5 research outputs found
Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study
- Author
- Abantanga FA
- Abatli SJ
- Abbas W
- Abbo O
- Abd Elmenam M
- Abd Razak RB
- Abdelbaqi R
- Abdelhady DS
- Abdelhafez MOM
- Abdelhamid SS
- Abdelmaksoud S
- Abdelmoumen R
- Abdelmutalib F
- Abdul-Mumin A
- Abduljawad FM
- Abdullah F
- Abdulraheem N
- Abdulrahman A
- Abdulsalam MA
- Abdunomonovich DA
- Abib SDCV
- Aboelela A
- Abouheba M
- Abrahamsson K
- Abu Ajwa AE
- Abu Al-saleem HSH
- Abu Alamrain AA
- Abu Bakar AH
- Abu Farha MS
- Abu Jamie N
- Abu Jamie YMK
- Abu Jayyab M
- Abu Mayaleh A
- Abu Shiha E
- Abu Za'nouneh FJ
- Abu-Nejmah F
- Abuajaila A
- Abuattaya AA
- Abubakar AM
- Abueideh A
- Abuhayyeh HA
- Abuhlega MA
- Abukhalaf S
- Abumunshar AA
- Acuna G
- Adams S
- Adamu S
- Adanan MFSBM
- Adawi I
- Adawi S
- Adawy A
- Ade-Ajayi N
- Adegboyega R
- Ademuyiwa A
- Adesanya O
- Adhiwidjaja CF
- Adofo-Ansong N
- Agboola TH
- Agelebe E
- Aguiar AA
- Aguilar FA
- Aguirre-Lopez P
- Agulham MA
- Ahmad H
- Ahmad ZAH
- Ahmed H
- Ahmed MA
- Ajai OT
- Ajao EA
- Ajiboye OS
- Ajrami Y
- Akan ME
- Akhbari M
- Akhter N
- Akova F
- Al Dammagh NM
- Al Hussein S
- Al Massry NA
- Al Quran TM
- Al-Attar HM
- Al-Halbouni L
- Al-Mamun A
- Al-Mayoof AF
- Al-Momani HM
- Al-Mouakeh A
- Al-Rayyes M
- Al-Salhi AA
- Al-Shwaikh SH
- Al-Slaibi I
- Al-Taher RN
- Al-Taher RN
- Al-Tammam H
- Alakaloko F
- Alattas K
- Alberto C
- Albozidi A
- Alcantara E
- Aldirawi MAM
- Alebbini MM
- Alfoghi M
- Algabri HNO
- Alglaib MM
- Alhamid A
- Alhamid A
- Alhassan P
- Ali H
- Ali KO
- Ali L
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- Alijla S
- Alijla SS
- Aliwisat AH
- Aljaboo H
- Aljadidi WOFS
- Aljarad Z
- Alkali YS
- Alkareem RMA
- Almada SA
- Almadhoun W
- Almasri M
- Almeida G
- Almengar I
- Almohamady H
- Almosaibli M
- Almusleh TFH
- Alnaeri A
- Alnahhal K
- Alonso V
- Alosta HM
- Alqarajeh F
- Alqor MOI
- Alsaadi NN
- Alsaggaf A
- Alsaied A
- Alser M
- Alser OH
- Alshaikhkhalil HAA
- Alshehri A
- Altamirano PR
- Altaweel A
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- Altokhais T
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- Alturki F
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- Carrillo I
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- Djordjevic I
- do Nascimento SD
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- dos Santos MSF
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- Vervoort D
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- Vierboom L
- Villalba AV
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- von Bismarck S
- von Delft D
- Vosoughi A
- Wafa T
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- Wishah N
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- Wright NJ
- Wu G
- Wyrzykowski D
- Xie H
- Yacoub MA
- Yaghi B
- Yaghi DH
- Yalcinkaya A
- Yang H-B
- Yanis AH
- Yao Y
- Yapo B
- Yeniay AO
- Yola MM
- Yong F
- Youn JK
- Yousuf H
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- Yuen QS
- Yuldashev RZ
- Yunus A
- Zaghlol LY
- Zain M
- Zaman ASK
- Zanellato JB
- Zea-Salazar LE
- Zeinelabdeen A
- Zelada JA
- Zhao X
- Zhu J
- Zhu L
- Zidan M
- Zivanovic D
- Zreeg DAS
- Zurikat RO
- Zvizdic N
- Zvizdic Z
- Publication venue
- ELSEVIER SCIENCE INC
- Publication date
- 24/07/2021
- Field of study
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 middle-income 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 low-income 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 low-income, 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
Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study
- Author
- A. Mohammed Kalakwa
- A. Nemer Ayoub
- Abantanga Francis A.
