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

Opinião do graduando de enfermagem sobre a formação do enfermeiro para o SUS: uma análise da FAEN/UERN Opinión del estudiante de enfermería sobre la formación del enfermero para el sus: un análisis de la FAEN/UERN Opinion of the nursing graduate student on the formation of nurses for sus: an analysis of FAEN/UERN

O estudo objetivou identificar a opinião dos graduandos sobre seu processo de formação para o Sistema Único de Saúde - SUS. O objeto é a opinião dos graduandos de enfermagem sobre sua formação para o SUS. Pesquisa quantitativa, realizada com 30 discentes da Faculdade de Enfermagem - FAEN, unidade integrante da Universidade do Estado do Rio Grande do Norte - UERN. Observaram-se os aspectos éticos da Resolução 196/96 do Conselho Nacional de Saúde, incluindo a assinatura do Termo de Consentimento Livre e Esclarecido pelos discentes. Os dados foram coletados por meio de questionários, tabulados no Microsoft Excel e apresentados em tabelas. Os resultados, apesar de apontarem alguma rejeição em certos aspectos da proposta curricular, revelaram uma boa aceitação dos discentes quanto à eficiência e realização dos objetivos do Projeto Político-Pedagógico, do perfil do egresso pretendido por esse projeto de ensino, bem como de seus aspectos organizacionais, implantados em 1996, ainda vigentes.<br>El presente estudio tuvo como objetivo identificar la opinión que tienen los estudiantes sobre el proceso de formación para el Sistema Único de Salud SUS. El objeto es registrar la opinión de los estudiantes de enfermería sobre su formación para el SUS. Investigación cuantitativa, realizada con 30 estudiantes de la Facultad de Enfermería FAEN, unidad componente de la Universidad del Estado de Rio Grande del Norte UERN. Se analizaron los aspectos éticos de la Resolución 196/96 del Concejo Nacional de Salud, incluyendo la firma del Término de Consentimiento Libre, con el consentimiento de los estudiantes. Los datos fueron colectados por medio de cuestionarios, tabulados en Microsoft Excel y presentados en tablas de datos. Los resultados, a pesar de reflejar algún rechazo de ciertos aspectos de la propuesta curricular, denotaron una buena aceptación de los estudiantes en relación a la eficiencia y cumplimiento de los objetivos del Proyecto Político-Pedagógico, del perfil del egresado exigido por este proyecto de enseñanza, tanto como sus aspectos organizativos, implantados en 1996, aún en vigor.<br>The study aimed to identify the opinion of graduating students on the process of training for the Single Health System SUS. The object is the opinion of the nursing graduate students on their training for the SUS. Quantitative research, conducted with 30 students of the School of Nursing - FAEN, integrative unity of the State University of Rio Grande do Norte UERN. It was observed the ethical aspects of Resolution 196/96 of the National Health Council, including the signing of the Free and Informed Consent Term by students. Data were collected through questionnaires, tabulated in Microsoft Excel and presented in tables. Results indicate some rejection in certain aspects of the proposed curriculum, revealing a good acceptance of students on the efficiency and achievement of the objectives of the Political and Educational Project, on the desired profile of the egress for this teaching project of, as well as its organizational aspects, established in 1996, currently in use