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

The determination of dehydrated apple shelf-life using accelerated assays

preview a food shelf-life is essential to evaluate the kinetics of degradation reactions beyond the orientation of the more appropriate conservation conditions of the products. For the dehydrated apple shelf-life estimative, the product was packed in PE film of 140 and stored at 5 degrees C (control), 25 degrees C (room) and 35 degrees C (accelerated) temperatures and then evaluated based on objective color readings of L, a and b Hunter during 6 months at a 15-day interval. Experimental data showed that the color degradation follows the model of a zero order kinetic reaction. The Arrhenius model was applied to reaction rates (k) at each temperature and an activation energy (E-a) of 7.6 kcal.mol(-1) and Q(10) of = 2.0 was obtained. Shelf-life evaluation was based on subjective (Difference from Control Sensorial Discriminative Test) measurements over 4 months at 15 day intervals. The results suggest that the product stored at 35 T has 100 days shelf-life time; Since Q(10)= 2.0, the product stored at room temperature might be 200 days shelf-life time.27114114

Factors associated with exclusive breastfeeding in children under four months old in Botucatu-SP, Brazil Factores asociados a la situación de lactancia materna exclusiva en niños menores de 4 meses en Botucatu-SP Fatores associados à situação do aleitamento materno exclusivo em crianças menores de 4 meses, em Botucatu-SP

This study aimed to identify factors associated with exclusive breastfeeding (AME) and the reasons mothers presented to introduce complementary feeding in the first four months of life. A total of 380 mothers (92.2%) of children under four months old vaccinated in a Multi-vaccination Campaign were interviewed. To identify factors associated to AME, univariate and multiple logistic regressions analyses were performed. Thirty-eight percent of the children were on AME; 33.4% consumed cow milk; 29.2% tea; and 22.4% water. The mothers justified introduction of cow milk by factors related to quantity/quality of maternal milk and "necessity" of the child. The use of a pacifier (odds ratio=2.63; CI95%=1.7-4.06) and difficulty to breastfeed (odds ratio=1.57; CI95%=1.02-2.41) were associated with the absence of AME. The populational attributable risk percentage for the use of a pacifier was estimated at 46.8 %. Thus, modifiable risk factors were associated with AME interruption.<br>El objetivo fue identificar factores asociados a la lactancia materna exclusiva (AME) y los motivos presentados por las madres para la introducción de alimentos complementares en los primeros 4 meses de vida. Se les entrevistaron a 380 madres (92,2%) de niños menores de 4 meses vacunados en una Campaña de Multivacunación. Para identificación de los factores asociados a la situación del niño con relación al AME, se realizaron análisis de regresión logísticas univariadas y múltiplas. En AME estaba el 38,0% de los niños; el 33,4% consumía leche de vaca; el 29,2% té y el 22,4% agua. Las madres justificaron la introducción de leche de vaca por factores relativos con la cantidad/calidad de la leche materna y "necesidad" del niño. El uso de chupete (odds ratio=2,63; IC95%=1,7-4,06) y relato de dificultad con la lactancia (odds ratio=1,57; IC95%=1,02-2,41) se asociaron a la ausencia de AME. El riesgo atribuible poblacional asociado al uso de chupete fue 46,8%. Así, factores modificables fueron identificados como de riesgo para interrupción de AME.<br>Objetivou-se identificar fatores associados ao aleitamento materno exclusivo (AME) e os motivos apresentados pelas mães para a introdução de alimentação complementar nos primeiros 4 meses de vida. Foram entrevistadas 380 mães (92,2%) de crianças menores de 4 meses vacinadas em Campanha de Multivacinação. Para identificação dos fatores associados à situação da criança em relação ao AME, realizaram-se análises de regressão logística univariadas e múltiplas. Em AME, estavam 38,0% das crianças; 33,4% consumiram leite de vaca; 29,2%, chás, e 22,4%, água. As mães justificaram a introdução de leite de vaca por fatores relativos à quantidade/ qualidade do leite materno e "necessidade" da criança. Uso de chupeta (odds ratio=2,63; IC95%=1,7-4,06) e relato de dificuldade com a amamentação (odds ratio=1,57; IC95%=1,02-2,41) associaram-se à ausência de AME. O risco atribuível populacional associado ao uso de chupeta estimado foi 46,8%. Assim, fatores modificáveis foram identificados como de risco para interrupção do AME