- Abatli Safa' Jamal
- Abbas Wisam
- Abbo Olivier
- Abdelbaqi Reem
- Abdelhady Dina Sobhy
- Abdelhafez Mohammad Omar Mohammad
- Abdelhamid Sultan S.
- Abdelmaksoud Sherif
- Abdelmoumen Roua
- Abdelmutalib Fakereldeen
- Abdul-Mumin Alhassan
- Abduljawad Fatima Mousa
- Abdullah Fizan
- Abdullah Mohd Yusof bin
- Abdulraheem Nurudeen
- Abdulrahman Alaa
- Abdulsalam Moruf Adekunle
- Abdunomonovich Dekhkonboev Avazjon
- Aboelela Ahmed
- Abouheba Mohamed
- Abrahamsson Kate
- Abrunhosa Matias Marcia
- Abu-Nejmah Fawzi
- Abuajaila Abdulsalam
- Abuattaya Adham Ashraf
- Abubakar Auwal M
- Abueideh Ahmad
- Abuhayyeh Husam Aldean
- Abuhlega Ma'aly A.
- Abukhalaf Sadi
- Abumunshar Ali Abdelhay
- Acuna Gaston
- Adams Stephen
- Adamu Sani
- Adanan Mohd Fitri Shukri bin Mohamed
- Adawi Ihda
- Adawi Samer
- Adawy Ahmad
- Ade-Ajayi Niyi
- Adegboyega Rilwan
- Ademuyiwa Adesoji
- Adesanya Opeoluwa
- Adhiwidjaja Cathline Freya
- Adofo-Ansong Nana
- Agboola Titiloye Hannah
- Agelebe Efeturi
- Aguilar Aguilar Faye
- Aguilar Gargurevich Prince Pamela
- Aguirre-Lopez Pastor
- Agulham Miguel Angelo
- Ahmad Hira
- Ahmad Zahidah Adlynee Haji
- Ahmed Hazem
- Ahmed Mahmoud Abdelfattah
- Ajai Olalekan Temitope
- Ajao Emmanuel Akinlabi
- Ajiboye Olalekan S.
- Ajrami Yara
- Ajwa Ahmad Elian Abu
- Akan M. Eren
- Akhbari Melika
- Akhter Nadeem
- Akova Fatih
- Al-Attar Hala M.
- Al-Halbouni Layana
- Al-Mamun Abdullah
- Al-Mayoof Ali Farooq
- Al-Momani Hashem M.
- Al-Mouakeh Ahmad
- Al-Rayyes Maisara
- Al-saleem Hasan Subhi Hasan Abu
- Al-Salhi Ashraf Ayman
- Al-Shwaikh Samar H.
- Al-Slaibi Ibrahim
- Al-Taher Raed Nael
- Al-Taher Raed Nael
- Al-Tammam Hiba
- Alakaloko Felix
- Alamrain Abdulwhhab Ayman Abu
- Alanguia Chipana Cathy Lee
- Alattas Khalid
- Alberto Carlos
- Albozidi Aya
- Alcántara Elvyn
- ALDIRAWI MOHAMMED A. M.
- Alebbini Mohanad Mutasem
- Alfoghi Mabroka
- Algabri Hayder Nadhim Obaid
- Alglaib Mohammed Meftah
- Alhamid Ahmad
- Alhamid Aos
- Alhassan Priscilla
- Ali Hassan
- Ali Karim Osamy
- Ali Liza
- Ali Mansour
- Alijla Sharif
- Alijla Sharif S.
- Aliwisat Ahmad Hasan
- Aljaboo Hajir
- Aljadidi Wesal Omar F. Saied
- Aljarad Ziad
- Alkareem Raghad mohammad abdu
- Almada Suad Ahmed
- Almadhoun Walaa
- Almasri Murad
- Almeida Aguiar Arthur
- Almeida Giovana
- Almengar Inas
- Almohamady Hisham
- Almosaibli Mohammad
- Almusleh Tasneem Fathi Hasan
- Alnaeri Ali
- Alnahhal Khaled
- Alonso VerĂłnica
- Alosta Hasan Mustafa
- Alqarajeh Firas
- Alqor Mohammad Omar Ibrahim
- Alsaadi Nijmeh Nasser
- Alsaggaf Ameen
- Alsaied Amer
- Alser Mohammed
- Alser Osaid H.
