ABSTRACT
BACKGROUND/PURPOSE: The aim of this study was to determine the frequency of postoperative death and to identify factors associated with adverse prognosis in cases of gastroschisis managed in a tertiary hospital of Brazil. METHODS: A retrospective transverse study was conducted including all cases of gastroschisis managed at Instituto Materno-Infantil De Pernambuco (IMIP), Recife, Brazil, between January 1995 and December 1999 (n = 31). Prevalence risk (PR) was determined for several prenatal, intraoperative, and postoperative factors. RESULTS: Overall mortality rate was 52% (16 cases), and sepsis was the main cause of death (93.8%). Prenatal diagnosis reduced about 70% the risk of death. Preterm and low birth weight babies had about 3 times increase in the risk of death. Risk of death was increased twice among outborn babies, but there was no association with delivery route. Increase in risk of neonatal death was related to these other factors: birth-to-admission interval longer than 2 hours and birth-to-surgery interval longer than 4 hours. Prevalence risk also was greater with staged silo repair, poor clinical conditions before surgery, and when mechanical ventilation was needed. CONCLUSIONS: A high mortality rate was associated with absence of prenatal diagnosis, prematurity, low birth weight, delivery outside the tertiary center, and delayed surgery, worsening clinical conditions that preclude primary closure and increases need of mechanical ventilation. J Pediatr Surg 36:559-564.
Subject(s)
Digestive System Surgical Procedures , Gastroschisis/mortality , Gastroschisis/surgery , Postoperative Complications/mortality , Brazil/epidemiology , Female , Gastroschisis/diagnosis , Hospitals, Pediatric , Humans , Incidence , Infant, Newborn , Logistic Models , Male , Multivariate Analysis , Probability , Regression Analysis , Retrospective Studies , Risk Factors , Survival Rate , Treatment OutcomeABSTRACT
OBJECTIVE: The homicide rate for children and adolescents in Recife, Brazil, mostly caused by firearms, is one of the highest that has been reported. The present case-control study was designed to identify factors that were potentially modifiable through preventive interventions. METHODS: Cases were 255 homicide victims under 20 years of age, who had died in 1997 and been identified at the Institute of Forensic Medicine, Police Department, Recife, and whose relatives were interviewed by two community health workers when they claimed the corpse. The 255 controls were neighbours of the cases, paired by age and sex to them, and identified within one week of identification of each case, and whose relatives were interviewed by a third community health worker. FINDINGS: The overall homicide rate in Recife for under-20-year-olds in 1997 was 49 per 100,000; among males aged 15-19 years it was 324 per 100,000. Firearms were responsible for 97% of deaths. After multivariate logistic regression, history of personal police records (odds ratio (OR) = 18.65; 95% confidence interval (CI) = 1.91-182.50), use of illicit drugs (OR = 7.48; 95% CI = 1.86-30.17), tap water at home (OR = 7.30; 95% CI = 1.80-29.59), and maternal age at birth over 26 years (OR = 3.98; 95% CI = 1.79-8.84) were identified as risk factors, while higher education (OR = 0.22; 95% CI = 0.11-0.43), religious practice (OR = 0.25; 95% CI = 0.10-0.65), and presence of the father in the household (OR = 0.28; 95% CI = 0.09-0.81) were protective factors. CONCLUSION: Public health authorities should plan preventive interventions based on the findings of this study and should control the acquisition, possession and carrying of firearms.
Subject(s)
Crime Victims/statistics & numerical data , Homicide/statistics & numerical data , Adolescent , Brazil , Case-Control Studies , Child , Child, Preschool , Female , Humans , Logistic Models , Male , Multivariate Analysis , Risk Factors , Socioeconomic FactorsABSTRACT
Avaliacao clinico-cirurgica de 20 criancas com RGE em cinco anos. A idade tardia ao diagnostico e tempo de doenca prolongado sugerem diagnostico tardio. Sintomatologia classica com pneumopatias anteriores (85%) e desnutricao (75%) alem da associacao com outras afeccoes como atrepor esofagograma e gastroesofagocospia com tratamento conservador em todos os casos, com excecao das estenoses pepticas de esofago.Nestes pacientes e nos refratarios ao tratamento conservador foi instituida a cirurgia de Nissen, associada em alguns casos e a gastrostomia para dilatacao pos-operatoria. A mortalidade foi nula com bons resultados em relacao ao quadro clinico