Mortality Rate In Children Research Articles

Progress towards health equity in Vietnam: evidence from nationwide official health statistics, 2010-2020

IntroductionOne of the ultimate goals of strengthening the health system is to achieve health equity. Vietnam is considered one of the ‘fast-track countries’ to achieve the health-related Millennium Development Goals,...

Current mortality situation in Bac Ninh province in the period 2017-2020

Objective: This study aims at describing the mortality situation in Bac Ninh province from 2017-2020 Methods: A cross-sectional study design was applied. Data regarding individual mortality during 2017-2020 in Bac Ninh province was collected from mortality registration system (namely A6/YTCS). In particular, information about each mortality was collected, including: age, gender, address, date of mortality and cause of mortality. Descriptive statistics was used to show the mortality rate between age groups and gender. A log-scale was used to show the pattern across age groups in each male and female mortality. Results: The results show that the mortality rate (per 1,000 people) of children under 5 years old was lowest among age groups in 2019 compared to other years (0.73 mortality per 1,000 people). However, when comparing the under-5-mortality rate across four years, the mentioned figure was higher than 2017, 2018 and 2020. During the entire period 2017-2020, the age group over 80 years old had the highest mortality rate (per 1,000 people) from 40.82 (in 2017) to 69.90 (in 2020). For gender comparison, male had higher mortality rates than female in all age groups Conclusions: Among children under 5 years old, the mortality rate were highest in 2019 when comparing with the other years, including 2017, 2018 and 2019. Conversely, the lowest mortality trend was observed in 2017 across most age groups, except for the 20-24 and 35-39 age groups. Throughout the period, the mortality rate consistently rose in the over 80 age group. Keywords: Current situation, mortality, mortality rate

Examining the implementation of facility-based integrated management of childhood illness and insecticide treated nets in Bangladesh: lessons learned through implementation research

BackgroundBangladesh significantly reduced under-5 mortality (U5M) between 2000 and 2015, despite its low economic development and projected high mortality rates in children aged under 5 years. A portion of this success was due to implementation of health systems-delivered evidence-based interventions (EBIs) known to reduce U5M. This study aims to understand how Bangladesh was able to achieve this success between 2000 and 2015. Implementation science studies such as this one provide insights on the implementation process that are not sufficiently documented in existing literature.MethodsBetween 2017 and 2020, we conducted mixed methods implementation research case studies to examine how six countries including Bangladesh outperformed their regional and economic peers in reducing U5M. Using existing data and reports supplemented by key informant interviews, we studied key implementation strategies and associated implementation outcomes for selected EBIs and contextual factors which facilitated or hindered this work. We used facility-based integrated management of childhood illnesses and insecticide treated nets as examples of two EBIs that were implemented successfully and with wide reach across the country to understand the strategies put in place as well as the facilitating and challenging contextual factors.ResultsStrategies which contributed to the successful implementation and wide coverage of the selected EBIs included community engagement, data use, and small-scale testing, important to achieving implementation outcomes such as effectiveness, reach and fidelity, although gaps persisted including in quality of care. Key contextual factors including a strong community-based health system, accountable leadership, and female empowerment facilitated implementation of these EBIs. Challenges included human resources for health, dependence on donor funding and poor service quality in the private sector.ConclusionAs countries work to reduce U5M, they should build strong community health systems, follow global guidance, adapt their implementation using local evidence as well as build sustainability into their programs. Strategies need to leverage facilitating contextual factors while addressing challenging ones.