- Alshaikhkhalil Haya Abdulnasser Ali
- Alshehri Abdullah
- Altaweel Ahmed
- Altın Merve
- Altokhais Tariq
- Altomi Mohamed
- Alturki Fahad
- Alvarado Zelada Jackelyne
- Alves Dutra da Silva Érika
- Alwadia Soha Marwan Salem
- Alwaggaa Nouriyah Ali
- Alzamari Ainaa Ata Mohammad
- Alzate Gallego Edgar
- Alzeer Asmahan Mohammad Suliman
- Alzerei Sulaiman T.
- Alzraikat Sayel H.
- Alzubair Afnan
- Alzughayyar Tareq Z.
- Amad Mohamed
- Amado Fernando
- Amaechi Chukwubinyelum
- Amah Christopher Chim
- Amarin Justin Z.
- Amarin Marzouq
- Ambriz-González Gabriela
- Ameh Emmanuel
- Amjad Muhammad Bin
- Amoabin Afua Amoabin
- Anatole Nzanzu
- Anatole Nzanzu Kipata
- Anaya Dominguez Marlene
- Anaya Firas
- Andrade Jerhy
- Andreussi Lorna
- Anicama Elias Rocio
- Annajjar Mohammad hasan
- Anntinea Jessmine
- Antunes Amanda
- Antunez-Mora Alexandra
- Anyomih Theophilus Teddy Kojo
- Anzelewicz Stefan
- Apaza Leon Jose Luis
- Appeadu-Mensah William
- Arabiat Esraa
- Arafa Mohamed Ahmed
- Arafat Hasan
- AragĂŁo Liliana
- Arancibia Gutiérrez Elsa
- Aranda Sánchez Cristian Irela
- Arar Ahmad Samih
- Arauco Jenny
- Arbab Hana
- Arboleda Jenny
- Aremo Anuoluwapo
- ArnadĂłttir Helena
- Arnaud Alexis P
- Arnold Marion
- Arnoletto Lucia Beatriz
- Arrmali Saddam
- Arrmalli Lina Ali
- Arshad Muhammad
- Arthur Felicity
- Arul Suren
- Ashour Dina Ayman
- Ashour Yara shareef
- Aslan Yakup
- Aspirot Ann
- Assi Ahmadfateh
- Assi Muath Abdelrahem Fuad
- Astudillo Miguel
- Atatri Yazid yousef mahmoud
- Atta Ahmed
- Attia Alaa Mobarak
- Avile Romina
- Avolio Luigi
- Awad Hadeel
- Aydin Emrah
- Aykut Merve
- Ayque Rosas Fernando
- Aziz Dayang Anita Abdul
- Ba'baa' Basheer
- Badr Helmy
- Baertschiger Reto
- Bagbio Dominic
- Bah Abdoulie
- Bai Qiang
- Bai Yu Zuo
- Baistrocchi Valentina
- Bakar Ainal Huda Abu
- Baker Wisam
- Ballouhey Quentin
- Balousha Abrar ghassan
- Bamanga Ahmed
- Baniowda Muath A. M.
- Bao Xiaozhou
- Barauskas Vidmantas
- Barbosa Patricia Reis
- Baseggio Natalia
- Bashir Fatma
- Bashir Muhammad Kashif
- Bassan Gonçalves Paulo César
- Bataineh Ziad A.
- Batal Mohammad Mohannad
- Bazozi Hana Milad
- Beasley Spencer
- Becker Karin
- Belmino Gadelha AluĂsio Augusto
- Benaskeur Yousra-Imane
- Beres Alana
- Berková Klára
- Bernaus Marianela
- Berrocal Anaya Waldo
- Berzanskis Mindaugas
- Beshtawi Doha mustafa saleh
- BeĹźir Ahmet
- Bianchin Ezequiel
- Bibas Fatma
- Biber Elna
- Bischoff Cristiano
- Bismarck Sylvester von
- Blain Otilia Eva
- Blanc Thomas
- Blazquez-Gomez Eva
- Bobadilla Morales Lucina
- Bode Christopher
- Bonnard Arnaud
- Boonthai Ampaipan
- Borbonet Daniel
- Bouhadiba Nordeen
- Bowder Alex
- Bracho Blanchet Eduardo
- Bradshaw Kate
- Bragagnini Paolo
- Brahmamdam Pavan
- Bravo Mauro Nicolas
- Bright Benedict Paul
- Brito Quevedo Luz Mery
- Broch Aline
- Brolin Santis Isolan Paola Maria
- Brunero Marco
- Bruxel Carla Luisa
- Bsisu Isam
- Bucaram Elena
- Bueno Mazzuca Rafael
- Bueno Motter Sarah
- Bujarimin Ahmad Shafiee bin
- Bulnes Mendizabal David
- Burks Stephen S.
