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

Productive performance of coporo with isotopic diets

Los peces detritívoros son la base de la cadena alimentaria y están ampliamente distribuidos en las cuencas neotropicales, los Prochilodus son representativos de este grupo y el bocachico llanero o coporo (Prochilodus mariae) es de interés comercial en acuicultura. Para evaluar el desempeño productivo en alevinos de coporo con dietas isotópicas, fueron conformados dos tratamientos: dieta comercial (δ13C -20.93±0.34) y dieta experimental (δ13C -24.6±0.9) suministradas durante sesenta días. Parámetros de peso medio, longitud media estándar, ganancia de peso (GP), tasa de crecimiento específico (TCE) y factor de conversión alimenticia (FCA) fueron determinados. La contribución y fraccionamiento de la dieta fueron estimados a partir de las lecturas isotópicas en muestras de músculo. El peso y longitud estándar del coporo fue superior en el tratamiento de la dieta comercial (DC). En los parámetros GP y TCE hubo diferencia significativa (P&amp;lt;0.05) entre tratamientos, siendo el tratamiento DC siempre superior frente a la dieta experimental (DE). La contribución relativa de la DC y DE fue de 59.2 y 53.4% respectivamente, en cuanto que el mayor fraccionamiento de la dieta en carbono y nitrógeno fue de la DE en 1.97 y 1.14%0 respectivamente. La relación entre la contribución de la dieta y la ganancia de peso fue más eficiente para DC en términos de carbono, contrariamente, la eficiencia del nitrógeno fue con DE. Aunque la contribución de las dietas fue inferior a 60%, ambas contribuyeron a mejorar el desempeño del coporo.The detritivorous fish are the base of the food chain and are widely distributed in neotropical basins, Prochilodus are representative of this group and bocachico llanero or coporo (Prochilodus mariae) is of commercial interest in aquaculture. This study aimed to evaluate the productive performance in fingerlings coporo with isotopic diets were comprised two treatments: commercial diet (δ 13C -20.93±0.34) and experimental diet (δ 13C -24.6±0.9) supplied for sixty days. Mean weight, mean standard length, weight gain (WG), specific growth rate (SGR) and feed conversion ratio (FCR) were determined. The contribution and fractionation of the diet were estimated from isotopic values muscle samples. The weight and length standard of coporo was more than in the treatment of the commercial diet (CD). In the WG and SGR parameters was significant difference (P&amp;lt; 0.05) between treatments, with the CD treatment better compared to the experimental diet (ED). The relative contribution of CD and DE were 59.2 and 53.4% respectively, in isotopic fractionation of carbon and nitrogen diet of ED was 1.97 and 1.14%0 respectively. The relation between the contribution of diet and weight gain was most efficient CD in terms of carbon contrary, nitrogen efficiency was with ED. Although the contribution of the diets was less than 60%, both contributed to improving the performance of coporo

