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. MethodsWe 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. FindingsWe 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•4...

Non-surgical procedures for the diagnosis of pediatric abdominal non-Hodgkin's lymphoma are an effective option with low morbidity rate, allowing an earlier resumption of a full diet and chemotherapy initiation. Furthermore, non-surgical procedures should also be considered for obtaining tumor samples from patients with extensive disease.

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OBJETIVO: Avaliar as diferentes posições e situações anatômicas do apêndice em pacientes pediátricos com apendicite aguda. MÉTODO: Estudo observacional do tipo corte transversal, realizado em Agosto de 2015 a Julho de 2016, na Emergência Pediátrica do Hospital da Restauração, na cidade do Recife. A amostra foi composta por 56 pacientes na faixa etária de 7 a 13 anos diagnosticados com apendicite aguda. Os dados clínico-epidemiológicos dos participantes foram obtidos antes do procedimento cirúrgico. Durante a cirurgia, foram coletadas as características anatômicas do apêndice (posição, situação, comprimento e fase da apendicite). RESULTADOS: As posições encontradas foram pélvica (37,5%), retrocecal (28,6%), pré-ileal (10,7%), pós-ileal (8,9%), subcecal (8,9%) e paracecal (5.4%). Quanto à situação, a mais vista foi descendente (46,4%), seguida por ascendente (28,6%), interna (19,6%) e externa (5,4%). As principais manifestações clínicas observadas foram dor em fossa ilíaca direita, vômitos e náuseas, independentemente da posição. Verificou-se que a fase inflamatória da apendicite foi a mais frequente em todas as posições, exceto na subcecal com 60% dos apêndices na fase perfurada. No entanto, não houve associação estatisticamente significante entre a posição subcecal e a fase da apendicite complicada (p=0,367). CONCLUSÃO: A posição pélvica e a situação descendente foram as mais frequentes na população de estudo. Não houve associação estatisticamente significante da posição do apêndice com a fase da apendicite e nem com o quadro clínico.