Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Non-MIS-C postacute sequelae of COVID-19, is it autoimmune or autoinflammatory? A systematic review of the reported cases

&lt;p&gt;  &lt;/p&gt; &lt;h2&gt;Introduction:&lt;/h2&gt; &lt;p&gt;Coronavirus Disease 2019 (COVID-19) is by far the most world-altering pandemic to ever hit modern humanity. Three years after the very first case emerged in December 2019, the virus continues to bring upon global disarray in the acute phase of the infection as well as months afterwards, causing the virus’s morbidity and mortality to further skyrocket. This systematic literature review was conducted up till December 2022, comprising all the case reports that thoroughly discuss a myriad of non-Multisystem Inflammatory Syndrome In Children (non-MIS-C) post-acute sequalae of COVID-19 (PASC) in the paediatric population, also known as Long COVID Syndrome.  In this review, we aimed to highlight the prevalent time interval between COVID-19 infection and the development of various non-MISC post-infectious sequalae (PIS). &lt;/p&gt; &lt;h2&gt;Methods:&lt;/h2&gt; &lt;p&gt;We conducted a holistic literature search on PubMed, Google Scholar, Google Search, and Scopus. Data bases were searched for studies that met our inclusion and exclusion criteria. The systematic review was performed on all case reports containing relevant outcome parameters such as age, sex, the interval between COVID-19 infection and subsequent PASC and, lastly, the need for hospitalization during the course of the disease.&lt;/p&gt; &lt;h2&gt;Results: &lt;/h2&gt; &lt;p&gt;We collected a total of 78 case reports discussing the various post-infectious immune sequalae following COVID-19 infection in the paediatric population, consisting of a total of 109 patients. The final screening revealed an equal sex distribution, whereas the two commonest age intervals were school-aged children and adolescents, with 38% of the patients having been older than six years. Interestingly, hospital admission throughout the course of COVID-19 wasn’t a predictor of the subsequent PASC; forty-nine patients (44.9%) were hospitalized while sixty patients (55.1%) were not hospitalized. More importantly, the most predominant time interval between COVID-19 infection and the developing PASC was observed to be within 14 days since the start of COVID-19 infection, accounting for 61% of the cases. &lt;/p&gt; &lt;h2&gt;Conclusion: &lt;/h2&gt; &lt;p&gt;These findings suggest a crucial link is slowly but surely unfolding between COVID-19 and an abundance of systemic post-infectious immune sequalae in the paediatric population, especially amongst children older than six years. Accordingly, meticulous follow-up and prompt management is largely encouraged for the paediatric population in case of unusual symptoms and signs following COVID-19 infection, regardless of COVID-19’s severity.  &lt;/p&gt;</jats:p