CHYLOTHORAX: APPROACHES TO DIAGNOSIS AND TREATMENT

Chylothorax is a rare disease and epidemiologically is most commonly found in children. It can also result in severe respiratory morbidity such as pleural effusion and has a high mortality rate in children. Conservative treatment and consideration of surgical intervention may be warranted as the primary goal of chylothorax management is to remove fluid accumulation in the pleural cavity, avoid recurrence, treat associated problems, and find the underlying cause while maintaining optimal nutrition. We report two cases of chylothorax in children. Data were collected retrospectively from children diagnosed with chylothorax in the pediatric ward of RSUD Dr. Soetomo in 2022. This is a series of cases that includes two children diagnosed with chylothorax. case series involving two patients who underwent cardiac and congenital thoracic surgery and developed chylothorax. Patients receiving partial parenteral nutrition with MCT have improved drainage outcomes. After birth, thoracentesis closes the thoracic drainage, and life support is usually necessary for babies with chylothorax because they often have poor cardiopulmonary function

Population-based Influenza and Respiratory Syncytial Virus Hospitalizations and In-hospital Mortality Rates Among Mexican Children Less Than Five Years of Age.

Population-based information regarding the impact of respiratory syncytial virus (RSV) and influenza on hospital admissions and mortality is scant for many countries. Prospective testing of RSV and influenza virus was undertaken in patients <5 years old admitted to hospital with acute respiratory infection (ARI) between July, 2014 and June, 2015, and mortality rates for children living in 3 municipalities in the state of San Luis Potosí were calculated. During the 12-month study period, 790 children living in these municipalities were admitted with ARI. RSV was detected in 245 (31%) and influenza in 47 (5.9%). History of preterm birth was recorded for 112 children on admission. For children <5 years old, ARI-, RSV- and influenza-associated admission rates were 23.2, 7.2 and 1.4 (per 1000 population), respectively. The corresponding admission rates per 1000 infants <1 year old were 78, 25.2 and 4.4. Preterm infant admission rates were 2 times higher than those of term infants. Six children died; RSV was detected in 4 (66.6%) of the deceased, while no deaths were associated with influenza. ARI and RSV in-hospital mortality rates for children <5 years were 0.18 and 0.12 per 1000 population. ARI and RSV mortality rates in preterm infants were 7 and 14 times higher than in term infants, respectively. RSV was associated with both high admission and in-hospital mortality rates in children <5 years old. Specific interventions, such as active or passive immunization, to prevent RSV infections are required to reduce ARI-associated infant mortality.

Under-five Mortality: Comparative Study of Kenya and other three East-african Developing Countries

Background An indicator called the under-five mortality rate makes it possible to compare deaths in several locations and groups of children of various sizes at once. Sub-Saharan Africa (SSA) still has a high under-five mortality rate that needs to be addressed before modifiable causes can be completely recognized. Objective The study investigates the stark disparity in mortality rates for children under five between Kenya, Rwanda, Tanzania, and Uganda. Methods The study assessed secondary data from the World Bank repository covering four East African nation's period from 1990 to 2019. Kruskal-Wallis One-way ANOVA was used in the study as a method of data analysis. Therefore, A significance threshold of 0.05 is therefore, considered for the statistical tests in this investigation, and the statistical software used is R. Results The findings showed that the under-five mortality rates of the four nations under consideration differed significantly (p&lt;0.05). The median under-five mortality for the country Kenya was 82 compared to 117 in Rwanda, Uganda was 113, while for Tanzania was 97. According to a Wilcoxon signed rank pairwise tests, there is a significant difference in under-five mortality between Kenya and Uganda. Conclusion Kenya has the lowest average under-five mortality rate (79.00 ± 26.40), while Rwanda has the highest average rate (123.53 ± 72.93). Within the review period, the average mortality rate in Rwanda was 40 higher than the average in Kenya and more than 20 more than the average for Tanzania's under-five mortality rate.

Association between Age and Mortality in Pediatric and Adult Acute Respiratory Distress Syndrome.

