Management Options and Outcomes for Neonatal XXXX in the Early Twenty-First Century.

@entity1 @entity1699
UNASSIGNED: Without surgical treatment, @entity1699 ( @entity1699 ) mortality in the first year of life exceeds 90  % and, in spite of improved surgical outcomes, many families still opt for non-surgical management. The purpose of this study was to investigate trends in neonatal @entity1699 management and to identify characteristics of @entity1 who did not undergo surgical palliation. Neonates with @entity1699 were identified from a serial cross-sectional analysis using the Healthcare Cost and Utilization Project's Kids' Inpatient Database from 2000 to 2012. The primary analysis compared @entity1 undergoing surgical palliation to those discharged alive without surgery using a binary logistic regression model. Multivariate logistic regression was conducted to determine factors associated with treatment choice. A total of 1750 @entity1 underwent analysis. Overall hospital mortality decreased from 35.3  % in 2000 to 22.9  % in 2012. The percentage of @entity1 undergoing comfort care discharge without surgery also decreased from 21.2 to 14.8  %. After controlling for demographics and comorbidities, older @entity1 at presentation were less likely to undergo surgery (OR 0.93, 0.91-0.96), and @entity1 in 2012 were more likely to undergo surgery compared to those in prior years (OR 1.5, 1.1-2.1). Discharge without surgical intervention is decreasing with a 30  % reduction between 2000 and 2012. Given the improvement in surgical outcomes, further dialogue about ethical justification of non-operative comfort or palliative care is warranted. In the meantime, clinicians should present families with surgical outcome data and recommend intervention, while supporting their option to refuse.