- Burns Kate
- Butler Marilyn
- Bvulani Bruce
- C. Nwosu David
- Caamal Lorenzo Juvencio
- Calancea Calin
- Calderon Moore Antonio
- Calderón Arancibia José Alfredo
- Calistus Nwachukwu
- Cama Jitoko
- Camamra Kajali
- Cameron Fraser
- Camp Lauren
- Canözer Ali
- Caouette-Laberge Louise
- Cardenas Alva Loreley Raquel
- Cardenas Ruiz Velasco Juan Jose
- Carrasco Ana Lucia
- Carrasco-Ortega Cesar
- Carrillo Isabel
- Casado Francis Tanise
- Casal Beloy Isabel
- Caseb Paloma
- Casquero Victor
- Castañeda Espinosa Sergio
- Castaño Avila Daniela
- Castedo Camacho Fabiola Ruth
- Cavaiuolo Silvia
- Cañapataña Sahuanay Veronica Raquel
- Cepeda Rodrigo
- Cesur İlknur Banlı
- Chan Jonathan
- Chang Jeremy
- Charras Maria Delia
- Chaudary Ali Raza
- Chaudhry Muhammad Amjad
- Chauhan Nirav
- Chavez Galvez Patricia
- Chen Lulu
- Chen Rui
- Cheung Maija
- Chipalavela Rossana Francisco
- Chiriboga Elena
- Chitiavi Soita Wycliffe
- Chitnis Milind
- Cho Seok Hyeon
- Choo Candy SC
- Chukwu Isaac
- Chukwuemeka Anyanwu Lofty-John
- Chung Jae Hee
- Cletus Cyril
- Coghill Griffin
- Collins Nwokoro
- Colombo de Holanda Felipe
- Contreras Carla Sofia
- Coon John
- Cordonnier Annelien
- Cornelli Fabio
- Cornwall Hannah
- Corona C. Rivera Jorge Román
- Corona Rivera Alfredo
- Correa Leite Mila Torii
- Correa Armandou
- Correa Catalina
- CorrĂŞa Costa Eduardo
- Cosoreanu Vlad
- Costas-Chavarri Ainhoa
- Cripovich Alejandrina
- Cunningham Aaron
- Czauderna Piotr
- Cáceres Aucatoma Freud
- Cárdenas Barón José de Jesús
- Cömert Hatice Sonay Yalçın
- da Silva Augusto Maria Lucia
- DagilytÄ— RĹ«ta
- Dahman Nesrine Ben Hadj
- Dajia Wang
- Dalek Noor Fa'izatul Rahil Ambok
- Dallegre Maria Belen
- Dalloul Hisham
- Damiani Andrea
- Dammagh Nagham Mohammed Al
- Dania Bouguermouh
- Darras Osama Majed
- Darwish Ahmed S
- Darwish Ammar
- Dass Anthony
- Dassonville Martine
- Davenport Kate
- David Kuria
- Davies Justine
- Davis Jenna Kylene
- de Assis Silva Murilo
- de Azevedo Belesa Flavia
- de Campos Vieira Abib Simone
- de Deus Passos Leles Kamila
- de Guzman Johann
- de Souza Santos Ferreira Mariana
- Dedeke Florence
- Defago Victor Hugo
- Defert Coralie
- Delefortrie Thomas
- Delforge Xavier
- Delft Dirk von
- Delgado Malaga Florangel Patricia
- Delgado Quinteros Edgar Fernando
- Dellenmark Blom Michaela
- Dendusic Nejra
- Derbew Miliard
- Derks Terry
- Deya Corazone
- Deyab Abdelaziz
- Di Siervi Oscar
- Diaz Castañeda Flor de Maria
- Diaz Echegaray Marlene
- Diaz Gomez Jose Manuel
- Diaz Leon Cesar
- Dieudonné Lemfuka
- Dimatatac Doris Mae
- Djordjevic Ivona
- Dogar Sohail
- Doheim Mohamed Fahmy
- Dominguez Danny
- Donglai Hu
- Dornellas do Nascimento Suely
- dos Santos Dias André Iván Bradley
- Dosselman Luke J.
