Risk factors associated with growth failure in the follow-up of very low birth weight newborns

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Most of these PI are born weighing between the 10th and 90th percentiles of the intrauterine growth curve, considered adequate for gestational age – (AGA). However, at the discharge from the neonatal intensive care unit (NICU) or at 36 weeks post-conception age, they are below the 10th percentile of the same curve, characterizing extrauterine growth restriction (EUGR).This situation influences the prognosis of PI, both in relation to growth and to development, leading to failure to thrive in childhood, stunting, and underweight, with consequences in adulthood.<a class="elsevierStyleCrossRefs" href="#bib0150">3,12</a> Factors associated with EUGR include: nutritional practice, male gender, need for ventilation on the first day of life, use of mechanical ventilation for long periods, hospital length of stay, and complications inherent to premature birth, such as bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), and late sepsis.<a class="elsevierStyleCrossRef" href="#bib0200">13</a>The post-hospital discharge and outpatient follow-up periods can also be accompanied by several complications, such as BPD, which favors frequent respiratory complications, resulting in recurrent hospitalizations early in life; gastroesophageal reflux; presence of visual and auditory deficits; psychomotor developmental delays; and cerebral palsy.<a class="elsevierStyleCrossRefs" href="#bib0205">14,15</a>Given the current survival rates of PI, especially those with VLBW, it becomes prudent to search for better long-term results, with growth constituting the critical point to be emphasized in the care of premature infants. Thus, the authors emphasize the need to identify complications during the hospital stay and post-discharge periods to understand the growth dynamics of the PI discharged from the NICU. Hence, the aim of this study was to assess variables during the NICU hospitalization and outpatient follow-up periods that can influence failure to thrive in VLBW PI.MethodsThis study was carried out based on medical records of preterm children born with VLBW, followed at the High-Risk Outpatient Clinic of a teaching hospital located in the Western region of the state of Paraná, Brazil. This service treated 305 children from the NICU during the study period; of this total, 101 were VLBW PI, the subject of the present study.The study included the VLBW PI followed between 2006 and 2013 that had, after hospital discharge, at least three appointments at the High-Risk Outpatient Clinic during the first 12 months of life, with at least one consultation in each period of the study, as follows: Period I, up to 3 months corrected age (CA); period II, between 4 and 6 months CA; and period III, between 7 and 12 months CA. The CA was considered as the chronological age minus the weeks of gestational age at birth, subtracted from 40 weeks.Patients with severe congenital malformations, those not hospitalized at birth in the NICU of the research hospital, or those who died during follow-up were excluded. Of the total of 101 VLBW PI, there was a loss of 30 patients, of which 22 (73%) had fewer appointments or at different periods than those determined by the study to assess the PI. Therefore, the study sample comprised 71 VLBW PI, with the power of analysis of 0.84 calculated by G Power software version 3.1, available at: <a id="intr0010" class="elsevierStyleInterRef" href="http://www.gpower.hhu.de/en.html">http://www.gpower.hhu.de/en.html</a>, considering in the logistic regression an error type 1 of 0.1; error type 2 of 0.2, and significant relative risk of 2.To correlate weight/GA and calculate the Z-score of the anthropometric variables weight, height, and head circumference (HC) at birth and at the time of hospital discharge, the Fenton and Kim curve<a class="elsevierStyleCrossRef" href="#bib0140">1</a> was used with the help of Fenton Growth Chart Calculator, available at: <a id="intr0015" class="elsevierStyleInterRef" href="http://www.ucalgary.ca/fenton/">http://www.ucalgary.ca/fenton/</a>. The Z-score of the anthropometric variables of the follow-up period was calculated using the anthropometric calculator of the Anthro program (2011), available at: <a id="intr0020" class="elsevierStyleInterRef" href="http://www.who.int/childgrowth/software/en/">http://www.who.int/childgrowth/software/en/</a>. When there were more appointments during the assessed periods, the Z-score was calculated for each appointment and then the average was obtained for each follow-up period.Data were entered into Microsoft Excel® 2010 (Microsoft®, WA, USA), using the CA, and descriptive statistics were performed (minimum, maximum, mean, standard deviation, relative frequency). The variables were analyzed regarding the distribution pattern using the Shapiro–Wilks test, followed by the homogeneity test of variance through the F-test. The variables that were in accordance with the assumptions of normality and homoscedasticity were analyzed between groups children that met the inclusion criteria with those who were not in accordance with the criteria (losses), using Student's t-test for independent samples. Other variables that were not in accordance with the statistical assumptions were assessed using the nonparametric Mann–Whitney U-test.The variables were then analyzed by logistic regression. Failure to thrive (Z-score<−2) was classified as a dichotomous dependent variable (0 – failure/1 – success) and the other variables were classified as explanatory variables for the periods of hospitalization and for each of the follow-up periods (I, II, and III). The explanatory variables of the hospitalization period were: gender, weight/GA classification; time of birth weight recovery; percentage of weight lost during hospitalization; hospital length of stay.For the follow-up period, the explanatory variables were: gastroesophageal reflux (GER) – (considered as the presence of abundant and frequent vomiting after feedings); retinopathy of prematurity (ROP – considering stages 3, 4, and 5); BPD (defined as the use of oxygen at 28 days of life); use of oxygen at hospital discharge; metabolic bone disease (MBD) – (regarded as alkaline phosphatase serial measurements>900mg/dL, calcium, and phosphorus associated with clinical and radiological criteria), and rehospitalization during the post-discharge follow-up period.Therefore, models were created for the anthropometric parameters for the time of discharge, as well as one model for each follow-up period after discharge from the NICU. The explanatory admission and postnatal variables were applied to each model separately. The logit model was used for the purpose of logistic regression analysis, using the stepwise-forward method with binary response. The receiver operating characteristic (ROC) curve was adjusted using the Hosmer and Lemeshow model. At the end of the adjustment, the sensitivity (the proportion of true positives) and specificity (the proportion of true negatives) were calculated, as well as the area under the ROC curve that represents the model adjustment explicability, showing how the model discriminates the outcome (growth). All statistical analyses were performed using XLStat software, 2014 version, available at: <a id="intr0025" class="elsevierStyleInterRef" href="https://www.xlstat.com/en/">https://www.xlstat.com/en/</a>.The study was approved by the Ethics Committee on Human Research of Universidade Estadual do Oeste do Paraná (UNIOESTE), opinion No. 385.407.ResultsA total of 71 VLBW PI was evaluated, of which 36 were males, with most children born by cesarean section (59%) and mean GA of 29.4±2.8 weeks, with 70% of children classified as AGA. At discharge, 68 children (95.8%) were below the 10th percentile of the Fenton and Kim curve.<a class="elsevierStyleCrossRef" href="#bib0140">1</a> At admission, 43 (61%) used parenteral nutrition (PN), for a mean of 21.38±13.90 days. The percentage of lost birth weight averaged 13.64±6.18%. This weight loss occurred within 5.27±2.60 days and the VLBW PI took an average of 14.96±5.82 days to recover the birth weight. The length of stay was 68.73±27.26 days. At hospital discharge, mean Z-scores for weight, length, and HC were: −3.05±1.21; −2.23±1.14, and −1.5±1.45.The 30 VLBW PI not included in the study, as they did not meet the established criteria, had mean GA of 29.33±2.77 weeks (p=0.895); 23 (73%) were AGA (p=0.541), mean birth weight 1154.16±274.08g (p=0.167); had length of 36.83±2.47cm (p=0.557), HC of 27±1.62cm (p=0.288), and birthweight Z-score of −1.0±0.9 (p=0.074). Significantly similar values were observed when comparing the excluded children with those included in the study.For the 71 VLBW PI, mean Z-scores of the follow-up periods I, II, and III of each anthropometric variable showed that weight ranged from −2.4±1.3 to −1.2±1.3, length varied from −2.5±1.5 to −1.1±1.4, and HC ranged from −1.1±1.6 to −0.5±1.5 between the first and third periods.At birth, 12 (17%) VLBW PI were below −2 SD for weight, 29% for height and 13% for HC. At discharge, 57 (80%) were below −2 SD for weight. During the follow-up from Period I until Period III, there was a decrease in the percentage of PI below the Z-scores<−2 SD; regarding weight, it decreased from 49% to 27%, height from 61% to 25%, and HC from 22% to 14% in Period III.The most