Birth Defects Res

. 2025 Nov;117(11):e2544.

 doi: 10.1002/bdr2.2544. https://pubmed.ncbi.nlm.nih.gov/41221820/

Infant Mortality due to Congenital Diaphragmatic Hernia, United States 2007-2021

Ramesh Vidavalur ^1 2, Kanekal S Gautham ³

Affiliations Expand

• PMID: 41221820
• DOI: 10.1002/bdr2.2544

Abstract

Objective: To analyze temporal trends and geographic variations in infant mortality rate associated with congenital diaphragmatic hernia (CDH-IMR) in the United States.

Methods: From 2007 to 2021, we used CDC-WONDER linked birth/death data to identify CDH-related infant deaths (ICD-10 code: Q79 as the underlying cause of death), analyze annual CDH-IMR trends, and explore associations with sex, gender, gestational age (GA), and U.S. state of birth. Descriptive statistics were derived, and bivariate analyses were conducted to discern differences in CDH-IMR by gender, race, and GA. CDH-IMR was expressed per 100,000 live births with Poisson-modeled 95% confidence intervals, and trends were assessed through joinpoint regression to extrapolate annual percent change (APC).

Results: Between 2007 and 2021, 59,117,761 live births and 3391 CDH-related infant deaths were recorded. CDH infant deaths accounted for 0.96% of all infant deaths and occurred in 0.006% of live births. The mean CDH-IMR was 5.7 (95% CI: 5.5-5.9) per 100,000 live births, with a significant downward trend (APC: -1.3%, [95% CI: -2.0, -0.5, p < 0.01]). Asian infants had a lower risk of mortality (RR 0.66 [95% CI: 0.55, 0.79]) compared to White infants, and higher GA at birth correlated with better survival. Regional analysis revealed a median CDH-IMR (IQR) of 5.9 (4.7, 7.2), with a three-fold variation across U.S. states.

Conclusion: In this national population-based U.S. study, we observed a decreasing trend in CDH-IMR. However, significant variation in CDH mortality persists by region, gender, and race. Despite evidence of current CDH care is associated with a decreasing trend in mortality, there remain many opportunities for equitable improvement in outcomes across race, gender and by geographic region.

Keywords: United States; congenital diaphragmatic hernia; infant mortality; joinpoint regression; trends.

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