- Douiri Abdel
- Drah Weam
- Dube Andile Maqhawe
- Duchesne Camille
- Duggan Eileen
- Duote Cai
- Dure Carolina
- Dávila Perez Roberto
- Ebeido Annan
- Egbuchulem Ifeanyichukwu Kelvin
- Ejinkeonye Eze Chukwuemeka
- Ekenze Sebastian Okwuchukwu
- Ekwunife Okechukwu Hyginus
- El-Ghazaly Mohammed
- Elassall Gena Mohamed Hamed
- Elayeb Abdallah
- Elebute Olumide Abiodun
- Elewaily Mohamed
- Elfiky Mahmoud
- Elgammudi Mala
- Elghazaly Shrouk Mahmoud
- Elhadi Ahmed
- Elhadi Muhammed
- Elhajjaji Yasmine Ali
- Elhattab Ahmad
- Elisante Joseph
- Elkaloush Abdullahn Abdousalam
- Elkhazmi Ebtesam Othman Abdulsalam
- Elmenam Mohamed Abd
- Elmzyyen Aya Mahmoud
- Elrais Safa Abdal
- Elsadek Menan Ahmed
- Elsaied Adham
- Elshaer Omar Adly
- Elsherbiny Mohamed
- Elsiraffy Omar Ossama
- Elstad Maria
- Elzohiri Mohamed
- Elzowawi Fathi
- Emam Omar Sameh
- Emil Sherif
- Enbaya Manal Ben
- Ensar Nicholas
- Erdem Melisa
- Eren Elif
- Ergenekon Ebru
- EroÄźlu Egemen
- Erturk Nazile
- Erçin Seçil
- Eshkabilov Shukurali
- Espineda Beda
- Essa Tarek Mohamed
- Essamilghi Kamila Almabrouk Mohammed
- Ezidiegwu Ugochukwu S
- Ezomike Uchechukwu Obiora
- Faboya Omolara Moronkeji
- Fachin Camila
- Fadhle Muhamed Jassim
- Faks Vivian
- Falah Eyad Hassan
- Farag Eman mohamed
- Fares Jehad
- Farha Mervat Sufian Abu
- Farion-Aguiar Luiz
- Fawzy Omar Moustafa
- Fayez Mohamed
- Fazli Mohamad Rafi
- Feldens Leticia
- Felix Michael
- Ferdousi Tamanna
- Fernandes de Oliveira Darli
- Fernandes de Souza Rachel
- Fernandez Ferrer Marianelly
- Fernandez Portilla Emilio
- Fernandez Wilson Miriam Daniela
- Ferraz Schopf Luciano
- Flores Carbajal Lenny
- Ford Kat
- Forero Ladino Angelica Maria
- Fouda Mohamed Fayez
- Fouly Mariam Albatoul Nageh
- Fouquet-Languillat Virginie
- Fourcade Laurent
- Fowler Kathryn L
- Fox Sarah
- Franco Helena
- Furtado Meyer Karine
- Furtado Mariana
- FĂ©liz Erick
- Gabriel Comba
- Gad Dalia
- Gadepalli Samir
- Gai A.
- Galdeano Marcelo
- Gall Caroline Le
- Gamage Tharanga
- Gamboa Kcomt Segundo
- Gao Zhigang
- Gao Zhou Chong
- Garcia Martinez Humberto
- Garcia Isidora
- Garcia Virginia
- Garcia-Aparicio Luis
- GarcĂa Miriam
- Gargum Sondas Ali
- Garnier Hanna
- Garrett-Cox Robin
- Gasana Georges
- Gatzinsky Vladimir
- Gavrila Bogdan
- Gavrilovska-Brzanov Aleksandra
- Gee Oliver
- Gerus Sylwester
- Geze Şükran
- Ghabayen Amir Talat Sheda
- Ghallab Alaa
- Ghaly Khaled Abd elrahman
- Ghanem Waleed H.
