Research: Birth Admission Length-of-Stay and Hospital Readmission in Children With Congenital Diaphragmatic Hernia

J Pediatr Surg

. 2023 Aug 9;S0022-3468(23)00468-2.

 doi: 10.1016/j.jpedsurg.2023.08.002. Online ahead of print.

Birth Admission Length-of-Stay and Hospital Readmission in Children With Congenital Diaphragmatic Hernia

Rachel Orlinsky 1Sierra Land 2Sabrina Flohr 3Natalie Rintoul 4Matthew Goldshore 3Holly L Hedrick 5

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Background: The objective of this study was to identify factors associated with prolonged birth admission length of stay (LOS) and to evaluate the association between these characteristics and readmission in the year following discharge for children with congenital diaphragmatic hernia (CDH).

Methods: This was a single-center retrospective cohort study of children with isolated CDH born in the Special Delivery Unit and admitted to the Newborn/Infant Intensive Care Unit at Children’s Hospital of Philadelphia from April 2008 to August 2019. Birth admission hospitalization was categorized into 3 groups (≤35, 36-75, and >76 days) based on the data distribution. Participant factors included gestational age (days), side of CDH (right/left), liver position (up/down), CDH repair technique (open/minimally invasive), exposure to extracorporeal membrane oxygenation, lung-to-head circumference ratio, and feeding tube at discharge. Chi-squared, t-tests and analysis of variance were used to examine bivariable associations between participant characteristics, birth admission LOS and readmission in the year following initial hospital discharge. Multivariable logistic regression was used to evaluate factors associated with readmission.

Results: Children hospitalized ≥76 days at birth had 4.33 (95% CI: 1.2, 15.2) higher odds of readmission than those admitted for ≤35 days. Children with a non-operative feeding tube at discharge had 4.12 (895% CI: 1.6, 10.5) higher odds of readmission when compared to those with no feeding tube at discharge.

Conclusions: Longer birth hospitalization and non-operative feeding tube are associated with increased readmissions in the year after discharge.

Level of evidence: Level III.

Keywords: Congenital diaphragmatic hernia; Length of stay; Readmission.

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