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Congenital Diaphragmatic Hernia in New Zealand; Survival Outcomes 2011‐16

Weston PJ, Austin N, Battin M Waikato Hospital, Hamilton, Christchurch Women’s Hospital, Christchurch, Auckland City Hospital, Auckland, New Zealand Email: phil.weston@waikatodhb.health.nz Background: A proposal for centralised care for the postnatal management of known congenital diaphragmatic hernia in New Zealand has generated a review by the Newborn Network, of survival outcomes taking into account cases from initial diagnosis. Methods: Details of cases were obtained from all three Maternal-fetal-medicine services in New Zealand, and from all 6 Neonatal Intensive Care Units for a 5 year period, 2011-16. Case ascertainment is believed to be complete for the whole of country. Four centres undertook medical and surgical management of the condition. Survival by centre of care was compared using logistic regression. Results: There were 83 cases of whom 12 underwent termination of pregnancy, with 2 stillbirths, 26 deaths, and 43 survivors. Incidence = 0.2/1000 total births. Overall survival rate was 52%, with centre-specific survival being 36%, 43%, 65%, and 78% for the 4 centres. The live-born survival rate was 62.3%. Differences between the centres were not statistically significant (p=0.08), although the numbers were very small for some centres (n=11, 40, 23, and 9 respectively), with the two smallest units having the most extreme results. The statistical power to detect a difference in survival between the smallest and largest unit was only 45%. There were 12 cases of severe associated malformations, with no change in interpretation when these were excluded (p=0.06). Conclusions: These national data provide no compelling rationale for nor against a centralised service, and do not support a relationship between case numbers and success.