- Ghayth Sumayyah
- Ghazzawi Ihsan
- Ghilardi Silva Ximena
- Ghorab Islam Abdelmonem
- Ghosh Dhruv
- Gilardi Jose
- GirĂŁo Tauffer Mariana
- Goddard Lucy
- Goebel Peter
- Gohil Hetal
- Gomes Adriano Luis
- Gomez Juanita
- Gomez Oscar
- Gondal Mudassir Fayaz
- Gonzales Brandy
- Gonzalez Cortez Luis Fernando
- Gonzalez Daniel Emilio
- Gonzalez Joann
- González Ojeda Alejandro
- Gonçalves Borges Carolina
- Gonçalves da Cunha
- Gonçalves Victor
- Gosain Ankush
- Grabowski Andrzej
- Granéli Christina
- Greenberg Jodie
- Grella Maria Giovanna
- Grosos CĂ©line
- Grottling Emma
- Grynberg Lucie
- Guadagno Elena
- Guayelema Marisol
- Guazzotti Marinella
- Guerin Florent
- GuimarĂŁes Patricia
- Guinsburg Ruth
- Guisse Carmen
- Gurgel do Amaral Antonio Cipriano
- Gurskas Pranas
- Gutarra Palomino Andrea
- Gutierrez Maldonado Joan Elizabeth
- Habiba Alouani
- Hagander Lars
- Hagander Lars
- Haidari Sayed Aman
- Haider Naveed
- Hajajreh Ma'alem sameer
- Hakan Nilay
- Halabi Yasmeen Adly
- Hall Nigel
- Hall Timothy
- Hameed Soban
- Hamidi Nadia
- Hamidovic Ajla
- Hamill James
- Hamilton April
- Hammato Abdalkarim Yhya
- Hammond Philip
- Hammouri Ahmad G.
- Hamzah Siti Nur Aien binti Hamid
- Han Yijiang
- Hanifah Nur Atiqah binti Mohd
- Haraux Elodie
- Harilal Shamaman
- Harper Luke
- Hasan Samiul
- Hasan Samiul
- Hasanain Doaa Khalil
- Hashim Hidayah Hayati binti
- Hashim Imran
- Hashim Sophia
- Hassan Majd Yousef Mohammed
- Hassan Mohamed Abada
- Hassan Mohd Razin bin
- Hassan Zulfitri bin Md
- Herappe Mellado Dorihela
- Herdan Mohamed Omar
- Hernández Córdova Karina
- Herrera Pesara Luciana Martina
- Herrera Carina
- Herrera Laura
- Hery GĂ©raldine
- Hinostroza Daniel
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- Wissanji Hussein
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- Wong Janice
- Wong Marilyn
- Wright Naomi Jane
- Wu Guowei
- Wyrzykowski Dariusz
- Xiaodong Guo
- Xie Hua
- Yacoub Mina A.
- Yaghi Bashar
- Yaghi Dua Hasan
- Yalcinkaya Ali
- Yang Hee-Beom
- Yanis Ahmad H.
- Yanowsky Reyes Guillermo
- Yao Yang
- Yapo Benjamin
- Yarza Fernández Jessica
- Yeniay Aslı Öztürk
- Yola Mariya Mukhtar
- Yong Feng
- Youn Joong Kee
- Yousuf Hina
- Yu Mengnan
- Yu Raisa
- Yuen Quah Soong
- Yuldashev Rustam Z.
- Yunus Aayenah
- Za'nouneh Faris J. Abu
- Zaghlol Louay Y.
- Zahari Dato' Dr Zakaria bin
- Zain Mostafa
- Zaman Azrina SK
- Zanellato Josiane Bernartt
- Zarwawi Ahmad Zulhisyam bin
- Zea-Salazar Luis Enrique
- Zeinelabdeen Ali
- Zhao Xiaoxia
- Zhu Jianming
- Zhu Libin
- Zidan Mazen
- Zivanovic Dragoljub
- Zottis Barcelos Fabricio
- Zreeg Dafer abdulhakim . S.
- Zurikat Rajai O.
