Influence of location of delivery on outcome in neonates with congenital diaphragmatic hernia Ahmed Nasr 1 , Jacob C. Langer 1, ⁎ for the Canadian Pediatric Surgery Network Department of Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada M5G1X8 Received 24 January 2011; accepted 11 February 2011 Key words: Congenital diaphragmatic hernia; CAPSnet; Perinatal center Abstract Background: Although it is often recommended that infants with antenatally diagnosed congenital diaphragmatichernia(CDH)be delivered ina perinatal center,thispractice 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. © 2011 Elsevier Inc. All rights reserved. The detection of many congenital anomalies has increased because of improved antenatal ultrasound diagnosis. This enables fetal medicine specialists to look for other associated structural anomalies, test for genetic abnormalities, offer fetal therapy in selected cases, and predict long-term outcome. Antenatal diagnosis facilitates parental counseling and allows preparation for a poten- tially complex postnatal course. In addition, it permits parents and health providers to make appropriate choices regarding location, timing, and mode of delivery for the affected fetus [1,2]. There are no data in the literature discussing whether infants with a prenatal diagnosis of congenital diaphrag- matic hernia (CDH) should be delivered in a perinatal center with a level 3 neonatal intensive care unit (NICU) and surgical facilities (inborn) or if they could be safely ⁎ Corresponding author. Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada M5G1X8. E-mail address: jacob.langer@sickkids.ca (J.C. Langer). 1 The Canadian Paediatric Surgery Network. www.elsevier.com/locate/jpedsurg 0022-3468/$ – see front matter © 2011 Elsevier Inc. All rights reserved. doi:10.1016/j.jpedsurg.2011.02.007 Journal of Pediatric Surgery (2011) 46, 814–816