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

Mixed-Field Radiation Qualification of a COTS Space On-Board Computer along with its CMOS Camera Payload

The radiation qualification of a complex space system made out of multiple commercial electronic components and modules is a non-standardized task with certain limitations, but also wide potentialities. This paper delves into the features of a system-level test methodologies and explains how to use the data retrieved with a mixed-field characterization. Lesson learned concepts can be applied to the the system level irradiation test preparation as well as the actual application

Radiation Hardness Assurance Through System-Level Testing: Risk Acceptance, Facility Requirements, Test Methodology, and Data Exploitation

International audienceFunctional verification schemes at a level different from component-level testing are emerging as a cost-effective tool for those space systems for which the risk associated with a lower level of assurance can be accepted. Despite the promising potential, system-level radiation testing can be applied to the functional verification of systems under restricted intrinsic boundaries. Most of them are related to the use of hadrons as opposed to heavy ions. Hadrons are preferred for the irradiation of any bulky system, in general, because of their deeper penetration capabilities. General guidelines about the test preparation and procedure for a high-level radiation test are provided to allow understanding which information can be extracted from these kinds of functional verification schemes in order to compare them with the reliability and availability requirements. The use of a general scaling factor for the observed high-level cross sections allows converting test cross sections into orbit rates

Radiation Hardness Assurance Through System-Level Testing: Risk Acceptance, Facility Requirements, Test Methodology, and Data Exploitation

International audienceFunctional verification schemes at a level different from component-level testing are emerging as a cost-effective tool for those space systems for which the risk associated with a lower level of assurance can be accepted. Despite the promising potential, system-level radiation testing can be applied to the functional verification of systems under restricted intrinsic boundaries. Most of them are related to the use of hadrons as opposed to heavy ions. Hadrons are preferred for the irradiation of any bulky system, in general, because of their deeper penetration capabilities. General guidelines about the test preparation and procedure for a high-level radiation test are provided to allow understanding which information can be extracted from these kinds of functional verification schemes in order to compare them with the reliability and availability requirements. The use of a general scaling factor for the observed high-level cross sections allows converting test cross sections into orbit rates