Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort 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

Dependence on pseudorapidity and on centrality of charged hadron production in PbPb collisions at \sqrt^{s}_{NN}\ = 2.76 TeV

A measurement is presented of the charged hadron multiplicity in hadronic PbPb collisions, as a function of pseudorapidity and centrality, at a collision energy of 2.76 TeV per nucleon pair. The data sample is collected using the CMS detector and a minimum-bias trigger, with the CMS solenoid off. The number of charged hadrons is measured both by counting the number of reconstructed particle hits and by forming hit doublets of pairs of layers in the pixel detector. The two methods give consistent results. The charged hadron multiplicity density dN(ch)/d eta, evaluated at eta=0 for head-on collisions, is found to be 1612 +/- 55, where the uncertainty is dominated by systematic effects. Comparisons of these results to previous measurements and to various models are also presented

Charged particle transverse momentum spectra in pp collisions at s =\sqrt{s} \ = 0.9 and 7 TeV

This is the pre-print version of the Published Article which can be accessed from the link below - Copyright @ 2011 Springer-VerlagThe charged particle transverse momentum (p T) spectra are presented for pp collisions at Ös = 0.9s=09 and 7 TeV. The data samples were collected with the CMS detector at the LHC and correspond to integrated luminosities of 231 μb−1 and 2.96 pb−1, respectively. Calorimeter-based high-transverse-energy triggers are employed to enhance the statistical reach of the high-p T measurements. The results are compared with leading and next-to-leading order QCD and with an empirical scaling of measurements at different collision energies using the scaling variable x\textT º 2p\textT / Ös xT2pTs over the p T range up to 200 GeV/c. Using a combination of x T scaling and direct interpolation at fixed p T, a reference transverse momentum spectrum at Ös = 2.76s=276 TeV is constructed, which can be used for studying high-p T particle suppression in the dense QCD medium produced in heavy-ion collisions at that centre-of-mass energy