Desempeño productivo del coporo con dietas isotópicas

The detritivorous fish are the base of the food chain and are widely distributed in neotropical basins, Prochilodus are representative of this group and bocachico llanero or coporo (Prochilodus mariae) is of commercial interest in aquaculture. This study aimed to evaluate the productive performance in fingerlings coporo with isotopic diets were comprised two treatments: commercial diet (δ 13C -20.93±0.34) and experimental diet (δ 13C -24.6±0.9) supplied for sixty days. Mean weight, mean standard length, weight gain (WG), specific growth rate (SGR) and feed conversion ratio (FCR) were determined. The contribution and fractionation of the diet were estimated from isotopic values muscle samples. The weight and length standard of coporo was more than in the treatment of the commercial diet (CD). In the WG and SGR parameters was significant difference (P< 0.05) between treatments, with the CD treatment better compared to the experimental diet (ED). The relative contribution of CD and DE were 59.2 and 53.4% respectively, in isotopic fractionation of carbon and nitrogen diet of ED was 1.97 and 1.14%0 respectively. The relation between the contribution of diet and weight gain was most efficient CD in terms of carbon contrary, nitrogen efficiency was with ED. Although the contribution of the diets was less than 60%, both contributed to improving the performance of coporo.Os peixes detritívoros são a base da cadeia alimentar e são amplamente distribuídos nas bacias neotropicais, os Prochilodus são representativos deste grupo e o bocachico llanero ou coporo (Prochilodus mariae) é de interesse comercial na aquicultura. A fim de avaliar o desempenho produtivo nos alevinos de coporo com dietas isotópicas, foram constituídos dois tratamentos: racão comercial (δ13C -20.93±0.34) e racão experimental (δ13C -24.6±0.9) fornecidas durante 60 dias. parâmetros médios, a média de comprimento padrão, ganho de peso (GP), taxa de crescimento específico (TCE) e conversão alimentar (CA) foram determinados. A contribuição do fracionamento da dieta foram estimados com as leituras de isótopos em amostras de músculo. O peso e comprimento padrão do coporo foi maior no tratamento da dieta comercial (DC). Nos parâmetros GP e TCE houve diferença significativa (P<0,05) entre os tratamentos, o tratamento DC sempre foi maior que o dieta experimental (DE). A contribuição relativa de DC e DE foram na ordem de 59.2 e 53.4%, o fracionamento da dieta no carbono e nitrogênio da ED foi de 1.97 e 1.14%0 respectivamente. A relação entre a contribuição da dieta e ganho de peso foi mais eficiente em termos de carbono na DC mas a eficiência de nitrogênio foi maior na DE. Embora a contribuição das dietas foi menor do 60%, as duas contribuíram para melhorar o desempenho do coporo.Los peces detritívoros son la base de la cadena alimentaria y están ampliamente distribuidos en las cuencas neotropicales, los Prochilodus son representativos de este grupo y el bocachico llanero o coporo (Prochilodus mariae) es de interés comercial en acuicultura. Para evaluar el desempeño productivo en alevinos de coporo con dietas isotópicas, fueron conformados dos tratamientos: dieta comercial (δ13C -20.93±0.34) y dieta experimental (δ13C -24.6±0.9) suministradas durante sesenta días. Parámetros de peso medio, longitud media estándar, ganancia de peso (GP), tasa de crecimiento específico (TCE) y factor de conversión alimenticia (FCA) fueron determinados. La contribución y fraccionamiento de la dieta fueron estimados a partir de las lecturas isotópicas en muestras de músculo. El peso y longitud estándar del coporo fue superior en el tratamiento de la dieta comercial (DC). En los parámetros GP y TCE hubo diferencia significativa (P<0.05) entre tratamientos, siendo el tratamiento DC siempre superior frente a la dieta experimental (DE). La contribución relativa de la DC y DE fue de 59.2 y 53.4% respectivamente, en cuanto que el mayor fraccionamiento de la dieta en carbono y nitrógeno fue de la DE en 1.97 y 1.14%0 respectivamente. La relación entre la contribución de la dieta y la ganancia de peso fue más eficiente para DC en términos de carbono, contrariamente, la eficiencia del nitrógeno fue con DE. Aunque la contribución de las dietas fue inferior a 60%, ambas contribuyeron a mejorar el desempeño del coporo

Composition and dynamics of sediments in fishponds with white cachama and red tilapia

