Predicting death or extended length of stay in infants with congenital diaphragmatic hernia

K. Murthy*, E. K. Pallotto, J. Gien, B. S. Brozanski, N. F.M. Porta, I. Zaniletti, S. Keene, L. G. Chicoine, N. E. Rintoul, F. D. Dykes, J. M. Asselin, B. L. Short, M. A. Padula, D. J. Durand, K. M. Reber, J. R. Evans, T. R. Grover

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

32 Scopus citations

Abstract

Objective:To predict mortality or length of stay (LOS) >109 days (90th percentile) among infants with congenital diaphragmatic hernia (CDH).Study Design: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.Results: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).Conclusions: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.

Original languageEnglish (US)
Pages (from-to)654-659
Number of pages6
JournalJournal of Perinatology
Volume36
Issue number8
DOIs
StatePublished - Aug 1 2016

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Pediatrics, Perinatology, and Child Health

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