Influence of location of delivery on outcome in neonates with congenital diaphragmatic hernia.

BACKGROUND: Although it is often recommended that infants with antenatally diagnosed congenital diaphragmatic hernia (CDH) be delivered in a perinatal center, this practice has not been scientifically validated.
METHODS: Data were obtained from The Canadian Pediatric Surgery Network, covering 16 pediatric surgical centers over a 4-year period. Inborn was defined as birth in a hospital with a neonatal intensive care unit or connected to a neonatal intensive care unit by a bridge or tunnel. Outborn was defined as requiring transfer by ambulance or flight. Primary outcome variable was mortality.
RESULTS: Of 140 infants with antenatally diagnosed CDH, 75 were inborn and 65 were outborn. Univariate analysis demonstrated no significant difference between groups with respect to gestational age, birth weight, days to surgery, primary repair, need for ventilation, use of pressors or extracorporeal membrane oxygenation, or incidence of comorbidities. Severity of illness, as reflected by the Score for Neonatal Acute Physiology II (SNAP II), was significantly higher among inborn infants (21 [interquartile range, 7-32] vs 5 [interquartile range, 9-12]; P = .0001). Logistic regression analysis, controlling for severity of illness, revealed that location of delivery was a significant independent predictor for mortality, with an odds ratio of dying when outborn of 2.8 (P = .04).
CONCLUSIONS: Outborn delivery is a significant predictor of mortality for infants with antenatally diagnosed CDH.