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

Journal of Perinatology volume 36, pages 654–659 (2016)Cite this article

Subjects

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) χ2, P=0.16) and acted similarly even after omitting extracorporeal support (AUC=0.82, GF χ2, 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.

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Acknowledgements

The CHNC (http://www.thechnc.org) has partnered with Children’s Hospital Association (Overland Park, KS, USA and Alexandria, VA, USA) to design, launch and maintain the CHND. We are indebted to the following institutions that serve infants and their families, and these institutions also have invested in and continue to participate in the CHND. For more information about CHND, please contact chnd@childrenshospitals.org. We also thank the site sponsors, data abstractors, and staff for the CHND for their investments in this program. The CHND site sponsors are:

1. Children's Healthcare of Atlanta at Egleston, Atlanta, GA (Francine Dykes, Anthony Piazza)

2. Children’s Healthcare of Atlanta at Scottish Rite, Atlanta, GA (Gregory Sysyn)

3. Children's of Alabama, Birmingham, AL (Carl Coghill)

4. Le Bonheur Children's Hospital, Memphis, TN (Ramasubbareddy Dhanireddy)

5. Boston Children’s Hospital, Boston, MA (Anne Hansen)

6. Ann and Robert H Lurie Children’s Hospital of Chicago, Chicago, IL (Karna Murthy)

7. Nationwide Children's Hospital, Columbus, OH (Kristina Reber)

8. Children's Medical Center Dallas, Dallas, TX (Rashmin Savani)

9. Children's Hospital Colorado, Aurora, CO (Theresa Grover)

10. Children’s Hospital of Michigan, Detroit, MI (Girija Natarajan)

11. Cook Children's Medical Center, Fort Worth, TX (Jonathan Nedrelow, Annie Chi)

12. Texas Children's Hospital, Houston, TX (Stephen Welty)

13. Children's Mercy-Kansas City, MO (Eugenia Pallotto)

14. Arkansas Children's Hospital, Little Rock, AR (Becky Rodgers, Robert Lyle)

15. Children’s Hospital Los Angeles, Los Angeles, CA (Lisa Kelly*, Steven Chin)

16. UCSF Benioff Children's Hospital Oakland, Oakland, CA (David Durand, Jeanette Asselin, Priscilla Joe)

17. The Children's Hospital of Philadelphia, Philadelphia, PA (Jacquelyn Evans, Michael Padula)

18. Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA (Beverly Brozanski)

19. St Louis Children's Hospital, St Louis, MO (Joan Rosenbaum, Tasmin Najaf, Amit Mathur, Rakesh Rao)

20. All Children's Hospital, St Petersburg, FL (Victor McKay)

21. Rady Children's Hospital San Diego, San Diego, CA (Mark Speziale)

22. Children's National Medical Center, Washington, DC (Billie Short)

23. Alfred I.duPont Hospital for Children, Wilmington, DE (Kevin Sullivan)

24. Primary Children’s Hospital, Salt Lake City, UT (Robert DiGeronimo)

25. Children’s Hospital of Wisconsin, Milwaukee, WI (Michael Uhing)

26. Children’s Hospital and Medical Center, Omaha, NE (Lynne Willett, John Grebe)

27. Florida Hospital for Children, Orlando, FL (Rajan Wadhawan)

28. Seattle Children’s, Seattle, WA (Elizabeth Jacobson Misbe)

* Deceased.

Author contributions

Each author participated and contributed to the design (KM, EKP, JG, BSB, NFMP, IZ, SK, LC, NR, TRG), data collection (KM, JMA, BLS, DJD, EKP, MAP, FDD, KMR, JRE), analysis (all) and/or interpretation (all). Also, all authors drafted and/or revised the manuscript critically for substantive content. Each reviewed and approved this submitted version. Dr Murthy wrote the first draft of this paper.

Author information

Author notes

  1. K Murthy, E K Pallotto, F D Dykes, J M Asselin, B L Short, M A Padula, D J Durand, K M Reber and J R Evans: KM, JRE, FDD, BLS, EKP, MAP, KMR, JMA and DJD form the Children’s Hospitals Neonatal Consortium (CHNC).

  2. J R Evans and T R Grover: TRG and JRE are the co-senior authors.

Authors and Affiliations

  1. and Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    K Murthy & N F M Porta

  2. Department of Pediatrics, Children’s Mercy – Kansas City, University of Missouri Kansas City School of Medicine, Kansas City, MO, USA

    E K Pallotto

  3. Children’s Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA

    J Gien & T R Grover

  4. Children’s Hospital of Pittsburgh and the Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    B S Brozanski

  5. Children’s Hospital Association,, Overland Park, KS, USA

    I Zaniletti

  6. Children’s Healthcare of Atlanta at Egleston and the Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA

    S Keene & F D Dykes

  7. Nationwide Children’s Hospital and the Department of Pediatrics at The Ohio State University College of Medicine, Columbus, OH, USA

    L G Chicoine & K M Reber

  8. Children’s Hospital of Philadelphia and the Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    N E Rintoul, M A Padula & J R Evans

  9. Department of Pediatrics, Children’s Hospital Oakland and Research Center, Neonatal/Pediatric Research, Oakland, CA, USA

    J M Asselin & D J Durand

  10. Children’s National Medical Center and the Department of Pediatrics, George Washington University School of Medicine, Washington, DC, USA

    B L Short

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  1. K Murthy
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  2. E K Pallotto
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Corresponding author

Correspondence to K Murthy.

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The authors declare no conflict of interest.

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Supplementary Information accompanies the paper on the Journal of Perinatology website

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Murthy, K., Pallotto, E., Gien, J. et al. Predicting death or extended length of stay in infants with congenital diaphragmatic hernia. J Perinatol 36, 654–659 (2016). https://doi.org/10.1038/jp.2016.26

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