PISCovid-1_final_preprint.docx

&lt;p&gt;  &lt;/p&gt; &lt;h2&gt;Introduction:&lt;/h2&gt; &lt;p&gt;Coronavirus Disease 2019 (COVID-19) is by far the most world-altering pandemic to ever hit modern humanity. Three years after the very first case emerged in December 2019, the virus continues to bring upon global disarray in the acute phase of the infection as well as months afterwards, causing the virus’s morbidity and mortality to further skyrocket. This systematic literature review was conducted up till December 2022, comprising all the case reports that thoroughly discuss a myriad of non-Multisystem Inflammatory Syndrome In Children (non-MIS-C) post-acute sequalae of COVID-19 (PASC) in the paediatric population, also known as Long COVID Syndrome.  In this review, we aimed to highlight the prevalent time interval between COVID-19 infection and the development of various non-MISC post-infectious sequalae (PIS). &lt;/p&gt; &lt;h2&gt;Methods:&lt;/h2&gt; &lt;p&gt;We conducted a holistic literature search on PubMed, Google Scholar, Google Search, and Scopus. Data bases were searched for studies that met our inclusion and exclusion criteria. The systematic review was performed on all case reports containing relevant outcome parameters such as age, sex, the interval between COVID-19 infection and subsequent PASC and, lastly, the need for hospitalization during the course of the disease.&lt;/p&gt; &lt;h2&gt;Results: &lt;/h2&gt; &lt;p&gt;We collected a total of 78 case reports discussing the various post-infectious immune sequalae following COVID-19 infection in the paediatric population, consisting of a total of 109 patients. The final screening revealed an equal sex distribution, whereas the two commonest age intervals were school-aged children and adolescents, with 38% of the patients having been older than six years. Interestingly, hospital admission throughout the course of COVID-19 wasn’t a predictor of the subsequent PASC; forty-nine patients (44.9%) were hospitalized while sixty patients (55.1%) were not hospitalized. More importantly, the most predominant time interval between COVID-19 infection and the developing PASC was observed to be within 14 days since the start of COVID-19 infection, accounting for 61% of the cases. &lt;/p&gt; &lt;h2&gt;Conclusion: &lt;/h2&gt; &lt;p&gt;These findings suggest a crucial link is slowly but surely unfolding between COVID-19 and an abundance of systemic post-infectious immune sequalae in the paediatric population, especially amongst children older than six years. Accordingly, meticulous follow-up and prompt management is largely encouraged for the paediatric population in case of unusual symptoms and signs following COVID-19 infection, regardless of COVID-19’s severity.  &lt;/p&gt;</jats:p

Non-MIS-C postacute sequelae of COVID-19, is it autoimmune or autoinflammatory? A systematic review of the reported cases

&lt;p&gt;  &lt;/p&gt; &lt;h2&gt;Introduction:&lt;/h2&gt; &lt;p&gt;Coronavirus Disease 2019 (COVID-19) is by far the most world-altering pandemic to ever hit modern humanity. Three years after the very first case emerged in December 2019, the virus continues to bring upon global disarray in the acute phase of the infection as well as months afterwards, causing the virus’s morbidity and mortality to further skyrocket. This systematic literature review was conducted up till December 2022, comprising all the case reports that thoroughly discuss a myriad of non-Multisystem Inflammatory Syndrome In Children (non-MIS-C) post-acute sequalae of COVID-19 (PASC) in the paediatric population, also known as Long COVID Syndrome.  In this review, we aimed to highlight the prevalent time interval between COVID-19 infection and the development of various non-MISC post-infectious sequalae (PIS). &lt;/p&gt; &lt;h2&gt;Methods:&lt;/h2&gt; &lt;p&gt;We conducted a holistic literature search on PubMed, Google Scholar, Google Search, and Scopus. Data bases were searched for studies that met our inclusion and exclusion criteria. The systematic review was performed on all case reports containing relevant outcome parameters such as age, sex, the interval between COVID-19 infection and subsequent PASC and, lastly, the need for hospitalization during the course of the disease.&lt;/p&gt; &lt;h2&gt;Results: &lt;/h2&gt; &lt;p&gt;We collected a total of 78 case reports discussing the various post-infectious immune sequalae following COVID-19 infection in the paediatric population, consisting of a total of 109 patients. The final screening revealed an equal sex distribution, whereas the two commonest age intervals were school-aged children and adolescents, with 38% of the patients having been older than six years. Interestingly, hospital admission throughout the course of COVID-19 wasn’t a predictor of the subsequent PASC; forty-nine patients (44.9%) were hospitalized while sixty patients (55.1%) were not hospitalized. More importantly, the most predominant time interval between COVID-19 infection and the developing PASC was observed to be within 14 days since the start of COVID-19 infection, accounting for 61% of the cases. &lt;/p&gt; &lt;h2&gt;Conclusion: &lt;/h2&gt; &lt;p&gt;These findings suggest a crucial link is slowly but surely unfolding between COVID-19 and an abundance of systemic post-infectious immune sequalae in the paediatric population, especially amongst children older than six years. Accordingly, meticulous follow-up and prompt management is largely encouraged for the paediatric population in case of unusual symptoms and signs following COVID-19 infection, regardless of COVID-19’s severity.  &lt;/p&gt;</jats:p

