj
authors.affiliation: Division of Neonatology, Department of Obstetrics and Gynecology, University Hospital Merkur, Zagreb, Croatia.
authors.forename: Katarina
authors.initials: K
authors.lastname: Bojanić
authors.affiliation: Department of Pediatrics, School of Medicine, University of Zagreb, University Hospital Centre Zagreb, Zagreb, Croatia.
authors.forename: Jurica
authors.initials: J
authors.lastname: Vuković
authors.affiliation: Department of Pediatrics, School of Medicine, University of Zagreb, University Hospital Centre Zagreb, Zagreb, Croatia.
authors.forename: Milivoj
authors.initials: M
authors.lastname: Novak
authors.affiliation: School of Public Health "A. Štampar" and Croatian Institute of Public Health, School of Medicine, University of Zagreb, Zagreb, Croatia.
authors.forename: Urelija
authors.initials: U
authors.lastname: Rodin
authors.affiliation: School of Public Health "A. Štampar" and Croatian Institute of Public Health, School of Medicine, University of Zagreb, Zagreb, Croatia.
authors.forename: Tanja
authors.initials: T
authors.lastname: Ćorić
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital Sveti Duh, School of Medicine, University of Zagreb, Zagreb, Croatia.
authors.forename: Milan
authors.initials: M
authors.lastname: Stanojević
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Darrell R
authors.initials: DR
authors.lastname: Schroeder
authors.affiliation: Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Toby N
authors.initials: TN
authors.lastname: Weingarten
authors.affiliation: Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Juraj
authors.initials: J
authors.lastname: Sprung
mesh_terms: D017523:Croatia / Q000453:epidemiology; D005260:Female; D065630:Hernias, Diaphragmatic, Congenital / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality*; D006776:Hospitals, Pediatric; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008297:Male; D011296:Prenatal Diagnosis; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate
keywords: antenatal diagnosis; case volume and outcome; congenital diaphragmatic hernia; survival