common morbidities in the follow-up period were GER, ROP, and BPD. MBD was observed in Periods I and II of clinical follow-up. In Period I, 13 (18.3%) children were rehospitalized, as were 12 (17%) in Periods II and III. The main cause of rehospitalization was respiratory problems, with pneumonia being the most common.When evaluating the predictive models, it was observed that the fact of being born AGA made children 10.3 times more likely to have a weight Z-score at discharge>−2 (OR=10.217, 95% CI: 1.117–93.436; p=0.04), in addition to increasing by 4.024- and 5.060-fold the chance of the weight Z-score>−2 during Periods II (OR=4.024, 95% CI: 1.210–13.383, p=0.023) and III (OR=5.060, 95% CI: 1.290–19.848; p=0.020) of the outpatient follow-up, respectively (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Longer hospital length of stay of the VLBW PI was associated with a 1.027-fold increased chance of weight at discharge<−2 SD (OR=0.973, 95% CI 0.946–1.001; p=0.057). A similar result was observed for the Z-scores of weight, height, and HC in the outpatient period. Higher percentage of weight lost during hospitalization in the NICU was associated with a 1.129-fold higher chance to fail at weight gain in Period III of follow-up (OR=0.885, 95% CI 0.794–0.987; p=0.028; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).The presence of MBD in Period I increased by more than 10-fold the risk to obtain a score<−2 SD in the same period for all assessed anthropometric parameters. Also, during Period II, there was a 4.608 higher chance of weight being<−2 SD.The occurrence of ROP in Period I increased by 7.194-fold the risk of failure to thrive for weight (OR=0.139; 95% CI: 0.027–0.723; p=0.019) and by 14.925-fold for height (OR=0.067, 95% CI: 0.008–0.571; p=0.013) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Re-hospitalization in Period II increased by 7.692-fold the chance of HC being<−2 SD in Period III (OR=0.130, 95% CI: 0.030–0.563; p=0.006). Likewise, rehospitalization in the Period III increased by 6.622-fold the risk of Z-scores<−2 SD for HC (OR=0.151, 95%CI: 0.036–0.641; p=0.010).<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows a flow chart from <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>, demonstrating the complications for each follow-up period and failures in their respective anthropometric variables.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Based on the ROC curve, the specificity, sensitivity, and explanatory power of the variables of hospital stay and the three follow-up periods were determined. The weight at discharge appears to be a good predictor among the variables that constitute the model of neonatal hospitalization, whereas in the three periods of outpatient follow-up, Z-score variations of head circumference (HC) showed better explanatory power (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>DiscussionThe main variable that influenced failure to thrive in VLBW PI during hospital stay and over the 12 months of CA was SGA, while those born AGA had 10.3 times more chance of having a Z-score for weight at discharge>−2 SD. The presence of MBD and ROP predicts risk for failure to thrive in the first and second trimesters of life of VLBW PI. Additionally, rehospitalization in the second and third trimesters of CA increased the chances of failure to thrive for the HC by 7.7- and 6.6-fold, respectively.EUGR is always considered to be a risk situation in the NICU, with variable frequencies in studies carried out in several countries: 63% in India,<a class="elsevierStyleCrossRef" href="#bib0205">14</a> 57% in Norway,<a class="elsevierStyleCrossRef" href="#bib0215">16</a> 63.5% in the state of Rio de Janeiro, Brazil,<a class="elsevierStyleCrossRef" href="#bib0170">7</a> and 39.1% in a study conducted in the same city, but approximately a decade later.<a class="elsevierStyleCrossRef" href="#bib0220">17</a> Among the assessed preterm infants, it was found that 95.6% were below the 10th percentile, a much higher EUGR rate than those found in the abovementioned studies. Of the PI that had EUGR, 12.6% had height<−2 SD in childhood, which was more common in the male gender.<a class="elsevierStyleCrossRef" href="#bib0225">18</a>Although the Z-scores of birth weight were similar<a class="elsevierStyleCrossRef" href="#bib0175">8</a> at the time of hospital discharge, there was a significant reduction when compared to the Z-score at discharge in the same study carried out in Southeastern Brazil (3.05 vs. −1.79). The present study includes children born before 2010, a period when there were different routines regarding nutrition. Standardized care practices and routines of aggressive PN and early enteral nutrition are necessary to try to avoid or minimize EUGR, which may reduce by up to 2.17-fold the risk of Z-score≤−2 SD.<a class="elsevierStyleCrossRef" href="#bib0170">7</a> Supplementation with choline, Uridine, and docosahexaenoic acid is being investigated aiming to improve growth in high-risk newborns.<a class="elsevierStyleCrossRef" href="#bib0230">19</a> Additionally, the fact that there is a multidisciplinary team in parenteral nutrition for nutritional management reduces the incidence of EUGR from 62.6% to 44%.<a class="elsevierStyleCrossRef" href="#bib0235">20</a>Being born SGA and have inadequate growth in the first year of life are risk factors for growth alterations at 24 months of CA.<a class="elsevierStyleCrossRef" href="#bib0240">21</a> Still, similar to other studies, in which being born SGA increased by 12.19 times the Z-score≤−2 SD<a class="elsevierStyleCrossRef" href="#bib0170">7</a> at term and increased by 3.41 times the risk of Z-score≤−2 SD at discharge,<a class="elsevierStyleCrossRef" href="#bib0220">17</a> being born SGA also represented an additional risk for EUGR.The failure to thrive, i.e., Z-score decrease>0.67 in follow-up periods, occurred in 28% of VLBW PI in Period II (between 4 and 8 months CA),<a class="elsevierStyleCrossRef" href="#bib0245">22</a> with BPD representing a significant predictor of failure to thrive for the Periods I (40 weeks to 4 months CA) and II of follow-up. The present study found no significant results for growth and presence of BPD; the morbidities occurring during outpatient follow-up that showed an influence on failure to thrive were MBD and the presence of ROP. Similar results showed there was no association between failure to thrive and chronic pulmonary disease; however, it was strongly influenced by severe ROP.<a class="elsevierStyleCrossRef" href="#bib0250">23</a>In a study<a class="elsevierStyleCrossRef" href="#bib0245">22</a> with extremely low birth weight PI, followed until 20 months of CA, the hospitalization rate was 40% during the entire follow-up period, with no statistical difference between those who showed failure to thrive (n=62; 40%) and those who did not (n=92; 60%). The present study's rehospitalization rate was higher (52%) and the occurrence of hospitalization during Periods II and III increased the chance of failure to thrive for the HC in Period III. This aspect is particularly relevant because in this phase of life, appropriate HC growth is essential for normal development.<a class="elsevierStyleCrossRef" href="#bib0255">24</a>Differences in the growth patterns after the discharge of VLBW PI should be considered. The findings shown here allow us to verify progressive increase in the value of the Z-score for weight, height, and HC throughout the outpatient follow-up. Although at 12 months of CA the obtained rates of these anthropometric parameters were lower than those found in Southern Brazil,<a class="elsevierStyleCrossRef" href="#bib0185">10</a> the growth rates were higher than those in an Indian study.<a class="elsevierStyleCrossRef" href="#bib0205">14</a> Thus, it is observed that one should consider, in addition to neonatal and follow-up complications inherent to preterm birth, the environment where the child lives, as well as socioeconomic, nutritional, educational, and regional cultural factors.<a class="elsevierStyleCrossRef" href="#bib0145">2</a> Many models of anthropometric variables considered significant, defined in the neonatal period and Periods I, II, and III of follow-up, showed high sensitivity and intermediate specificity, i.e. they define high probability of detecting cases of growth success, and moderately the probability of detecting cases of failure to thrive. HC showed high sensitivity, but zero specificity, except for the neonatal period. The definition of three periods for critical evaluation of the PI growth, allows a closer look by the professional to detect early failures and promote appropriate growth patterns during those moments.Based on these findings, it can be concluded that the main factor that influenced the VLBW PI throughout the hospital stay was SGA, which during hospital discharge and also over the 12 months of CA, increased failure to thrive. The presence of MBD and ROP significantly influence growth in the first quarter of the first 12 months of life of VLBW PI.Although growth is also influenced by maternal and family socioeconomic factors,<a class="elsevierStyleCrossRef" href="#bib0260">25</a> it was not possible to verify this influence in the present study, as it was retrospective, in addition to the fact that this information was not included in the reviewed medical records, significantly limiting the findings. Similarly, the number of PI that were excluded for not having the minimum number of three appointments during the first year of life constituted a limiting factor to extend the results of this study. The difficulty to perform long-term follow-up is also found in other contexts.