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

Troponin T and NT ProBNP levels in infants of gestational, type1 and type2 diabetic mothers and macrosomic infants.

TEZ10019Tez (Uzmanlık) -- Çukurova Üniversitesi, Adana, 2013.Kaynakça (s. 61-67) var.viii, 70 s. : res., tablo ; 29 cm.Amaç: Çalışmamızda, pregestasyonel ve gestasyonel diyabetik anne bebekleri ve makrozomik bebeklerde doğum sırasında alınan umblikal arter N Terminal-Pro Beyin Natriüretik Peptid (NT ProBNP), Troponin T düzeyleri ve postnatal 24. saatten sonra ekokardiografik bulguların karşılaştırılması amaçlanmıştır. Gereç-Yöntem: Çalışmaya prospektif olarak Eylül 2011- Eylül 2012 tarihleri arasında hastanemizde doğan, gebelik haftası > 34 hafta olan 27 pregestasyonel diyabetik anne bebeği, 61 gestasyonel diyabetik anne bebeği, diyabetik anne bebeği olmayan makrozomik 37 bebek ve kontrol grubu olarak annede kronik veya gebelik ilişkili problemi olmayan 58 sağlıklı yenidoğan alındı. Çalışmaya alınan bebeklerde NT ProBNP ve troponin T değerleri doğum sırasında umblikal kord arteryel kandan alınan örneklerde çalışıldı. Bebeklere 24-72. saatlerinde ekokardiografi yapıldı. Ekokardiyografik çalışma sırasında M-Mode, iki boyutlu ekokardiyografi, Doppler ekokardiyografi ve ayrıca “pulse” doku Doppler ekokardiyografi teknikleri kullanıldı. Bulgular: Umblikal arter NT ProBNP ve troponin T düzeyleri, diyabetik ve makrozomik grupta kontrol grubuna göre yüksek bulundu (hepsi için p% 6.1) metabolik kontrollü olarak ikiye ayrıldı. NT ProBNP düzeyi, iyi ve suboptimal metabolik kontrollü diyabetik anne bebeklerinin interventriküler septum kalınlığı (IVS) arasında pozitif korelasyon saptandı (sırasıyla r=0.536, p 6.1%) metabolic controlled. In good and suboptimal metabolic controlled diabetic group, NT ProBNP levels were positively correlated with interventricular septum thickness (r=0.536 and r=0.576 respectively, p0.05). While there was not any correlation related to myocardial performance index between infants of diabetic mothers and control group, myocardial performance index of macrosomic infants was lower than the control group (p=0,017). Conclusion: NT proBNP levels correlation with septal hypertrophy in suboptimal metabolic controlled infants of diabetic mothers shown in this study make an emphasize the importance of the control of diabetes mellitus during pregnancy

Nöbet tanısı koyma ve nöbet-epilepsi sınıflamasında kısa süreli video-eeg monitorizasyonun yeri

TEZ7216Tez (Uzmanlık) -- Çukurova Üniversitesi, Adana, 2009.Kaynakça (s.45-51) var.vii, 56 s. : res. ; 29 cm.Objective: This prospective study was designed for assessing the effectivity of short time (3-4 hours) video-electroencephalography monitorization in classification of localisation associated epilepsia and making differential diagnosis of seizure/pseudoseizure. Material and methods: For this purpose, short time daily (3-4 hours) video- electroencephalography monitorization was applied to 75 children between October 2005 and October 2008. In the first group, 43 children whom attended pediatric neurology service with seizure like complaints altough with no differential diagnosis of seizure, pseudoseizure or paroxysmal disorder mimmicking seizure and normal interictal electroencephalographies was evaluated. Median age was 9,63±3,81 (minimum 3, maximum 17). In the second group, children who attended to hospital with partial seizure complaints and had a diagnosis of seizure type and localisation with history and clinical examination, had normal interictal electroencephalographies, was evaluated and the median age was 9,62±3,77 ( minimum 3, maximum 16)...Amaç: Bu prospektif çalışma kısa süreli (3-4 saat) video-elektroensefalografi monitorizasyonun lokalizasyon ilişkili epilepsilerin sınıflandırılmasında ve nöbet/psödonöbet ayırımının yapılmasındaki etkinliğini değerlendirmek amacıyla Ekim 2005- Ekim 2008 arasında yapıldı. Gereç ve Yöntem: Çalışmada gündüz zamanlı kısa süreli (3-4 saat) video-elektroensefalografi monitorizasyonun, toplam 75 çocuk hastaya uygulandı. İlk grupta; polikliniğe nöbet benzeri yakınmalar ile başvuran, ancak nöbet-yalancı nöbet veya nöbeti taklit eden paroksismal bozukluk ayrımı yapılamayan ve çekilen interiktal elektroensefalografileri normal olan ortalama yaşı 9,633,81 (minimum 3, maksimum 17 yaş) olan toplam 43 hasta incelendi. İkinci grupta ise; aynı dönem içinde polikliniğe parsiyel nöbet geçirme öyküsü ile başvuran, öykü ve klinik muayene bulguları ile nöbet tipi ve lokalizasyonu belirlenen ve çekilen interiktal elektroensefalografileri normal olan ortalama yaşı 9,623,77 (minimum 3, maksimum 16 yaş) olan hastalar incelendi...Bu çalışma Ç.Ü. Bilimsel Araştırma Projeleri Birimi Tarafından Desteklenmiştir. Proje No

