A population-based study of congenital diaphragmatic hernia outcome in New South Wales and the Australian Capital Territory, Australia, 1992-2001 |
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Authors: | Levison John,Halliday Robert,Holland Andrew J A,Walker Karen,Williams Gary,Shi Edward,Badawi Nadia Neonatal Intensive Care Units Study of the NSW Pregnancy Newborn Services Network |
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Affiliation: | a Department of Neonatology, The Children's Hospital at Westmead, Sydney, NSW 2145, Australia b Department of Academic Surgery, The Children's Hospital at Westmead, The University of Sydney, Sydney, NSW 2145, Australia c Department of Paediatric Intensive Care, The Sydney Children's Hospital at Randwick, Sydney, NSW 2031, Australia d Department of Surgery, The Sydney Children's Hospital at Randwick, Sydney, NSW 2031, Australia e Department of Paediatrics, The University of Sydney, Sydney, NSW 2006, Australia |
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Abstract: | PurposeThe aim of the study was to describe the incidence and survival of infants born with congenital diaphragmatic hernia (CDH) in the state of New South Wales (NSW) and the Australian Capital Territory (ACT), Australia.MethodsA population-based cohort study of all infants inclusive up to 1 month of age diagnosed with CDH in NSW and the ACT between 1992 and 2001 was conducted. Data sources were the NSW and ACT Neonatal Intensive Care Data Collection (Neonatal Intensive Care Units Study), NSW Birth Defects Register, Population Health Research Centre of ACT Health, and NSW Midwives Data Collection.Individual risk factors for mortality were assessed using the χ2 test with P < .05 being considered statistically significant. Multivariate analysis was performed using logistic regression to adjust for potential confounding variables.ResultsFrom the databases used, the incidence of CDH in NSW and the ACT was 1 per 3800 births. Of 242 infants identified with CDH, 8% underwent termination of pregnancy, 10% were stillborn after 20 weeks' gestation, and 82% were liveborn.Most liveborn infants (70%) were delivered at term with a 64% survival, whereas 30% were preterm with a 35% survival. For liveborn infants, the overall preoperative mortality was 35% with 56% surviving to discharge.Logistic regression identified a low 5-minute Apgar score, prematurity, and air leak as independent risk factors for mortality.ConclusionsThis population-based study of CDH provides us with baseline data for our states. Mortality is high in preterm infants and in the preoperative period. Avoiding preterm delivery and improving preoperative stabilization are the measures most likely to improve survival. |
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Keywords: | Congenital diaphragmatic hernia Neonate Outcome Population-based Survival |
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