Management and Outcomes of Congenital Anomalies in Low-, Middle- and High-Income Countries

NCT ID: NCT03666767

Last Updated: 2020-02-24

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

3850 participants

Study Classification

OBSERVATIONAL

Study Start Date

2018-10-01

Study Completion Date

2020-02-09

Brief Summary

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This study is a multi-centre, international, prospective cohort study of congenital anomalies to compare outcomes between LMICs and high-income countries (HICs) globally.

Detailed Description

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Background: Congenital anomalies have risen to become the 5th leading cause of death in children under 5-years of age globally, yet limited literature exists, particularly from low- and middle-income countries (LMICs) where most of these deaths occur.

Aim: To undertake a multi-centre prospective cohort study of congenital anomalies to compare outcomes between LMICs and high-income countries (HICs) globally.

Methods: The Global PaedSurg Research Collaboration will be established consisting of children's surgical care providers from around the world to participate in the study; collaborators will be co-authors of resulting presentations and publication(s). Data will be collected on patients presenting primarily with seven congenital anomalies (oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation and Hirschsprung's disease) for a minimum of one month between Oct 2018 - April 2019. Anonymous data will be collected on patient demographics, clinical status, interventions and outcome. Data will be captured using the secure, online data collection tool REDCap.

The primary outcome will be all-cause in-hospital mortality and the secondary outcomes will be occurrence of post-operative complications. Chi-squared analysis will be used to compare mortality between LMICs and HICs. Multilevel, multivariate logistic regression analysis will be undertaken to identify patient level and hospital level factors affecting outcomes with adjustment for confounding factors. P\<0.05 will be deemed significant. Study approval will be sought from all participating centres. Funding has been granted by the Wellcome Trust.

Outcomes: The study aims to be the first large-scale, geographically comprehensive, multi-centre prospective cohort study of a selection of common congenital anomalies to define current management and outcomes globally. Results will be used to aid advocacy and global health prioritisation and inform future interventional studies aimed at improving outcomes.

Conditions

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Oesophageal Atresia Congenital Diaphragmatic Hernia Intestinal Atresia Gastroschisis Exomphalos Anorectal Malformation Hirschsprung Disease

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Oesophageal atresia (OA) +/- tracheo-oesophageal fistula (TOF)

Comparisons will be made between LMICs and HICs

Intervention Type OTHER

Countries will be defined as low, middle or high-income using the World Bank classification.

Congenital diaphragmatic hernia (CDH)

Comparisons will be made between LMICs and HICs

Intervention Type OTHER

Countries will be defined as low, middle or high-income using the World Bank classification.

Intestinal atresia (IA)

Comparisons will be made between LMICs and HICs

Intervention Type OTHER

Countries will be defined as low, middle or high-income using the World Bank classification.

Gastroschisis

Comparisons will be made between LMICs and HICs

Intervention Type OTHER

Countries will be defined as low, middle or high-income using the World Bank classification.

Exomphalos

Comparisons will be made between LMICs and HICs

Intervention Type OTHER

Countries will be defined as low, middle or high-income using the World Bank classification.

Anorectal malformation (ARM)

Comparisons will be made between LMICs and HICs

Intervention Type OTHER

Countries will be defined as low, middle or high-income using the World Bank classification.

Hirschsprung's disease

Comparisons will be made between LMICs and HICs

Intervention Type OTHER

Countries will be defined as low, middle or high-income using the World Bank classification.

Interventions

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Comparisons will be made between LMICs and HICs

Countries will be defined as low, middle or high-income using the World Bank classification.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Any neonate, infant or child under the age of 16-years, presenting for the first time, with one of the study conditions can be included in the study.
* Children who have NOT previously received any surgery for their condition.
* Children who have received basic resuscitative and supportive care for their condition at a different healthcare facility and then been transferred to the study centre.
* Patients presenting primarily with one of the study conditions who receive palliative care or no care must be included within the study to reflect true outcomes.

Exclusion Criteria

* Any neonate, infant or child with one of the study conditions who has previously received surgery (including a stoma) for their condition
* If they have recently received surgery for their condition, were discharged and then represented with a complication of the surgery during the study period they should NOT be included in the study.
Maximum Eligible Age

16 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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King's College London

OTHER

Sponsor Role lead

Responsible Party

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Miss Naomi Wright

Miss Naomi Wright

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Naomi J Wright, MBChB BSc MRCS DCH MSc

Role: PRINCIPAL_INVESTIGATOR

King's College London

Locations

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King's College London

London, , United Kingdom

Site Status

Countries

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United Kingdom

References

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Wright NJ; Global PaedSurg Research Collaboration. Management and outcomes of gastrointestinal congenital anomalies in low, middle and high income countries: protocol for a multicentre, international, prospective cohort study. BMJ Open. 2019 Sep 3;9(8):e030452. doi: 10.1136/bmjopen-2019-030452.

Reference Type DERIVED
PMID: 31481373 (View on PubMed)

Other Identifiers

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GPSv7.7/6/2018

Identifier Type: -

Identifier Source: org_study_id

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