Normal Values of Third Ventricular Width of Preterm Infants

Objective: Although the third ventricle width reference ranges obtained by cranial ultrasonography in term infants are known in the literature but there are no adequate and up to date data regarding the reference ranges of third ventricle width in premature infants. In our study, we aimed to obtain the normal reference values of third ventricle width and the third ventricle related parameters in preterm infants (gestational age &lt;32 weeks).&#x0D; Materials and Methods:In our study 156 preterm infant and 64 term infants were included. Weights and head circumference of all infants were measured before C-US. The right and left lateral ventricle anterior horn width (AHW), ventricular index (VI) and third ventricle width were recorded in C-US. Study data were divided into 2 groups as term infants and preterm infants.&#x0D; Results:Third ventricle measurement was successfully performed in all infants. The frequency of cesarean section was significantly higher in preterm infants, while weight and head circumference were significantly lower (p&lt;0.05). R-AHW, L-AHW, R-VI, L-VI was significantly higher in term infants than in preterm infants (p&lt;0.05). Mean ± SD, median, minimum and maximum third ventricle diameters were 1.27±0.33mm, 1.20mm, 0.50mm and 1.90mm respectively in preterm infants. In univariate analysis, GA, R-AHW, L-AHW, R-VI, L-VI values were found to be associated with third ventricle diameters. Linear regression analysis revealed that only GA and R-AHW were independently associated with third ventricle (beta: 0.611 - p&lt;0.001 and beta: 0.141 - p = 0.011, respectively).&#x0D; Conclusion:The third ventricle width obtained by C-US is significantly lower in preterm infants than in term infants and this is independently associated with GA. These results of our study are important for the detection of third ventricle dilatation in preterm infants with abnormal C-US and our data’s were thought to be used clinically.</jats:p

Does the timing of surgery affect short-term prognosis in newborn infants with meningomyelocele?

Abstract Objective: To investigate the effect of postnatal primary repair surgery time on short-term (first 30 days) prognosis in neonates with meningomyelocele (MMC).Methods: The records of meningomyelocele patients treated at Adana City Training and Research Hospital between June 30, 2015 and August 1, 2019 were retrospectively reviewed. Demographic and clinical characteristics, surgical time, hospitalization and antibiotic duration, complications and associated anomalies were recorded.Results: Data of 41 patients were evaluated. The patients were divided into two groups according to the time of surgery. There were 18 patients in the early surgery (≤3 days) group and 23 patients in the late surgery (&gt;3 days) group. There was no difference between groups in terms of birth weight, gestational week, head circumference, sex and type of delivery (p&gt;0.05). The length of hospitalization was 17.2 ± 8.2 in the early surgery group and 24.8 ± 16.1 in the late surgery group (p&gt;0.05). Antibiotic duration was 11.8 ± 7.6 in the early surgery group and 13.8 ± 10.1 in the late surgery group (p&gt;0.05). There was no difference between the two groups between the average size of the MMC sac (5.4±1.1 vs 6.1±2.3, p&gt;0.05). The number of patients with postoperative complications in early surgery group was 8 (44.4%) and in late surgery group was 7 (30.4%), and the number of patients reoperated in the first 30 days in early surgery group was 5 (27.7%) and in late surgery group was 6 (26.1%). The number of patients requiring ventriculoperitoneal shunt (VPS) was 9 (50%) in the early surgery group and 13 (56.5%) in the late surgery group. Surgical complications minor-major dehiscences, CSF leakage, local infection, meningitis and ventriculitis are not statistically different between the groups (p&gt;0.05).Conclusion: Although postnatal early surgical intervention in MMC positively affects short-term outcomes, short-term prognosis is also determined by the presence of associated anomalies, VPS placement time, and rupture of the sac.</jats:p

Placento-Cranial Adhesions in Amniotic Band Syndrome and the Role of Surgery in Their Management: An Unusual Case Presentation and Systematic Literature Review

Amniotic band syndrome is a group of sporadic congenital anomalies that involve the limbs, craniofacial regions and trunk, ranging from simple digital band constriction to complex craniofacial and central nervous system abnormalities. Placento-cranial adhesions in amniotic band syndrome are extremely rare, and severe conditions are associated with high morbidity and mortality rates. In this study, we pooled placento-cranial adhesion case reports that were published in the medical literature and added an unpublished case from our institution. The purpose of this article was to review and discuss the clinical features and outcomes of placento-cranial adhesions in amniotic band syndrome.</jats:p