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

Research output: Contribution to journalArticlepeer-review

31 Scopus citations


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
Pages (from-to)654-659
Number of pages6
JournalJournal of Perinatology
Issue number8
StatePublished - Aug 1 2016


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