Rationale: The epidemiology, management, and outcomes of acute respiratory distress syndrome (ARDS) differ between children and adults, with lower mortality rates in children despite comparable severity of hypoxemia. However, the relationship between age and mortality is unclear.Objective: We aimed to define the association between age and mortality in ARDS, hypothesizing that it would be nonlinear.Methods: We performed a retrospective cohort study using data from two pediatric ARDS observational cohorts (n = 1,236), multiple adult ARDS trials (n = 5,547), and an adult observational ARDS cohort (n = 1,079). We aligned all datasets to meet Berlin criteria. We performed unadjusted and adjusted logistic regression using fractional polynomials to assess the potentially nonlinear relationship between age and 90-day mortality, adjusting for sex, PaO2/FiO2, immunosuppressed status, year of study, and observational versus randomized controlled trial, treating each individual study as a fixed effect.Measurements and Main Results: There were 7,862 subjects with median ages of 4 years in the pediatric cohorts, 52 years in the adult trials, and 61 years in the adult observational cohort. Most subjects (43%) had moderate ARDS by Berlin criteria. Ninety-day mortality was 19% in the pediatric cohorts, 33% in the adult trials, and 67% in the adult observational cohort. We found a nonlinear relationship between age and mortality, with mortality risk increasing at an accelerating rate between 11 and 65 years of age, after which mortality risk increased more slowly.Conclusions: There was a nonlinear relationship between age and mortality in pediatric and adult ARDS.

Health Problems Among Under-Five Age Group Children in Developing Countries: A Narrative Review.

The under-five age group is a crucial time for development because children's quick mental, physical, and socio-emotional aspects serve as the "building blocks" for their future development. The issue of child health is multifaceted, with certain regions, especially developing nations, experiencing an alarming rise in under-five children morbidity and mortality rates. Progress in reducing these rates in developing countries lags behind that of developed nations. Disparities in children's survival rates are pronounced worldwide, with developing nations bearing a disproportionate burden. Key contributors to child fatalities include malnutrition, respiratory infections, diarrheal diseases, measles, malaria, and neonatal complications. Extensive research utilizing prominent databases like PubMed and Google Scholar has been undertaken to explore this topic. Vaccination, adequate home care, access to medical services, and improved dietary practices emerge as crucial strategies for preventing many child fatalities. This review aims to delve into the underlying causes of illnesses and deaths among children under the age of five in developing nations.

The Influence of Health Education on Mothers' Knowledge About Prevention of Acute Respiratory Infections (ARI) in Toddlers at Majalengka Public Health Center

Acute Respiratory Infections (ARI) can be easily transmitted and if not treated immediately will cause high morbidity and mortality rates in children under five. A low level of knowledge regarding ARI in toddlers will have an impact on mothers' inability to prevent and treat children with ARI. One intervention that can be done to solve the problem of lack of knowledge is health education. This study aims to determine the effect of health education on mothers' knowledge about preventing ARI in toddlers. This type of research was quantitative and a Quasi Experimental method with a pre test-post test design. The sample in this study was 49 mothers who had ARI toddlers (1-5 years) obtained using accidental sampling technique. Data was obtained using a questionnaire and univariate analysis with the T-Test. The results of this research showed that most of the knowledge was poor (40.8%) and this increased after health education was carried out, most of the knowledge was good (46.9%). The statistical test results obtained a p value of 0.000, meaning that there is an influence of health education on mothers' knowledge about preventing ARI in toddlers. The conclusion of this research was that health education can increase knowledge about preventing ARI in toddlers. Suggestions to the community health center nurses to develop innovative and more interesting health promotion media (for example: animated videos, motion graphics, etc.). It would be better if the health promotion media can be shared widely on the internet and social media (Instagram, WhatsApp, Facebook, YouTube) so that people can easily access information provided by the Puskesmas.

Robust Immune Response and Protection against Lethal Pneumococcal Challenge with a Recombinant BCG-PspA-PdT Prime/Boost Scheme Administered to Neonatal Mice.