El objetivo de este estudio fue caracterizar y comparar el sedimento de estanques piscícolas comerciales de cachama blanca y tilapia rojadurante dos ciclos productivos. El sedimento fue muestreado en tres puntos del estanque y para cada especie fueron seleccionados tres estanques al azar. La materia orgánica, el pH, el fósforo disponible, los macro y micronutrientes fueron comparados entre ciclos por especie. El sedimento de estanques con cachama no fue diferente entre ciclos, excepto en calcio (P&amp;lt;0.05), pH, potasio y cobre (P&amp;lt;0.01). Entre tanto, materia orgánica, fósforo disponible (P&amp;lt;0.05) y cobre (P&amp;lt;0.01) fueron las variables con diferencia significativa entre ciclos en los sedimentos de los estanques de tilapia. El valor medio de materia orgánica (1.8%) fue inferior en los estanques de tilapia lo que podría estar asociado con la acción bioturbadora de la especie que contribuye con el proceso de mineralización de la materia orgánica.The objective of this study was to characterize and compare the sediment fish ponds commercial of cachama blanca and red tilapia during two productive cycles. The sediment was sampled at three points in the pond and for each species were selected three ponds at random. Organic matter, pH, phosphorus available, the macro- and micronutrients were compared between cycles per species. The sediment of ponds with cachama was not significant different between cycles, except in calcium (P&amp;lt;0.05), pH, potassium and copper (P&amp;lt;0.01). In the other hand, organic matter, available phosphorus (P&amp;lt;0.05) and copper (P&amp;lt;0.01) were the variables with significant different between cycles in the sediments of the ponds of tilapia. The mean value of organic matter (1.8%) was lower in tilapia ponds what could be associated with the action bioturbation of the species and contribute to the process of mineralization of organic matter

Composición y dinámica de los sedimentos en estanques de cachama blanca y tilapia roja

The objective of this study was to characterize and compare the sediment fish ponds commercial of cachama blanca and red tilapia during two productive cycles. The sediment was sampled at three points in the pond and for each species were selected three ponds at random. Organic matter, pH, phosphorus available, the macro- and micronutrients were compared between cycles per species. The sediment of ponds with cachama was not significant different between cycles, except in calcium (P<0.05), pH, potassium and copper (P<0.01). In the other hand, organic matter, available phosphorus (P<0.05) and copper (P<0.01) were the variables with significant different between cycles in the sediments of the ponds of tilapia. The mean value of organic matter (1.8%) was lower in tilapia ponds what could be associated with the action bioturbation of the species and contribute to the process of mineralization of organic matter.O objetivo deste estudo foi caracterizar e comparar os sedimentos dos viveiros comerciais de pirapitinga e tilápia para dois ciclos de produção. O sedimento foi amostrado em três pontos do viveiro e para cada espécie, foram selecionados aleatoriamente três viveiros. A matéria orgânica, pH, fósforo disponível, macro e micronutrientes foram comparados entre os ciclos por espécie. O sedimento nos viveiros de pirapitinga não diferiram entre os ciclos, exceto em cálcio (P<0,05), pH, potássio e cobre (P<0,01). Enquanto isso, a matéria orgânica, fósforo disponível (P<0,05) e cobre (P<0,01) foram as variáveis com diferenças significativas entre os ciclos em sedimentos dos viveiros de tilápia. O valor médio de matéria orgânica (1,8 %) foi mais baixa nos de tilápia e poderiam ser associadas com a ação bioturbadora da espécie que contribui para o processo de mineralização da matéria orgânica.El objetivo de este estudio fue caracterizar y comparar el sedimento de estanques piscícolas comerciales de cachama blanca y tilapia rojadurante dos ciclos productivos. El sedimento fue muestreado en tres puntos del estanque y para cada especie fueron seleccionados tres estanques al azar. La materia orgánica, el pH, el fósforo disponible, los macro y micronutrientes fueron comparados entre ciclos por especie. El sedimento de estanques con cachama no fue diferente entre ciclos, excepto en calcio (P<0.05), pH, potasio y cobre (P<0.01). Entre tanto, materia orgánica, fósforo disponible (P<0.05) y cobre (P<0.01) fueron las variables con diferencia significativa entre ciclos en los sedimentos de los estanques de tilapia. El valor medio de materia orgánica (1.8%) fue inferior en los estanques de tilapia lo que podría estar asociado con la acción bioturbadora de la especie que contribuye con el proceso de mineralización de la materia orgánica