Non-Multisystem Inflammatory Syndrome in Children—Postacute Sequelae of Paediatric COVID-19: Autoimmune or Autoinflammatory? A Systematic Review of the Reported Cases

Three years after its emergence, coronavirus disease 2019 (COVID-19) continues to be a leading cause of worldwide morbidity and mortality. This systematic review comprises relevant case reports that discuss non-multisystem inflammatory syndrome in children (non-MIS-C) and postacute sequalae of COVID-19 (PASC) in the paediatric population, also known as long COVID syndrome. The study aims to highlight the prevalent time interval between COVID-19 and the development of non-MIS-C post-infectious sequalae (PIS). Databases were searched for studies that met our inclusion and exclusion criteria. The final screening revealed an equal sex distribution where the commonest age intervals were school-age and adolescence, with 38% of the patients being older than six years. Interestingly, hospital admission during the course of COVID-19 was not a predictor of the subsequent PASC; forty-nine patients (44.9%) were hospitalized while sixty patients (55.1%) were not hospitalized. Moreover, the most predominant time interval between COVID-19 and the developing PASC was within 14 days from the start of COVID-19 infection (61%). These findings suggest a crucial link between COVID-19 and immune PIS in the paediatric population, especially those older than six years. Accordingly, follow-up and management are encouraged in case of unusual symptoms and signs following COVID-19 infection, regardless of the COVID-19 infection severity

Non-MIS-C postacute sequelae of COVID-19, is it autoimmune or autoinflammatory? A systematic review of the reported cases

   Introduction: Coronavirus Disease 2019 (COVID-19) is by far the most world-altering pandemic to ever hit modern humanity. Three years after the very first case emerged in December 2019, the virus continues to bring upon global disarray in the acute phase of the infection as well as months afterwards, causing the virus’s morbidity and mortality to further skyrocket. This systematic literature review was conducted up till December 2022, comprising all the case reports that thoroughly discuss a myriad of non-Multisystem Inflammatory Syndrome In Children (non-MIS-C) post-acute sequalae of COVID-19 (PASC) in the paediatric population, also known as Long COVID Syndrome.  In this review, we aimed to highlight the prevalent time interval between COVID-19 infection and the development of various non-MISC post-infectious sequalae (PIS).  Methods: We conducted a holistic literature search on PubMed, Google Scholar, Google Search, and Scopus. Data bases were searched for studies that met our inclusion and exclusion criteria. The systematic review was performed on all case reports containing relevant outcome parameters such as age, sex, the interval between COVID-19 infection and subsequent PASC and, lastly, the need for hospitalization during the course of the disease. Results:  We collected a total of 78 case reports discussing the various post-infectious immune sequalae following COVID-19 infection in the paediatric population, consisting of a total of 109 patients. The final screening revealed an equal sex distribution, whereas the two commonest age intervals were school-aged children and adolescents, with 38% of the patients having been older than six years. Interestingly, hospital admission throughout the course of COVID-19 wasn’t a predictor of the subsequent PASC; forty-nine patients (44.9%) were hospitalized while sixty patients (55.1%) were not hospitalized. More importantly, the most predominant time interval between COVID-19 infection and the developing PASC was observed to be within 14 days since the start of COVID-19 infection, accounting for 61% of the cases.  Conclusion:  These findings suggest a crucial link is slowly but surely unfolding between COVID-19 and an abundance of systemic post-infectious immune sequalae in the paediatric population, especially amongst children older than six years. Accordingly, meticulous follow-up and prompt management is largely encouraged for the paediatric population in case of unusual symptoms and signs following COVID-19 infection, regardless of COVID-19’s severity.  </p