Pneumococcal diseases are an important public health problem, with high mortality rates in young children. Although conjugated pneumococcal vaccines offer high protection against invasive pneumococcal diseases, this is restricted to vaccine serotypes, leading to serotype replacement. Furthermore, the current vaccines do not protect neonates. Therefore, several protein-based pneumococcal vaccines have been studied over the last few decades. Our group established a recombinant BCG expressing rPspA-PdT as a prime/rPspA-PdT boost strategy, which protected adult mice against lethal intranasal pneumococcal challenge. Here, we immunized groups of neonate C57/Bl6 mice (6-10) (at 5 days) with rBCG PspA-PdT and a boost with rPspA-PdT (at 12 days). Controls were saline or each antigen alone. The prime/boost strategy promoted an IgG1 to IgG2c isotype shift compared to protein alone. Furthermore, there was an increase in specific memory cells (T and B lymphocytes) and higher cytokine production (IFN-γ, IL-17, TNF-α, IL-10, and IL-6). Immunization with rBCG PspA-PdT/rPspA-PdT showed 100% protection against pulmonary challenge with the WU2 pneumococcal strain; two doses of rPspA-PdT showed non-significant protection in the neonates. These results demonstrate that a prime/boost strategy using rBCG PspA-PdT/rPspA-PdT is effective in protecting neonates against lethal pneumococcal infection via the induction of strong antibody and cytokine responses.

Principles of management of patients with short bowel syndrome

Short bowel syndrome (SBS) is a rare disease accompanied by the phenomena of malabsorption (impaired absorption of food) and maldigestion (phenomena of creato-, steato-and amilorrhea), as a result of resection of most of the small intestine (usually with a residual part of the intestine less than 200 cm) from – due to various etiological factors. One of the severe complications of this syndrome is the development of intestinal failure, which can be manifested by the occurrence of water, electrolyte and white matter disturbances, hypovitaminosis, and deficiency of micro-and macronutrients. It is possible to suspect the development of intestinal failure if the patient continues to have repeated diarrhea 2–3 months after surgery and a progressive decrease in body weight by 5% or more of the initial weight within a month. Therefore, an important aspect in the treatment of SBS is the correction of electrolyte disturbances and maintenance of nutritional status. However, the severity of the patient’s condition is often determined not only by the course of the disease itself, but also by the long-term use of parenteral nutrition after surgery. Therefore, an important aspect in the management of patients with SBS is the cessation of parenteral nutrition as early as possible and the transition to a physiological nature of food intake. This can be achieved both by choosing certain surgical treatment techniques and by using drug therapy – an analogue of glucagon-like peptide-2 – Teduglutide, which increases the functional ability of enterocytes to absorb. SBS is a significant social problem due to the high mortality rate in childhood and a significant percentage of disability in people of working age, which makes it highly relevant to discuss the management strategy for this category of patients.

Predictors of recovery from severe acute malnutrition among 6-59 months children admitted to a hospital.

Severe acute malnutrition is a threat to child survival as mortality rates in children with severe malnutrition are nine times higher. Globally, about 19 million children are severely malnourished. This study looked at children aged 6-59 months admitted to hospital to see how quickly they recovered from severe acute malnutrition as well as what factors predicted their recovery. The study included 543 systematically chosen children with severe acute malnutrition who were admitted to the stabilization center of a hospital. Data from the patient registry were gathered using a retrospective follow-up study design. In order to find predictors of recovery, the Cox proportional hazard model was applied. From 543 children, 425 (78.27%) were recovered. The median survival time was 8 days. Having grade II edema, grade III edema, and pneumonia were negatively associated with recovery. Similarly, taking ceftriaxone, cloxacillin, and being on a nasogastric tube were associated with poor recovery. Conversely, better recovery rates were linked to exclusive breastfeeding and vitamin A supplementation. Both the recovery rate and the median survival time fell within acceptable bounds. To boost the recovery rate, efforts are needed to lessen comorbidities.

Prevalence and determinants of under-nutrition among children on ART in Ethiopia: A systematic review and meta-analysis.

