Effects of Extracorporeal Life Support Volume on Neonatal Mortality in Congenital Diaphragmatic Hernia: A Retrospective Cohort Study.

Abstract

We conducted a retrospective cohort study of 29 499 neonatal cases requiring extracorporeal life support (ECLS) at 237 centers from 2000 to 2023; there were 6747 infants with congenital diaphragmatic hernia (CDH) and 22 752 without CDH. Infants with CDH treated at ECLS centers with low total neonatal volumes (<28.5 total cases) had increased odds of inpatient mortality compared with those at high-volume centers (> 140 total cases, adjusted odds ratio [aOR]: 1.9; 95% confidence interval [CI]: 1.2-2.9). Similarly, centers with low non-CDH ECLS volumes were associated with higher odds of mortality among infants with CDH (aOR: 1.7; 95% CI: 1.1-2.5). Combined analysis of neonates with and without CDH also showed that low-volume centers were associated with higher odds of mortality compared with high-volume centers (aOR: 1.6; 95% CI: 1.3-2.0). These findings underscore the importance of procedural experience and support further investigation into the potential best practices adopted by high-volume centers.