<a class="elsevierStyleCrossRefs" href="#bib0265">26,27</a>The growth of VLBW PI during the first 12 months of life is influenced by several factors, from the nutritional status in utero, nutritional practices in the NICU and the follow-up period, as well as regional, cultural, and environmental aspects, which need to be clarified in further studies designed for this purpose.Conflicts of interestThe authors declare no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres655712" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec665332" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres655713" "titulo" => "Resumo" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusão" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec665331" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-05-18" "fechaAceptado" => "2015-09-02" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec665332" "palabras" => array:4 [ 0 => "Preterm infant" 1 => "Growth" 2 => "Very low birth weight" 3 => "Risk factors" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec665331" "palabras" => array:4 [ 0 => "Prematuro" 1 => "Crescimento" 2 => "Recém-nascido de muito baixo peso" 3 => "Fatores de risco" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveTo determine risk factors during neonatal hospital stay and follow-up associated with failure to thrive in the first year of life of very low birth weight newborns. MethodsStudy of preterm very low birth weight newborns followed from 2006 to 2013 in a public institutional hospital program. The study included newborns that attended at least one appointment in each of the three periods: Period I, up to 3 months of corrected age (CA); Period II, 4–6 months of CA; and Period III, 7–12 months of CA. The variables were analyzed by logistic regression with XLSTAT 2014 software (Microsoft®, WA, USA). Failure to thrive (Z-score below −2 SD) was classified as a dichotomous dependent variable (0 – failure/1 – success), while the other variables were classified as explanatory variables for the hospitalization periods and for each of the follow-up periods (I, II, and III). ResultsChildren born adequate for gestational age increased the chance of Z-score for weight at discharge>−2 SD (OR=10.217; 95% CI: 1.117–93.436). Metabolic bone disease and retinopathy of prematurity in Period I, as well as hospital readmissions in Periods II and III during follow-up increased the chance of Z-score<−2 SD. ConclusionFailure to thrive is influenced by intrauterine factors and, subsequently, by several morbidities, both in the birth and hospitalization period, as well as in the post-discharge period and thus, such variables should be prioritized in the follow-up." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "pt" => array:3 [ "titulo" => "Resumo" "resumen" => "ObjetivoDeterminar fatores de risco do período de internação neonatal e do seguimento ambulatorial associados à falha de crescimento no primeiro ano de vida de recém-nascidos de muito baixo peso. MétodosEstudo com crianças nascidas prematuras de muito baixo peso em acompanhamento de 2006 a 2013 em Ambulatório de Alto Risco de um Hospital Escola. Incluídas aquelas que realizaram pelo uma consulta em cada um dos três períodos assim determinados: Período I – até 3 meses de Idade Corrigida (IC); Período II – entre 4 a 6 meses de IC e Período III – entre 7 a 12 meses de IC. As variáveis foram analisadas por regressão logística com programa XLStat 2014 (Microsoft®, WA, EUA). A falha de crescimento (escore z abaixo de −2 DP) classificada como variável dependente do tipo dicotômica (0 – falha/1 – sucesso) e demais variáveis classificadas como variáveis explicativas para os períodos de internação e para cada um dos períodos de seguimento (I, II e III). ResultadosNascer Adequado para a Idade Gestacional aumenta a chance de apresentar escore Z do peso na alta hospitalar acima de −2 DP (OR=10,217; IC95% 1117–93,436). Doença Metabólica Óssea e Retinopatia da Prematuridade, durante o Período I e reinternações nos Períodos II e III de seguimento aumentam a chance de escore Z abaixo de −2 DP. ConclusãoA falha de crescimento é influenciada por fatores intrauterinos e posteriormente por diversas morbidades, tanto no período da internação como no pós-alta, tais variáveis estudadas deveriam ser priorizadas no seguimento." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusão" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Rover MM, Viera CS, Silveira RC, Guimarães AT, Grassiolli S. Risk factors associated with growth failure in the follow-up of very low birth weight newborns. J Pediatr (Rio J). 2016;92:307–13." ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1437 "Ancho" => 2496 "Tamanyo" => 138113 ] ] "descripcion" => array:1 [ "en" => "Risk factors associated with growth failure in the follow-up of very low birth weight preterm infants." ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "OR, odds ratio; 95% CI, 95% confidence interval; Period I, up to 3 months corrected age; Period II, 4–6 months corrected age; Period III, 7–12 months corrected age; AGA, adequate for gestational age." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Period \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Source \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">95% CI \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p-Value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Weight \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Discharge \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Number of days of hospitalization \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.973 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.946–1.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.057 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">AGA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.217 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.117–93.436 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.040 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Follow-up I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Number of days of hospitalization \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.979 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.961–0.998 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.030 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Follow-up II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">AGA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.024 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.210–13.383 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.023 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Follow-up III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lost weight \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.885 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.794–0.987 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.028 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">AGA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.060 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.290–19.848 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.020 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Height \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Follow-up I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Number of days of hospitalization \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.975 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.956–0.994 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.012 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Follow-up I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Number of days of hospitalization \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.975 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.954–0.997 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.023 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1077219.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Explanatory variables of the hospitalization period: gender, weight/GA ratio, birth weight recovery time, percentage of weight lost during hospitalization in the NICU, and hospital length of stay." ] ] ] "descripcion" => array:1 [ "en" => "Hospital admission variables<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> and growth failure in the follow-up of very low birth weight preterm infants." ] ] 2 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "OR, odds ratio; 95% CI, 95% confidence interval; Period I, up to 3 months corrected age; Period II, 4–6 months corrected age; Period III, 7–12 months corrected age; MBD, metabolic bone disease; ROP, retinopathy of prematurity; GER, gastroesophageal reflux." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Period \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Source \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">95% CI \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p-Value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Period I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Weight \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Follow-up I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ROP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.139 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.027–0.723 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.019 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">MBD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.076 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.009–0.653 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.019 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Follow-up II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">MBD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.217 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.059–0.794 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.021 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Height \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Follow-up I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ROP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.067 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.008–0.571 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.013 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">MBD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.089 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.010–0.783 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.029 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Follow-up I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">MBD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.026–0.383 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Period II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Follow-up III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Intern II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.130 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.030–0.563 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.006 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Period III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Follow-up III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Intern III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.151 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.036–0.641 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.010 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1077218.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn2005" "etiqueta" => "a" "nota" => "Explanatory variables of the outpatient follow-up period up to 12 months of corrected age: GER, ROP, BPD, oxygen at the time of hospital discharge, BMD, and hospitalization during the outpatient follow-up period." ] ] ] "descripcion" => array:1 [ "en" => "Outpatient follow-up variables<a class="elsevierStyleCrossRef" href="#tblfn2005">a</a> and growth failure in the follow-up of very low birth weight preterm infants." ] ] 3 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "Period I, up to 3 months corrected age; Period II, 4–6 months corrected age; Period III, 7–12 months corrected age." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Specificity (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sensitivity (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Explanatory power (%) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Hospitalization period models</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Weight Z discharge \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">79.71 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Weight Z I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58.82 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">65.71 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62.32 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Weight Z II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29.63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">85.71 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63.77 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Weight Z III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21.05 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">94.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">73.91 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Height Z I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66.67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63.64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">65.22 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HC Z I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">98.11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">78.26 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Follow-up period I models</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Weight Z I–I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">52.78 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">91.43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">71.83 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Weight Z II–I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32.14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90.70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">78.87 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Height Z I–I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">52.63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">93.94 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">71.83 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HC Z I–I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90.91 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">81.69 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HC Z III–I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80.28 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Follow-up period II models</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HC Z III–II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">85.92 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Follow-up period III models</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HC Z III–III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">85.92 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1077220.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Specificity, sensitivity, and explanatory power of variables during the hospital stay and follow-up periods." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:27 [ 0 => array:3 [ "identificador" => "bib0140" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "T.R. 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Fatores de risco associados à falha de crescimento no seguimento de recém-nascidos de muito baixo peso

Milene M.S. Rovera,

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mmsrover@hotmail.com
milenerover@uol.com.br

Corresponding author.

, Cláudia S. Vieraa, Rita C. Silveirab, Ana T.B. Guimarãesa, Sabrina Grassiollia

a Universidade Estadual do Oeste do Paraná (UNIOESTE), Cascavel, PR, Brazil

b Department of Pediatrics, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil

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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Risk factors associated with growth failure in the follow-up of very low birth weight preterm infants&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Failure to thrive during early childhood can have permanent harmful effects&#44; especially in preterm infants &#40;PI&#41;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">1</span></a> as growth&#44; mainly in those born with very low birth weight &#40;VLBW&#41;&#44; is influenced by intrauterine and birth factors&#44; as well as variables during hospitalization and post-hospital discharge&#44;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">2</span></a> causing future problems such as neurodevelopmental alterations<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">3&#44;4</span></a> and metabolic syndrome&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">5&#44;6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Studies have addressed the influence of the hospitalization period and the first years of life after discharge on the growth of PI&#44;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">7&#8211;10</span></a> demonstrating that birth &#40;weight&#44; weight&#47;GA ratio&#41; and hospitalization &#40;hospital length of stay&#44; presence of hyaline membrane disease&#41; variables have an effect on growth in the short- and long term&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">11</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">During hospitalization&#44; the VLBW preterm infant has restricted growth&#44; with significantly lower rates than the intrauterine rates&#46; Most of these PI are born weighing between the 10th and 90th percentiles of the intrauterine growth curve&#44; considered adequate for gestational age &#8211; &#40;AGA&#41;&#46; However&#44; at the discharge from the neonatal intensive care unit &#40;NICU&#41; or at 36 weeks post-conception age&#44; they are below the 10th percentile of the same curve&#44; characterizing extrauterine growth restriction &#40;EUGR&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">This situation influences the prognosis of PI&#44; both in relation to growth and to development&#44; leading to failure to thrive in childhood&#44; stunting&#44; and underweight&#44; with consequences in adulthood&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">3&#44;12</span></a> Factors