Children living with HIV/AIDS are particularly vulnerable to under-nutrition. Under-nutrition associated with HIV/AIDS infection increases the rate of morbidity and mortality in children. To reaffirm a future objective, there needs to be evidence regarding the current national burden of under-nutrition and related factors among children infected with HIV. Hence, the objective of this systematic review and meta-analysis was to estimate the pooled prevalence of under-nutrition, and the pooled effect sizes of associated factors among HIV-infected children in Ethiopia. We searched Ethiopian universities' online libraries, Google, Google Scholar, PubMed, CINAHL, Cochrane Library, and Scopus to find the primary studies for this review. Publication bias was checked through Egger's regression test. Heterogeneity among the included studies was assessed using the I2 test. The data were extracted using Microsoft Excel and exported to STATA Version 14 statistical software. A random effect meta-analysis model was performed to estimate the pooled prevalence of Under-nutrition. After reviewing 1449 primary studies, 16 articles met the inclusion criteria and were included in the final meta-analysis. The estimated pooled prevalence of stunting, underweight, and wasting among children living with HIV/AIDS was 32.98% (95% CI: 22.47, 43.50), 29.76% (95% CI: 21.87, 37.66), and 21.16% (95% CI: 14.96, 27.35) respectively. This study showed that under-nutrition among HIV-infected children in Ethiopia was significantly high. Under-nutrition is more common among HIV-infected children with opportunistic infections, child feeding problems, do not adhere to dietary recommendations, and have diarrhea. The national policies and strategies for ART service- provider centers should maximize their emphasis on reducing under-nutrition among HIV-infected children. Based on this finding, we recommend HIV intervention programs to address nutritional assessment and interventions for HIV-infected children. The protocol has been registered in the PROSPERO database with a registration number of CRD-394170.

Microbiological Characteristics, Risk Factors, and Short-Term Mortality of Carbapenem-Resistant Enterobacteriaceae Bloodstream Infections in Pediatric Patients in China: A 10-Year Longitudinal Study.

Carbapenem-resistant Enterobacteriaceae (CRE) is rapidly becoming a major threat to hospitalized children worldwide. The purpose of this study was to summarize etiological characteristics and identify risk factors relevant to CRE bloodstream infection (BSI) and short-term mortality among pediatric patients in China. In this study, we included 370 inpatients ≤17 years old with BSI caused by Enterobacteriaceae in China from January 2013 to December 2022. By collecting data on demographics, etiological features, and clinical outcomes, we conducted an in-depth analysis. Among the 370 BSI patients with infections caused by Enterobacteriaceae, 35 patients (9.46%) were caused by CRE. Among these CRE strains, Klebsiella pneumoniae (49.46%) was the most important pathogen of BSI in pediatric patients, followed by Escherichia coli (31.62%) and Enterobacter cloacae (5.95%). The most frequent carbapenemase was NDM (23/35, 65.71%), followed by KPC (8/35, 22.86%). The overall 28-day mortality rate of children with an Enterobacteriaceae BSI episode was 1.89% (7/370), of which CRE BSI patients (3/35, 8.57%) were significantly higher than CSE patients (4/335, 1.19%, P < 0.001). Congenital malformation (OR: 8.162, 95% CI: 3.859-16.680, P < 0.001) and catheter-related (OR: 6.645, 95% CI: 3.159-13.28, P: <0.001) were associated with the development of CRE BSI in pediatric patients. A multivariate analysis showed that the infection of CRE (OR 7.758, 95% CI 1.869-29.62, P = 0.021) were independent risk factors for 28-day mortality of Enterobacteriaceae BSI. When the MIC of any carbapenems was ≥8 μg/mL, the mortality rate in the ICU was higher (P < 0.05). Congenital malformation, previous cephalosporin/carbapenems administration, and catheter-related conditions were closely related to the development of CRE BSI. The mortality rate of CRE BSI was higher. NDM was the predominant carbapenemase-producing mechanism in children.

