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

Influencia de las características del exudado nasofaríngeo sobre los resultados en la PCR para SARS-COV-2

Introduction. The coronaviruses known as SARS-COV are the cause of severe acute respiratory syndrome. One of the diagnostic tests for coronavirus is the PCR test. The results that we can find after performing the PCR test are: Negative IgM, Positive IgM, indeterminate IgM or inhibited sample.Objective. The main objective of this study was to assess whether the blood content or nasopharyngeal secretions in the PCR extraction inhibits the sample or causes an indeterminate SARS-CoV-2 result.Methodology. This study retrospectively evaluates 213 samples taken from healthcare personnel who underwent a PCR test for SARS COV-2. Parameters such as blood content, nasopharyngeal secretions, difficulty in extraction and change of nostril during the PCR extraction were analyzed.Results. 85,7% of the samples obtained an inhibited result and 78,9% an indeterminate result, when the extracted sample contained hematic content.Conclusions. We conclude that a PCR extraction with hematic content can inhibit or indeterminate the result of a PCR for SARS-COV-2, however, the PCR extraction for SARS-COV-2 with nasopharyngeal secretions, as well as the difficulty in the extraction or the change of fossa during the same, neither inhibits nor causes an indeterminate result in the result of the sample.Introducción. Los coronavirus conocidos por SARS-COV son los causantes del síndrome respiratorio agudo severo. Una de las pruebas diagnósticas del coronavirus, es el test PCR. Los resultados que podemos encontrar tras realizar el test PCR son: IgM Negativa, IgM Positiva, IgM indeterminada o muestra inhibida.Objetivo. El objetivo principal de este estudio fue evaluar si el contenido hemático o las secreciones nasofaríngeas en la extracción de PCR, inhibe la muestra u ocasiona un resultado de SARS-CoV-2 indeterminado.Metodología. Este estudio evalúa retrospectivamente 213 muestras extraídas a personal sanitario que se sometieran a una prueba de PCR de SARS COV-2. Se analizaron parámetros como contenido hemático, secreciones nasofaríngeas, dificultad en la extracción y cambio de fosa nasal durante la extracción de PCR.Resultados. Un 85,7% de las muestras obtuvieron un resultado inhibido y un 78,9% un resultado indeterminado, cuando la muestra extraída contenía contenido hemático.Conclusiones. Concluimos que una extracción de PCR con contenido hemático puede inhibir o indeterminar el resultado de una PCR para SARS-COV- 2, sin embargo, la extracción de PCR para SARS-COV-2 con secreciones nasofaríngeas, así como la dificultad en la extracción o el cambio de fosa durante la misma, no inhibe ni provoca un resultado indeterminado en el resultado de la muestra.