associated with EUGR include&#58; nutritional practice&#44; male gender&#44; need for ventilation on the first day of life&#44; use of mechanical ventilation for long periods&#44; hospital length of stay&#44; and complications inherent to premature birth&#44; such as bronchopulmonary dysplasia &#40;BPD&#41;&#44; necrotizing enterocolitis &#40;NEC&#41;&#44; and late sepsis&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">13</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The post-hospital discharge and outpatient follow-up periods can also be accompanied by several complications&#44; such as BPD&#44; which favors frequent respiratory complications&#44; resulting in recurrent hospitalizations early in life&#59; gastroesophageal reflux&#59; presence of visual and auditory deficits&#59; psychomotor developmental delays&#59; and cerebral palsy&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">14&#44;15</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Given the current survival rates of PI&#44; especially those with VLBW&#44; it becomes prudent to search for better long-term results&#44; with growth constituting the critical point to be emphasized in the care of premature infants&#46; Thus&#44; the authors emphasize the need to identify complications during the hospital stay and post-discharge periods to understand the growth dynamics of the PI discharged from the NICU&#46; Hence&#44; the aim of this study was to assess variables during the NICU hospitalization and outpatient follow-up periods that can influence failure to thrive in VLBW PI&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">This study was carried out based on medical records of preterm children born with VLBW&#44; followed at the High-Risk Outpatient Clinic of a teaching hospital located in the Western region of the state of Paran&#225;&#44; Brazil&#46; This service treated 305 children from the NICU during the study period&#59; of this total&#44; 101 were VLBW PI&#44; the subject of the present study&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The study included the VLBW PI followed between 2006 and 2013 that had&#44; after hospital discharge&#44; at least three appointments at the High-Risk Outpatient Clinic during the first 12 months of life&#44; with at least one consultation in each period of the study&#44; as follows&#58; Period I&#44; up to 3 months corrected age &#40;CA&#41;&#59; period II&#44; between 4 and 6 months CA&#59; and period III&#44; between 7 and 12 months CA&#46; The CA was considered as the chronological age minus the weeks of gestational age at birth&#44; subtracted from 40 weeks&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Patients with severe congenital malformations&#44; those not hospitalized at birth in the NICU of the research hospital&#44; or those who died during follow-up were excluded&#46; Of the total of 101 VLBW PI&#44; there was a loss of 30 patients&#44; of which 22 &#40;73&#37;&#41; had fewer appointments or at different periods than those determined by the study to assess the PI&#46; Therefore&#44; the study sample comprised 71 VLBW PI&#44; with the power of analysis of 0&#46;84 calculated by G Power software version 3&#46;1&#44; available at&#58; <a id="intr0010" class="elsevierStyleInterRef" href="http://www.gpower.hhu.de/en.html">http&#58;&#47;&#47;www&#46;gpower&#46;hhu&#46;de&#47;en&#46;html</a>&#44; considering in the logistic regression an error type 1 of 0&#46;1&#59; error type 2 of 0&#46;2&#44; and significant relative risk of 2&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">To correlate weight&#47;GA and calculate the <span class="elsevierStyleItalic">Z</span>-score of the anthropometric variables weight&#44; height&#44; and head circumference &#40;HC&#41; at birth and at the time of hospital discharge&#44; the Fenton and Kim curve<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">1</span></a> was used with the help of Fenton Growth Chart Calculator&#44; available at&#58; <a id="intr0015" class="elsevierStyleInterRef" href="http://www.ucalgary.ca/fenton/">http&#58;&#47;&#47;www&#46;ucalgary&#46;ca&#47;fenton&#47;</a>&#46; The <span class="elsevierStyleItalic">Z</span>-score of the anthropometric variables of the follow-up period was calculated using the anthropometric calculator of the Anthro program &#40;2011&#41;&#44; available at&#58; <a id="intr0020" class="elsevierStyleInterRef" href="http://www.who.int/childgrowth/software/en/">http&#58;&#47;&#47;www&#46;who&#46;int&#47;childgrowth&#47;software&#47;en&#47;</a>&#46; When there were more appointments during the assessed periods&#44; the <span class="elsevierStyleItalic">Z</span>-score was calculated for each appointment and then the average was obtained for each follow-up period&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Data were entered into Microsoft Excel<span class="elsevierStyleSup">&#174;</span> 2010 &#40;Microsoft&#174;&#44; WA&#44; USA&#41;&#44; using the CA&#44; and descriptive statistics were performed &#40;minimum&#44; maximum&#44; mean&#44; standard deviation&#44; relative frequency&#41;&#46; The variables were analyzed regarding the distribution pattern using the Shapiro&#8211;Wilks test&#44; followed by the homogeneity test of variance through the <span class="elsevierStyleItalic">F</span>-test&#46; The variables that were in accordance with the assumptions of normality and homoscedasticity were analyzed between groups children that met the inclusion criteria with those who were not in accordance with the criteria &#40;losses&#41;&#44; using Student&#39;s <span class="elsevierStyleItalic">t</span>-test for independent samples&#46; Other variables that were not in accordance with the statistical assumptions were assessed using the nonparametric Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span>-test&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The variables were then analyzed by logistic regression&#46; Failure to thrive &#40;<span class="elsevierStyleItalic">Z</span>-score<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#8722;2&#41; was classified as a dichotomous dependent variable &#40;0 &#8211; failure&#47;1 &#8211; success&#41; and the other variables were classified as explanatory variables for the periods of hospitalization and for each of the follow-up periods &#40;I&#44; II&#44; and III&#41;&#46; The explanatory variables of the hospitalization period were&#58; gender&#44; weight&#47;GA classification&#59; time of birth weight recovery&#59; percentage of weight lost during hospitalization&#59; hospital length of stay&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">For the follow-up period&#44; the explanatory variables were&#58; gastroesophageal reflux &#40;GER&#41; &#8211; &#40;considered as the presence of abundant and frequent vomiting after feedings&#41;&#59; retinopathy of prematurity &#40;ROP &#8211; considering stages 3&#44; 4&#44; and 5&#41;&#59; BPD &#40;defined as the use of oxygen at 28 days of life&#41;&#59; use of oxygen at hospital discharge&#59; metabolic bone disease &#40;MBD&#41; &#8211; &#40;regarded as alkaline phosphatase serial measurements<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>900<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; calcium&#44; and phosphorus associated with clinical and radiological criteria&#41;&#44; and rehospitalization during the post-discharge follow-up period&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Therefore&#44; models were created for the anthropometric parameters for the time of discharge&#44; as well as one model for each follow-up period after discharge from the NICU&#46; The explanatory admission and postnatal variables were applied to each model separately&#46; The logit model was used for the purpose of logistic regression analysis&#44; using the stepwise-forward method with binary response&#46; The receiver operating characteristic &#40;ROC&#41; curve was adjusted using the Hosmer and Lemeshow model&#46; At the end of the adjustment&#44; the sensitivity &#40;the proportion of true positives&#41; and specificity &#40;the proportion of true negatives&#41; were calculated&#44; as well as the area under the ROC curve that represents the model adjustment explicability&#44; showing how the model discriminates the outcome &#40;growth&#41;&#46; All statistical analyses were performed using XLStat software&#44; 2014 version&#44; available at&#58; <a id="intr0025" class="elsevierStyleInterRef" href="https://www.xlstat.com/en/">https&#58;&#47;&#47;www&#46;xlstat&#46;com&#47;en&#47;</a>&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The study was approved by the Ethics Committee on Human Research of Universidade Estadual do Oeste do Paran&#225; &#40;UNIOESTE&#41;&#44; opinion No&#46; 385&#46;407&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0080" class="elsevierStylePara elsevierViewall">A total of 71 VLBW PI was evaluated&#44; of which 36 were males&#44; with most children born by cesarean section &#40;59&#37;&#41; and mean GA of 29&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;8 weeks&#44; with 70&#37; of children classified as AGA&#46; At discharge&#44; 68 children &#40;95&#46;8&#37;&#41; were below the 10th percentile of the Fenton and Kim curve&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">1</span></a> At admission&#44; 43 &#40;61&#37;&#41; used parenteral nutrition &#40;PN&#41;&#44; for a mean of 