АНАЛИЗ ОРГАНИЗАЦИИ ОКАЗАНИЯ МЕДИЦИНСКОЙ ПОМОЩИ ДЕТЯМ, ПРОЖИВАЮЩИМ В СЕЛЬСКОЙ МЕСТНОСТИ ОРЕНБУРГСКОЙ ОБЛАСТИ

In order to understand how the situation in rural health care is changing as a result of the processes taking place within the framework of the Healthcare project, it is necessary to periodically analyze the situation in the provision of medical care to residents of rural areas. The purpose of the study: to assess the organization of medical care for children living in rural areas of the Orenburg region. Materials and methods. An assessment of the organization of medical care for children in rural areas in the Orenburg region was carried out for the period 2016–2020. A retrospective study was conducted using the methods of statistical and epidemiological analysis. Data provided by the state budgetary healthcare institution of the Orenburg region "Medical Information and Analytical Center" (MIAC). Results. A decrease in the population of the Orenburg region in rural areas, a decrease in the number of outpatient clinics, medical outpatient clinics and FAPs have been established. There was an increase in the capacity of polyclinics by 5.8% (from 196.8 to 213.9); decrease in the indicator of provision with pediatric and infectious beds (44.0%; 9.5%); the provision of pediatricians (per 10,000 population) decreased by 11.6% (2016 - 18.1; 2020 - 16.0). The incidence of children (0-14 years old), adolescents (15-17 years old) decreased respectively by 17.6% (in cities - by 14.5%, in districts - by 15.9%) and 20.2% (in cities - by 10.7%, in districts - by 30.9%). Infant mortality (per 1000 live births) decreased by 50% (from 6.5‰ in 2016 to 3.7‰ in 2020). In rural areas, infant mortality was on average 40% higher than in urban areas. Conclusions. Structural changes in rural healthcare are associated with a reduction in the rural population and optimization of healthcare. A positive trend in morbidity was revealed, a decrease in the mortality of children and adolescents in rural areas, but there is an increase in the incidence of certain classes of diseases, there are differences in the mortality rates of children and adolescents in rural areas from the urban population.

Sistem pakar Diagnosa Penyakit Campak Pada Anak Dengan Menerapkan Metode Fuzzy Mamdani

Measles, also known as morbili in Latin and measles in English, or known as gabagen (in Banjarese) or rubeola (German measles) is a viral infection that causes chronic intrauterine infection, disrupting fetal growth and development, an infection highly contagious virus, which is characterized by fever, weakness, cough (inflammation of the connective membrane of the eye) and red spots on the skin. The group most vulnerable to contracting this disease are infants and children who have never received measles immunization. This disease is also one of the causes of high morbidity and mortality rates in infants and children. The problem of measles is that it is often difficult to detect symptoms and needs further medical treatment to find out the symptoms of measles. Ignorance of the community about traces of measles can be fatal and can even cause death. Measles is an endemic disease in developing countries, including Indonesia. Based on the results of the final calculation test at the defuzzification stage, the severity of the diagnosis of measles in children is in the definite category

Anemia in children with chronic kidney disease

Chronic kidney disease (CKD) causes numerous changes that destabilize homeostasis, of which anemia is one of its important complications. Anemia significantly reduces the quality of life in children with CKD and plays a crucial role in the progression of cardiovascular disease such as left ventricular hypertrophy, a major cause of mortality in those with advanced CKD. The treatment of anemia is a pivotal factor in reducing morbidity and mortality rates in children with CKD, representing one of the methods for enhancing patients’ quality of life.

Modelling Infant Mortality Rate using Time Series Models

The world’s main indicator of children’s health and general development is the infant mortality rate for infant under the age of five. Infant mortality is the term used to describe the death of a child before their first birthday. The infant mortality rate (IMR), which is the number of deaths of infants under one year of age per 1,000 live births, can be used to describe the prevalence of infant mortality in a population. Comparing the death rate of children under the age of five is the child mortality rate, commonly referred to as the under-five mortality rate. Nigeria, one of the nations with a high under-five mortality rate of 117 per 1,000 live births in 2019, is among those nations. The nation is among the top five nations with the highest mortality rate for children under five in 2019. This study aims to model infant mortality(Live birth and Still birth) rate using time series models and to predict the mortality rate using these models. Adeoyo Maternity Hospital Yemetu in Ibadan provided the data for this study. The data set is a monthly data and also a secondary data span for a period of 12 years (2009 to 2020). The time plot showed visual inspection and non-stationarity. Differencing was done and the unit root test performed for the purpose of comparison thereafter. Augmented-Dickey Fuller test and Phillip Perron unit root test was further tested for the establishment of stationarity in order to the main objectives. Three time series methods are the Autoregressive Integrated Moving Average Model(ARIMA), Exponential Smoothing and the Holt-Winters Method were used to model and predict the infant mortality rate data. The result shows that ARIMA order=c(0,0,1) with zero (0) mean for stillbirth and ARIMA order=c(1,0, 2) for live birth with the smallest AIC = (9.102 and 13.991). Akaike Information Criterion(AIC) values of (9.289, 14.139) and (9.102, 13.991) for live birth and still birth, respectively, were derived by exponential smoothing and Holtwinters technique. This means that Holtwinters' technique, which yielded the lowest AIC when compared to ARIMA and exponential smoothing, is the most accurate predictor of both stillbirth and live birth data. Given the high mortality rate for children under the age of five, it is crucial for the government to place more of an emphasis on health issues and to solve the problems plaguing Nigeria's child health care system.

