Congenital diaphragmatic hernia outcomes: navigating center-to-center variability in level 4 NICUs in the Children’s Hospitals Neonatal Consortium
Authors: Guner Yigit S. , Zaniletti Isabella , Grover Theresa R. , Gowda Sharada H. , Porta Nicolas F. M. , Padula Michael A. , Keene Sarah , Mahmood Burhan , Evans Jacquelyn R. , Hedrick Holly L. , Murthy Karna ,   on behalf of the Children’s Hospitals Neonatal Consortium Congenital Diaphragmatic Hernia Focus Group, Piazza Anthony , Sysyn Gregory , Lucke Ashley , Pont Molly , Black Allison , Coghill Carl , Hansen Anne , Pallotto Eugenia , Murthy Karna , Falciglia Gustave , Haberman Beth , Nesterenko Tetyana , Bartman Thomas , Yallapragada Sushmita , Chalak Lina , Smith Danielle , Bourque Stephanie , Natarjan Girija , Chi Annie , Johnson Yvette , Gotiolo Annmarie , Katarkan Lakshmi , Reber Kristina , Rose Rebecca , Lindower Julie , Weiner Julie , Carroll Laura , Chapman Rachel , Menda Nina , Weems Mark , Downey Ann , Lagatta Joanne , Joe Priscilla , Tipple Trent , Williams Patricia , Birge Nicole , Mikhael Michel , Dereddy Narendra , Wadhawan Rajan , Weiss Aaron , Padula Michael , Quinones Vilarmis , Griffiths Pam , Yanowitz Toby , Bendel-Stenzel Ellen , Ling Con Yee , Speziale Mark , DiGeronimo Robert , Jacobsen Elizabeth , Brozanski Beverly , Rao Rakesh , Downey Ann , Van Marter Linda , Lee Kyong-Soon , Short Billie Lou , Sullivan Kevin , Welch Cherrie 
Published: February 2025

Abstract

Background
This study examined inter-center variation (ICV) in inpatient outcomes for infants with congenital diaphragmatic hernia (CDH), aiming to contribute to quality metrics and clinical benchmarks in neonatal care.

Methods
We retrospectively analyzed CDH cases from the Children’s Hospitals Neonatal Consortium (CHNC) database (2010–2022), focusing on infants without prior surgical repair or discharge. Our outcomes of interest included inpatient survival, survival without ECMO, and hospital length of stay (LOS). We incorporated centers with ≥30 cases into multivariable models to adjust for patient and clinical factors.

Results
Analysis of 3639 infants revealed significant ICV. Unadjusted inpatient survival rate was 76.5%, with ICV ranging from 55.4% to 90.7%. The composite outcome of survival without ECMO was 63.3% (ICV: 38.6–87.9%). The median LOS for survivors was 50 days (ICV: 29–68 days). Multivariable analyses confirmed these trends, indicating an 18-fold variation in survival, a 35-fold variation in survival without ECMO, and a 3.3-fold variation in LOS across centers (p < 0.001 for all).

Conclusion
The treating center was a significant predictor of risk-adjusted inpatient outcomes for infants with CDH. These findings highlight substantial disparities in care and support the integration of these metrics into future research and quality improvement efforts in level IV NICUs.

Impact statement

This study reveals considerable inter-center differences in CDH outcomes, contributing extensive, multicenter data to the existing body of literature. It underscores how center-specific practices affect survival and ECMO use, suggesting that organized high-level care could enhance outcomes for CDH patients. These insights lay the groundwork for center-specific quality improvement initiatives to elevate the standard of care.