21&#46;38<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;90 days&#46; The percentage of lost birth weight averaged 13&#46;64<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;18&#37;&#46; This weight loss occurred within 5&#46;27<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;60 days and the VLBW PI took an average of 14&#46;96<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;82 days to recover the birth weight&#46; The length of stay was 68&#46;73<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>27&#46;26 days&#46; At hospital discharge&#44; mean <span class="elsevierStyleItalic">Z</span>-scores for weight&#44; length&#44; and HC were&#58; &#8722;3&#46;05<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;21&#59; &#8722;2&#46;23<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;14&#44; and &#8722;1&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;45&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The 30 VLBW PI not included in the study&#44; as they did not meet the established criteria&#44; had mean GA of 29&#46;33<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;77 weeks &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;895&#41;&#59; 23 &#40;73&#37;&#41; were AGA &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;541&#41;&#44; mean birth weight 1154&#46;16<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>274&#46;08<span class="elsevierStyleHsp" style=""></span>g &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;167&#41;&#59; had length of 36&#46;83<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;47<span class="elsevierStyleHsp" style=""></span>cm &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;557&#41;&#44; HC of 27<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;62<span class="elsevierStyleHsp" style=""></span>cm &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;288&#41;&#44; and birthweight <span class="elsevierStyleItalic">Z</span>-score of &#8722;1&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;9 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;074&#41;&#46; Significantly similar values were observed when comparing the excluded children with those included in the study&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">For the 71 VLBW PI&#44; mean <span class="elsevierStyleItalic">Z</span>-scores of the follow-up periods I&#44; II&#44; and III of each anthropometric variable showed that weight ranged from &#8722;2&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;3 to &#8722;1&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;3&#44; length varied from &#8722;2&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;5 to &#8722;1&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;4&#44; and HC ranged from &#8722;1&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;6 to &#8722;0&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;5 between the first and third periods&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">At birth&#44; 12 &#40;17&#37;&#41; VLBW PI were below &#8722;2 SD for weight&#44; 29&#37; for height and 13&#37; for HC&#46; At discharge&#44; 57 &#40;80&#37;&#41; were below &#8722;2 SD for weight&#46; During the follow-up from Period I until Period III&#44; there was a decrease in the percentage of PI below the <span class="elsevierStyleItalic">Z</span>-scores<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#8722;2 SD&#59; regarding weight&#44; it decreased from 49&#37; to 27&#37;&#44; height from 61&#37; to 25&#37;&#44; and HC from 22&#37; to 14&#37; in Period III&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">The most common morbidities in the follow-up period were GER&#44; ROP&#44; and BPD&#46; MBD was observed in Periods I and II of clinical follow-up&#46; In Period I&#44; 13 &#40;18&#46;3&#37;&#41; children were rehospitalized&#44; as were 12 &#40;17&#37;&#41; in Periods II and III&#46; The main cause of rehospitalization was respiratory problems&#44; with pneumonia being the most common&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">When evaluating the predictive models&#44; it was observed that the fact of being born AGA made children 10&#46;3 times more likely to have a weight <span class="elsevierStyleItalic">Z</span>-score at discharge<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>&#8722;2 &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10&#46;217&#44; 95&#37; CI&#58; 1&#46;117&#8211;93&#46;436&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;04&#41;&#44; in addition to increasing by 4&#46;024- and 5&#46;060-fold the chance of the weight <span class="elsevierStyleItalic">Z</span>-score<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>&#8722;2 during Periods II &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#46;024&#44; 95&#37; CI&#58; 1&#46;210&#8211;13&#46;383&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;023&#41; and III &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#46;060&#44; 95&#37; CI&#58; 1&#46;290&#8211;19&#46;848&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;020&#41; of the outpatient follow-up&#44; respectively &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Longer hospital length of stay of the VLBW PI was associated with a 1&#46;027-fold increased chance of weight at discharge<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#8722;2 SD &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;973&#44; 95&#37; CI 0&#46;946&#8211;1&#46;001&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;057&#41;&#46; A similar result was observed for the <span class="elsevierStyleItalic">Z</span>-scores of weight&#44; height&#44; and HC in the outpatient period&#46; Higher percentage of weight lost during hospitalization in the NICU was associated with a 1&#46;129-fold higher chance to fail at weight gain in Period III of follow-up &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;885&#44; 95&#37; CI 0&#46;794&#8211;0&#46;987&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;028&#59; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The presence of MBD in Period I increased by more than 10-fold the risk to obtain a score<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#8722;2 SD in the same period for all assessed anthropometric parameters&#46; Also&#44; during Period II&#44; there was a 4&#46;608 higher chance of weight being<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#8722;2 SD&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">The occurrence of ROP in Period I increased by 7&#46;194-fold the risk of failure to thrive for weight &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;139&#59; 95&#37; CI&#58; 0&#46;027&#8211;0&#46;723&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;019&#41; and by 14&#46;925-fold for height &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;067&#44; 95&#37; CI&#58; 0&#46;008&#8211;0&#46;571&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;013&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">Re-hospitalization in Period II increased by 7&#46;692-fold the chance of HC being<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#8722;2 SD in Period III &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;130&#44; 95&#37; CI&#58; 0&#46;030&#8211;0&#46;563&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;006&#41;&#46; Likewise&#44; rehospitalization in the Period III increased by 6&#46;622-fold the risk of <span class="elsevierStyleItalic">Z</span>-scores<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#8722;2 SD for HC &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;151&#44; 95&#37;CI&#58; 0&#46;036&#8211;0&#46;641&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;010&#41;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> shows a flow chart from <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#44; demonstrating the complications for each follow-up period and failures in their respective anthropometric variables&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">Based on the ROC curve&#44; the specificity&#44; sensitivity&#44; and explanatory power of the variables of hospital stay and the three follow-up periods were determined&#46; The weight at discharge appears to be a good predictor among the variables that constitute the model of neonatal hospitalization&#44; whereas in the three periods of outpatient follow-up&#44; <span class="elsevierStyleItalic">Z</span>-score variations of head circumference &#40;HC&#41; showed better explanatory power &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0140" class="elsevierStylePara elsevierViewall">The main variable that influenced failure to thrive in VLBW PI during hospital stay and over the 12 months of CA was SGA&#44; while those born AGA had 10&#46;3 times more chance of having a <span class="elsevierStyleItalic">Z</span>-score for weight at discharge<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>&#8722;2 SD&#46; The presence of MBD and ROP predicts risk for failure to thrive in the first and second trimesters of life of VLBW PI&#46; Additionally&#44; rehospitalization in the second and third trimesters of CA increased the chances of failure to thrive for the HC by 7&#46;7- and 6&#46;6-fold&#44; respectively&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">EUGR is always considered to be a risk situation in the NICU&#44; with variable frequencies in studies carried out in several countries&#58; 63&#37; in