Timing of Cardiac Surgical Interventions and Postoperative Mortality in Children With Severe Congenital Heart Defects Across Europe: Data From the EUROlinkCAT Study.

The purpose of this study was to evaluate the timing of the first cardiac surgery, the number of cardiac surgeries performed, and 30-day postoperative mortality rate for children with severe congenital heart defects (sCHDs) in their first 5 years of life. This was a population-based data linkage cohort study linking information from 9 European congenital anomaly registries to vital statistics and hospital databases. Data were extracted for 5693 children with sCHDs born from 1995 to 2004. Subgroup analyses were performed for specific types of sCHD. Children with sCHDs underwent their first surgical intervention at a median age of 3.6 (95% CI, 2.6-4.5) weeks. The timing of the first surgery for most subtypes of sCHD was consistent across Europe. In the first 5 years of life, children with hypoplastic left heart underwent the most cardiac surgeries, with a median of 4.4 (95% CI, 3.1-5.6). The 30-day postoperative mortality rate in children aged <1 year ranged from 1.1% (95% CI, 0.5%-2.1%) for tetralogy of Fallot to 23% (95% CI, 12%-37%) for Ebstein anomaly. The 30-day postoperative mortality rate was highest for children undergoing surgery in the first month of life. Overall 5-year survival for sCHD was <90% for all sCHDs, except transposition of the great arteries, tetralogy of Fallot, and coarctation of the aorta. There were no major differences among the 9 regions in the timing, 30-day postoperative mortality rate, and number of operations performed for sCHD. Despite an overall good prognosis for most congenital heart defects, some lesions were still associated with substantial postoperative death.

Characteristics and Outcome of Neonates With Postnatally Diagnosed Congenital Diaphragmatic Hernia

Congenital diaphragmatic hernia (CDH) is one of the most severe neonatal malformations with a mortality of 20-35%. Currently, the rate of prenatally recognized CDHs is 60-80%. This study investigated the characteristics and outcome data of children with prenatally unrecognized CDH. Postnatally diagnosed CDH newborns treated at the University Hospital Bonn between 2012 and 2021 were included. Treatment and outcome data were compared according to type of maternity hospital, Apgar values, and between prenatally and postnatally diagnosed CDH. Of 244 CDH newborns, 22 were included. Comparison for birth in a facility with vs. without pediatric care showed for mortality: 9% vs. 27%, p=0.478; ECMO rate: 9% vs. 36%, p=0.300; age at diagnosis: 84 vs. 129 min, p=0.049; time between intubation and diagnosis: 20 vs. 86 min, p=0.019. Newborns in the second group showed significantly worse values for pH and pCO2. Furthermore, there was a tendency for higher mortality and ECMO rates in children with an Apgar score<7 vs.≥7. Children diagnosed postnatally were significantly more likely to have moderate or severe PH and tended to have cardiac dysfunction more often than those diagnosed prenatally. In our cohort, ca. one in 10 newborns received a postnatal CDH diagnosis. Birth in a facility without pediatric care is associated with later diagnosis, which may favor hypercapnia/acidosis and more severe pulm.