Survival of infants with congenital diaphragmatic hernia in California: Impact of hospital, clinical, and sociodemographic factors

OBJECTIVE. To understand factors associated with care and survival among babies with congenital diaphragmatic hernia (CDH). STUDY DESIGN. We used data on California births (2006–2011) to examine birth hospital level of care, hospital transfer before repair, and survival. RESULT. Among 577 infants, 25% were born at lower-level hospitals, 62% were transferred, and 31% died during infancy. Late or no prenatal care had the strongest association with birth at lower-level hospitals (adjusted Relative Risk (ARR)=1.9, 95% confidence interval (CI)=1.0–3.6). Birth at lower-level hospitals was associated with transfer (ARR=1.2, CI=1.1–1.4), and transferred infants tended to be less clinically complex. Infants with low birthweight, other birth defects, low Apgar scores, and late or no prenatal care had 2–4-fold higher risk of mortality than their comparison groups. CONCLUSIONS. These data support the importance of prenatal care and delivery planning into higher-level hospitals for optimal care and outcomes for newborns with CDH.