India&#44;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">14</span></a> 57&#37; in Norway&#44;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">16</span></a> 63&#46;5&#37; in the state of Rio de Janeiro&#44; Brazil&#44;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">7</span></a> and 39&#46;1&#37; in a study conducted in the same city&#44; but approximately a decade later&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">17</span></a> Among the assessed preterm infants&#44; it was found that 95&#46;6&#37; were below the 10th percentile&#44; a much higher EUGR rate than those found in the abovementioned studies&#46; Of the PI that had EUGR&#44; 12&#46;6&#37; had height<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#8722;2 SD in childhood&#44; which was more common in the male gender&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">18</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Although the <span class="elsevierStyleItalic">Z</span>-scores of birth weight were similar<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">8</span></a> at the time of hospital discharge&#44; there was a significant reduction when compared to the <span class="elsevierStyleItalic">Z</span>-score at discharge in the same study carried out in Southeastern Brazil &#40;3&#46;05 vs&#46; &#8722;1&#46;79&#41;&#46; The present study includes children born before 2010&#44; a period when there were different routines regarding nutrition&#46; Standardized care practices and routines of aggressive PN and early enteral nutrition are necessary to try to avoid or minimize EUGR&#44; which may reduce by up to 2&#46;17-fold the risk of <span class="elsevierStyleItalic">Z</span>-score<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>&#8722;2 SD&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">7</span></a> Supplementation with choline&#44; Uridine&#44; and docosahexaenoic acid is being investigated aiming to improve growth in high-risk newborns&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">19</span></a> Additionally&#44; the fact that there is a multidisciplinary team in parenteral nutrition for nutritional management reduces the incidence of EUGR from 62&#46;6&#37; to 44&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">20</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">Being born SGA and have inadequate growth in the first year of life are risk factors for growth alterations at 24 months of CA&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">21</span></a> Still&#44; similar to other studies&#44; in which being born SGA increased by 12&#46;19 times the <span class="elsevierStyleItalic">Z</span>-score<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>&#8722;2 SD<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">7</span></a> at term and increased by 3&#46;41 times the risk of <span class="elsevierStyleItalic">Z</span>-score<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>&#8722;2 SD at discharge&#44;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">17</span></a> being born SGA also represented an additional risk for EUGR&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">The failure to thrive&#44; <span class="elsevierStyleItalic">i&#46;e&#46;</span>&#44; <span class="elsevierStyleItalic">Z</span>-score decrease<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;67 in follow-up periods&#44; occurred in 28&#37; of VLBW PI in Period II &#40;between 4 and 8 months CA&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">22</span></a> with BPD representing a significant predictor of failure to thrive for the Periods I &#40;40 weeks to 4 months CA&#41; and II of follow-up&#46; The present study found no significant results for growth and presence of BPD&#59; the morbidities occurring during outpatient follow-up that showed an influence on failure to thrive were MBD and the presence of ROP&#46; Similar results showed there was no association between failure to thrive and chronic pulmonary disease&#59; however&#44; it was strongly influenced by severe ROP&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">23</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">In a study<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">22</span></a> with extremely low birth weight PI&#44; followed until 20 months of CA&#44; the hospitalization rate was 40&#37; during the entire follow-up period&#44; with no statistical difference between those who showed failure to thrive &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>62&#59; 40&#37;&#41; and those who did not &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>92&#59; 60&#37;&#41;&#46; The present study&#39;s rehospitalization rate was higher &#40;52&#37;&#41; and the occurrence of hospitalization during Periods II and III increased the chance of failure to thrive for the HC in Period III&#46; This aspect is particularly relevant because in this phase of life&#44; appropriate HC growth is essential for normal development&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">24</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">Differences in the growth patterns after the discharge of VLBW PI should be considered&#46; The findings shown here allow us to verify progressive increase in the value of the <span class="elsevierStyleItalic">Z</span>-score for weight&#44; height&#44; and HC throughout the outpatient follow-up&#46; Although at 12 months of CA the obtained rates of these anthropometric parameters were lower than those found in Southern Brazil&#44;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">10</span></a> the growth rates were higher than those in an Indian study&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">14</span></a> Thus&#44; it is observed that one should consider&#44; in addition to neonatal and follow-up complications inherent to preterm birth&#44; the environment where the child lives&#44; as well as socioeconomic&#44; nutritional&#44; educational&#44; and regional cultural factors&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">2</span></a> Many models of anthropometric variables considered significant&#44; defined in the neonatal period and Periods I&#44; II&#44; and III of follow-up&#44; showed high sensitivity and intermediate specificity&#44; <span class="elsevierStyleItalic">i&#46;e&#46;</span> they define high probability of detecting cases of growth success&#44; and moderately the probability of detecting cases of failure to thrive&#46; HC showed high sensitivity&#44; but zero specificity&#44; except for the neonatal period&#46; The definition of three periods for critical evaluation of the PI growth&#44; allows a closer look by the professional to detect early failures and promote appropriate growth patterns during those moments&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Based on these findings&#44; it can be concluded that the main factor that influenced the VLBW PI throughout the hospital stay was SGA&#44; which during hospital discharge and also over the 12 months of CA&#44; increased failure to thrive&#46; The presence of MBD and ROP significantly influence growth in the first quarter of the first 12 months of life of VLBW PI&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Although growth is also influenced by maternal and family socioeconomic factors&#44;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">25</span></a> it was not possible to verify this influence in the present study&#44; as it was retrospective&#44; in addition to the fact that this information was not included in the reviewed medical records&#44; significantly limiting the findings&#46; Similarly&#44; the number of PI that were excluded for not having the minimum number of three appointments during the first year of life constituted a limiting factor to extend the results of this study&#46; The difficulty to perform long-term follow-up is also found in other contexts&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">26&#44;27</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">The growth of VLBW PI during the first 12 months of life is influenced by several factors&#44; from the nutritional status <span class="elsevierStyleItalic">in utero</span>&#44; nutritional practices in the NICU and the follow-up period&#44; as well as regional&#44; cultural&#44; and environmental aspects&#44; which need to be clarified in further studies designed for this purpose&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflicts of interest</span><p id="par0190" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest&#46;</p></span></span>"
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    "fechaRecibido" => "2015-05-18"
    "fechaAceptado" => "2015-09-02"
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          "clase" => "keyword"
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            0 => "Preterm infant"
            1 => "Growth"
            2 => "Very low birth weight"
            3 => "Risk factors"
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          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec665331"
          "palabras" => array:4 [
            0 => "Prematuro"
            1 => "Crescimento"
            2 => "Rec&#233;m-nascido de muito baixo peso"
