Objective To describe clinical pathways for infants with congenital diaphragmatic hernia (CDH) and short-term outcomes. Design Retrospective observational cohort study using the UK National Neonatal Research Database (NNRD). Patients Babies with a diagnosis of CDH admitted to a neonatal unit in England and Wales between 2012 and 2020. Main outcome measures Clinical pathways defined by place of birth (with or without colocated neonatal and surgical facilities), transfers, clinical interventions, length of hospital stay and discharge outcome. Results There were 1319 babies with a diagnosis of CDH cared for in four clinical pathways: born in maternity units with (1) colocated tertiary neonatal and surgical units (‘ neonatal surgical units ’), 50% (660/1319); (2) designated tertiary neonatal unit and transfer to stand-alone surgical centre (‘ tertiary designated ’), 25% (337/1319); (3) non-designated tertiary neonatal unit (‘ tertiary non-designated’ ), 7% (89/1319); or (4) non-tertiary unit (‘ non-tertiary ’), 18% (233/1319)—the latter three needing postnatal transfers. Infant characteristics were similar for infants born in neonatal surgical and tertiary designated units. Excluding 149 infants with minimal data due to early transfer (median (IQR) 2.2 (0.4–4.5) days) to other settings, survival to neonatal discharge was 73% (851/1170), with a median (IQR) stay of 26 (16–44) days. Conclusions We found that half of the babies with CDH were born in hospitals that did not have on-site surgical services and required postnatal transfer. Similar characteristics between infants born in neonatal surgical units and tertiary designated units suggest that organisation rather than infant factors influence place of birth. Future work linking the NNRD to other datasets will enable comparisons between care pathways. Data may be obtained from a third party and are not publicly available.

中文翻译：

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英格兰和威尔士先天性膈疝婴儿的出生地点和产后转运：一项描述性观察队列研究

目的 描述先天性膈疝 (CDH) 婴儿的临床路径和短期结局。使用英国国家新生儿研究数据库 (NNRD) 设计回顾性观察队列研究。患者 2012 年至 2020 年间入住英格兰和威尔士新生儿病房的诊断为 CDH 的婴儿。 主要结局指标 按出生地（有或没有同处新生儿和手术设施）、转院、临床干预、住院时间定义的临床路径住院和出院结果。结果 有 1319 名诊断为 CDH 的婴儿通过四种临床途径接受护理：出生于产科病房，其中 (1) 位于同一地点的三级新生儿和外科病房（“新生儿外科病房”），占 50% (660/1319)； (2) 指定三级新生儿病房并转移至独立手术中心（‘三级指定’），25% (337/1319)； (3)非指定三级新生儿病房（‘tertiary non-designated’），7%（89/1319）； (4) 非高等教育机构（‘non-tertiary’），18% (233/1319)——后三者需要产后转院。在新生儿外科和三级指定单位出生的婴儿的婴儿特征相似。排除因早期转移（中位 (IQR) 2.2 (0.4–4.5) 天）至其他环境而数据极少的 149 名婴儿，新生儿出院存活率为 73% (851/1170)，中位 (IQR) 停留时间为 26 ( 16–44）天。结论 我们发现，一半的 CDH 婴儿出生在没有现场手术服务且需要产后转运的医院。在新生儿外科病房和三级指定病房出生的婴儿之间的相似特征表明，组织而不是婴儿因素影响出生地点。未来将 NNRD 与其他数据集联系起来的工作将使护理途径之间进行比较。数据可能从第三方获得，并且不公开。