OBJECTIVE To understand factors associated with care and survival among babies with congenital diaphragmatic hernia (CDH). STUDY DESIGN We used data on California births (2006-2011) to examine birth hospital level of care, hospital transfer before repair, and survival. RESULT Among 577 infants, 25% were born at lower-level hospitals, 62% were transferred, and 31% died during infancy. Late or no prenatal care had the strongest association with birth at lower-level hospitals (adjusted relative risk (ARR) = 1.9, 95% confidence interval (CI) = 1.0-3.6). Birth at lower-level hospitals was associated with transfer (ARR = 1.2, CI = 1.1-1.4), and transferred infants tended to be less clinically complex. Infants with low birthweight, other birth defects, low Apgar scores, and late or no prenatal care had two- to fourfold higher risk of mortality than their comparison groups. CONCLUSIONS These data support the importance of prenatal care and delivery planning into higher-level hospitals for optimal care and outcomes for newborns with CDH.

中文翻译：

---

加利福尼亚先天性膈疝婴儿的存活率：医院、临床和社会人口学因素的影响。

目的 了解与先天性膈疝 (CDH) 婴儿护理和生存相关的因素。研究设计 我们使用加州出生（2006-2011 年）的数据来检查出生医院的护理水平、修复前的医院转移和存活率。结果 577例婴儿中，25%在下级医院出生，62%转入，31%在婴儿期死亡。产前检查晚或没有与在低级医院出生的相关性最强（调整后的相对风险 (ARR) = 1.9，95% 置信区间 (CI) = 1.0-3.6）。在低级医院出生与转院相关（ARR = 1.2，CI = 1.1-1.4），转院婴儿的临床复杂性往往较低。低出生体重、其他出生缺陷、Apgar 评分低的婴儿，与对照组相比，迟到或没有产前护理的死亡风险高出两到四倍。结论 这些数据支持将产前护理和分娩计划纳入更高级别医院的重要性，以便为患有 CDH 的新生儿提供最佳护理和结果。