3 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
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
Naturaleza urbana. Plataforma de experiencias
Naturaleza Urbana presenta experiencias autogestionadas que, con el tiempo, se han posicionado como ejercicios alternativos de identificación, monitoreo y recuperación de la
biodiversidad urbana. En otros casos, el modelo comunidad-gobierno ha permitido desarrollar diagnósticos y propuestas de gestión corresponsables y sistémicas, entendiendo por esto último iniciativas que nacen desde los valores mismos que cada comunidad le atribuye a su biodiversidad. Del mismo modo, se presentan esfuerzos
gubernamentales que han enriquecido la visión ambiental de los principales
instrumentos de planificación urbana, por ejemplo, integrando la condición propiamente urbana como oportunidad para aumentar la oferta ambiental de la ciudad, fortaleciendo las funciones y procesos de la biodiversidad y revitalizando, con ello, la calidad de vida del
entorno urbano. Por su parte, las universidades y los centros de investigación se han sumado a la ola emergente de generación de conocimiento en biodiversidad urbana (fenómeno nacional e internacional), han brindado evidencia científica de su valor para el bienestar humano y han propuesto reflexiones y lineamientos cualitativos de biodiversidad, con miras a hacer del ordenamiento un ejercicio más coherente con cada
contexto territorial en particular.Bogotá, D. C., ColombiaInstituto de Investigación de Recursos Biológicos Alexander von Humbold
Urban Nature
Preservation, restoration, monitoring of biodiversity and promotion of native species, in their strict and classical sense, could be unviable strategies in the cities. Management systems such as the protected areas acquire profoundly different connotations and objectives from the traditional ones when thought of in the context of a city. Similarly, although ecological restoration seeks to return to a baseline ecosystem, there is little that we know
about the vegetation present on the urban borders of the main Colombian cities prior to the 20th century. Finally, the models for potential distribution of species could produce unreliable results, because their methodological bases were not conceived based on urban dynamics. In this context, to de ne urban biodiversity and what strategy must be applied for its conservation implies a challenge that, beyond being scienti c, is necessarily social and cultural and involves planning and design. Innovation is inevitable.Bogotá, D. C