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...

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Background: Infantile hemangioma (IH) is the commonest vascular tumor affecting children that appears in the first 2 weeks of life and follows a proliferative phase that continues during the first year of life. After then, it undergoes involution, which lasts for several months or years depending on the size, site, gender, and development of complications. The purpose of this prospective study was to evaluate the correlation of age and duration of propranolol therapy to the outcomes of infantile hemangioma. Methods: A prospective study included 28 patients with IH in which the propranolol therapy was initiated in a dose of 3 mg/kg/day divided into two to three doses. The surface area of IH was calculated monthly using AutoCAD software. Treatment with propranolol was discontinued when there was no more decrease in the surface area for two consecutive visits. Eleven males and 17 females completed the study. The age at initiation of therapy ranged from 2 to 16 months while at the end of therapy it was 9 to 23 months.

BackgroundEmpty scrotum may be due to many reasons; besides true undescended testis these are monorchia, retractile testis, atrophy of testis due to torsion and ectopic testis. The location of testis in an aberrant site after passing through the inguinal canal and leaving it via external ring is a condition called ectopic testis. The most common aberrant locations of ectopic testes are superficial inguinal pouch (Denis Browne pouch), within anterior abdominal wall, perineum, femoral canal, contralateral scrotum (transverse testicular ectopia) and prepenile area.MethodsDescription of management of five different cases of ectopic testes over a period of 10 years’ experience in pediatric surgery have been done with review of the literature about this rarity.ResultsFive different cases of ectopic testes were as follows: infants 3 months of age with right ectopic testis in anterior abdominal wall near anterior superior iliac spine, 4 months of age with left perineal testis, 6 months of age with an ectopic femoral testis on left side, 8 months of age with transverse testicular ectopia on left side and 10 months of age with right true undescended testis and left perineal testis.ConclusionsSearch for ectopic sites of testes should always be in mind during examination of patients with empty scrotum. Early surgical repair of ectopic testes is recommended, as there is no chance of spontaneous correction to the normal location. Long-term follow-up is necessary due to relatively high incidence of infertility and malignant transformation. Surgeons should be aware of the rare possibility of transverse testicular ectopia in cases of inguinal hernia with impalpable testis on the contralateral side.

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