- Zvizdic Nada
- Zvizdic Zlatan
- Çekiç Bahanur
- Çelik Müge
- Özçelik Zerrin
- Şeref Kıvanç
- Ĺ afus AntonĂn
- Škvařil Jan
- Ĺ tichhauer Radek
- Publication venue
- 'Elsevier BV'
- Publication date
- 01/01/2021
- Field of 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
La problemática de la intermediación laboral en el Perú
- Author
- Publication venue
- Pontificia Universidad CatĂłlica del PerĂş
- Publication date
- 12/12/2001
- Field of study
Un nuevo laico ¿un nuevo Dios? El nacimiento de una moral y un devocionalismo «burgueses» en Nueva España entre finales del siglo xvii y principios del xviii
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- Aguirre Salvador
- Baz Sánchez
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- Scarfe F.
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- Scherer A.
- Schiaffini A.
- Schick Carla
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- Schwiderski O.
- Schöneweiss H. G.
- Scientiarum S
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- Seche M.
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- Seco M.
- Seco R.
- See
- Segalen Victor F.
- Segre C.
- Seidel-Slotty Ingeb
- Selva J.B.
- Selvaggi E.
- Sem Tob E.
- Semantique
- Seneca W. H.
- Sep
- Sequeira C.F. M
- Serie II
- Serments de Strasbourg R. A.
- Serra
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- Serrano Montalvo A.
- Sertoli Salis R.
- Setti Maria Vittoria
- Shake
- Shulman D.
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- Silva Irene Alves
- Silva V.
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- Silva-Fuenzalida L
- Silveira Alipio
- Silveira J.
- Silveira Sousa
- Simonini R. C.
- Sistema
- Situatives
- Skok P.
- Slasche H.
- Sletsj L.
- Slg
- Smither W. J.
- Sobrado
- Sobre
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- Sofer J.
- Solazzi V.
- Solinger D. L.
- Sologuren J.
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- Southwestern
- Soutou A.
- Soyer J.
- Soyer J.
- Spalinger Edeltraut
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- Specht F.
- Speroni Gh
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- Spitzer L.
- Spitzer L.
- Spitzer L.
- Spitzer L.
- Spoglio
- Sprache
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- Steiger A.
- Steinen W.
- Stempel W.
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- Stone H.
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- Stoppani P.
- Straka G.
- Straka G.
- Strohmeyer F.
- Strubbe E.
- Struble G. G.
- Structural
- Structural
- Structure
- Stud
- Studi
- Studien
- Studien
- Studii
- Su
- Subject
- Substrat
- Substrattheorie
- Suchy J.
- Sufijos
- Sullivan G. P.
- Sur
- Sur
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- Suzanne
- Suärez Marco Fidel R.
- Swadesh M.
- Syntaxe
- Szadrowsky M.
- Szemer O.
- Szemerenyi O.
- Szemerenyi O.
- Säenz H. S.
- Södergard
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- Taf
- Tafeln
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- Tafeln S
- Tagliavini C.
- Tagliavini C.
- Taibo V.
- Tampa Spanish
- Tarditi G.
- Tarnoczy T.
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- Tauro A.
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- Taylor D.
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- Technical Report S
- Temple-Patterson H.
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- Terlingen Juan
- Termes
- Terminologia
- Terminologia
- Terminologia
- Terminologia
- Tertius
- Tesniere L.
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- Texte
- Th A.
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- Ugamo
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- Univ
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- Univ N.
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- Univ. Catt
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- Utley J.H.
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- Vacilaciones
- Vaillant R.
- Valdes
- Valencia
- Valencian
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- Vocabulari
- Vocale
- Vogt H.
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- Vol II
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- Vorrömisches Dorngestrüpp
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- Vossler K.
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- Vulgärlateinisches
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- Wycichl W.
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- Yndurain F.
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- Zambetti P.
- Zamora Vicente A.
- Zamora Vicente A.
- Zdrenghea M.
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- Zueinzelnenillyrischen Eigennamen
- Zum Stand
- Zum XIII
- Zur
- Zur
- Zur
- Zur
- Zur Kritik
- Zur Lesung
- Zwei
- Zwirner E.
- ZĂ–
- Ăźvrard Johanna
- ägäische Pflanzennamen
- Ă–erech Y.
- öes
- Ă–hmann E.
- Ă–ihar V.
- Ăśber
- Ăśber
- Ăśber den Begriff
- Ăśber Ortsnamen
- Ăśber Ortsnamen
- ΑνβΓςό Luis
- ΡοΙοΓηÎΕ
- Publication venue
- 'Walter de Gruyter GmbH'
- Publication date
- 01/01/1961
- Field of study