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
Satisfação e ajuste Ă prĂłtese de indivĂduos com amputação de membro inferior
AIMS: Evaluate satisfaction and adjustment to the prosthesis of individuals with lower limb amputation.METHODS: Participants were 24 patients with lower limb amputation with 46,1±17,5 years and using the prosthesis for 10,8±8,7 years. A card was used to characterize the individuals and the Prosthesis Evaluation Questionnaire (PEQ) to evaluate satisfaction and adjustment to the prosthesis. Data were collected from institutions that serving amputees in the states of Rio Grande do Sul and Santa Catarina and analyzed by descriptive and inferential statistics at a 5% significance level.RESULTS: There was no significant difference in the results of the PEQ between individuals when compared to the level of amputation and time using the prosthesis. Regarding the scores between groups with vascular and traumatic amputation, was a significant difference in residual limb health subscale, with higher scores and consequently better health of the residual limb in amputees with vascular causes, besides better higher scores on the scale of satisfaction in these individuals.CONCLUSIONS: It was concluded that patients with a vascular cause of amputation are more satisfied with their prosthesis, with the way they walk and how things are from amputation and also have better health of the residual limb in relation to individuals with traumatic amputation. However, the level and time of amputation do not seem to influence the satisfaction and adjustment of the prosthesis.OBJETIVOS: Avaliar a satisfação e o ajuste Ă prĂłtese de indivĂduos com amputação de membro inferior.MÉTODOS: Participaram 24 indivĂduos com amputação de membro inferior com 46,1±17,5 anos e que utilizam prĂłtese há 10,8±8,7 anos. Foi utilizada uma ficha para caracterização dos indivĂduos e o questionário Prosthesis Evaluation Questionnaire (PEQ) para avaliar a satisfação e o ajuste Ă prĂłtese. Os dados foram coletados em instituições que atendem pessoas amputadas nos estados do Rio Grande do Sul e Santa Catarina e analisados pela estatĂstica descritiva e inferencial com nĂvel de significância de 5%.RESULTADOS: NĂŁo houve diferença significativa nos resultados do PEQ entre os indivĂduos quando comparados em relação ao nĂvel de amputação e ao tempo que utilizam a prĂłtese. Em relação aos escores obtidos entre os grupos com amputação vascular e traumática, houve diferença significativa na subescala de saĂşde do membro residual, com maiores escores e consequente melhor saĂşde do membro residual nos indivĂduos com amputação de causa vascular, alĂ©m de melhores escores na escala de satisfação nestes indivĂduos.CONCLUSĂ•ES: Foi possĂvel concluir que indivĂduos com amputação de causa vascular sĂŁo mais satisfeitos com sua prĂłtese, com a maneira como andam e como as coisas estĂŁo desde a amputação e tambĂ©m possuem melhor saĂşde do membro residual em relação a indivĂduos com amputação traumática. PorĂ©m, o nĂvel e o tempo de amputação parecem nĂŁo influenciar na satisfação e no ajuste Ă prĂłtese
Satisfação e ajuste Ă prĂłtese de indivĂduos com amputação de membro inferior = Satisfaction and adjustment to the prosthesis of individuals with lower limb amputation
OBJETIVOS: Avaliar a satisfação e o ajuste Ă prĂłtese de indivĂduos com amputação de membro inferior. MÉTODOS: Participaram 24 indivĂduos com amputação de membro inferior com 46,1±17,5 anos e que utilizam prĂłtese há 10,8±8,7 anos. Foi utilizada uma ficha para caracterização dos indivĂduos e o questionário Prosthesis Evaluation Questionnaire (PEQ) para avaliar a satisfação e o ajuste Ă prĂłtese. Os dados foram coletados em instituições que atendem pessoas amputadas nos estados do Rio Grande do Sul e Santa Catarina e analisados pela estatĂstica descritiva e inferencial com nĂvel de significância de 5%. RESULTADOS: NĂŁo houve diferença significativa nos resultados do PEQ entre os indivĂduos quando comparados em relação ao nĂvel de amputação e ao tempo que utilizam a prĂłtese. Em relação aos escores obtidos entre os grupos com amputação vascular e traumática, houve diferença significativa na subescala de saĂşde do membro residual, com maiores escores e consequente melhor saĂşde do membro residual nos indivĂduos com amputação de causa vascular, alĂ©m de melhores escores na escala de satisfação nestes indivĂduos. CONCLUSĂ•ES: Foi possĂvel concluir que indivĂduos com amputação de causa vascular sĂŁo mais satisfeitos com sua prĂłtese, com a maneira como andam e como as coisas estĂŁo desde a amputação e tambĂ©m possuem melhor saĂşde do membro residual em relação a indivĂduos com amputação traumática. PorĂ©m, o nĂvel e o tempo de amputação parecem nĂŁo influenciar na satisfação e no ajuste Ă prĂłtes