            3 => "Fatores de risco"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To determine risk factors during neonatal hospital stay and follow-up associated with failure to thrive in the first year of life of very low birth weight newborns&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Study of preterm very low birth weight newborns followed from 2006 to 2013 in a public institutional hospital program&#46; The study included newborns that attended at least one appointment in each of the three periods&#58; Period I&#44; up to 3 months of corrected age &#40;CA&#41;&#59; Period II&#44; 4&#8211;6 months of CA&#59; and Period III&#44; 7&#8211;12 months of CA&#46; The variables were analyzed by logistic regression with XLSTAT 2014 software &#40;Microsoft&#174;&#44; WA&#44; USA&#41;&#46; Failure to thrive &#40;<span class="elsevierStyleItalic">Z</span>-score below &#8722;2 SD&#41; was classified as a dichotomous dependent variable &#40;0 &#8211; failure&#47;1 &#8211; success&#41;&#44; while the other variables were classified as explanatory variables for the hospitalization periods and for each of the follow-up periods &#40;I&#44; II&#44; and III&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Children born adequate for gestational age increased the chance of <span class="elsevierStyleItalic">Z</span>-score for weight at discharge<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>&#8722;2 SD &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10&#46;217&#59; 95&#37; CI&#58; 1&#46;117&#8211;93&#46;436&#41;&#46; Metabolic bone disease and retinopathy of prematurity in Period I&#44; as well as hospital readmissions in Periods II and III during follow-up increased the chance of <span class="elsevierStyleItalic">Z</span>-score<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#8722;2 SD&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Failure to thrive is influenced by intrauterine factors and&#44; subsequently&#44; by several morbidities&#44; both in the birth and hospitalization period&#44; as well as in the post-discharge period and thus&#44; such variables should be prioritized in the follow-up&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Determinar fatores de risco do per&#237;odo de interna&#231;&#227;o neonatal e do seguimento ambulatorial associados &#224; falha de crescimento no primeiro ano de vida de rec&#233;m-nascidos de muito baixo peso&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudo com crian&#231;as nascidas prematuras de muito baixo peso em acompanhamento de 2006 a 2013 em Ambulat&#243;rio de Alto Risco de um Hospital Escola&#46; Inclu&#237;das aquelas que realizaram pelo uma consulta em cada um dos tr&#234;s per&#237;odos assim determinados&#58; Per&#237;odo I &#8211; at&#233; 3 meses de Idade Corrigida &#40;IC&#41;&#59; Per&#237;odo II &#8211; entre 4 a 6 meses de IC e Per&#237;odo III &#8211; entre 7 a 12 meses de IC&#46; As vari&#225;veis foram analisadas por regress&#227;o log&#237;stica com programa XLStat 2014 &#40;Microsoft&#174;&#44; WA&#44; EUA&#41;&#46; A falha de crescimento &#40;escore z abaixo de &#8722;2 DP&#41; classificada como vari&#225;vel dependente do tipo dicot&#244;mica &#40;0 &#8211; falha&#47;1 &#8211; sucesso&#41; e demais vari&#225;veis classificadas como vari&#225;veis explicativas para os per&#237;odos de interna&#231;&#227;o e para cada um dos per&#237;odos de seguimento &#40;I&#44; II e III&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Nascer Adequado para a Idade Gestacional aumenta a chance de apresentar escore Z do peso na alta hospitalar acima de &#8722;2 DP &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10&#44;217&#59; IC95&#37; 1117&#8211;93&#44;436&#41;&#46; Doen&#231;a Metab&#243;lica &#211;ssea e Retinopatia da Prematuridade&#44; durante o Per&#237;odo I e reinterna&#231;&#245;es nos Per&#237;odos II e III de seguimento aumentam a chance de escore Z abaixo de &#8722;2 DP&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#227;o</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A falha de crescimento &#233; influenciada por fatores intrauterinos e posteriormente por diversas morbidades&#44; tanto no per&#237;odo da interna&#231;&#227;o como no p&#243;s-alta&#44; tais vari&#225;veis estudadas deveriam ser priorizadas no seguimento&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as&#58; Rover MM&#44; Viera CS&#44; Silveira RC&#44; Guimar&#227;es AT&#44; Grassiolli S&#46; Risk factors associated with growth failure in the follow-up of very low birth weight newborns&#46; J Pediatr &#40;Rio J&#41;&#46; 2016&#59;92&#58;307&#8211;13&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Risk factors associated with growth failure in the follow-up of very low birth weight preterm infants&#46;</p>"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">OR&#44; odds ratio&#59; 95&#37; CI&#44; 95&#37; confidence interval&#59; Period I&#44; up to 3 months corrected age&#59; Period II&#44; 4&#8211;6 months corrected age&#59; Period III&#44; 7&#8211;12 months corrected age&#59; AGA&#44; adequate for gestational age&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Period&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Source&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>-Value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Weight&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Discharge&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Number of days of hospitalization&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;973&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;946&#8211;1&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;057&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">AGA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;217&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;117&#8211;93&#46;436&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;040&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Follow-up I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Number of days of hospitalization&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;979&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;961&#8211;0&#46;998&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;030&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Follow-up II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">AGA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;024&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;210&#8211;13&#46;383&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;023&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Follow-up III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Lost weight&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;885&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;794&#8211;0&#46;987&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;028&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">AGA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;060&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;290&#8211;19&#46;848&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Height&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Follow-up I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Number of days of hospitalization&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;975&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;956&#8211;0&#46;994&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Follow-up I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Number of days of hospitalization&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;975&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;954&#8211;0&#46;997&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;023&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab1077219.png"
              ]
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          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Explanatory variables of the hospitalization period&#58; gender&#44; weight&#47;GA ratio&#44; birth weight recovery time&#44; percentage of weight lost during hospitalization in the NICU&#44; and hospital length of stay&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Hospital admission variables<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> and growth failure in the follow-up of very low birth weight preterm infants&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">OR&#44; odds ratio&#59; 95&#37; CI&#44; 95&#37; confidence interval&#59; Period I&#44; up to 3 months corrected age&#59; Period II&#44; 4&#8211;6 months corrected age&#59; Period III&#44; 7&#8211;12 months corrected age&#59; MBD&#44; metabolic bone disease&#59; ROP&#44; retinopathy of prematurity&#59; GER&#44; gastroesophageal reflux&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Period&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Source&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>-Value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Period I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Weight&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Follow-up I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ROP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;139&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;027&#8211;0&#46;723&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">MBD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;076&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;009&#8211;0&#46;653&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Follow-up II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">MBD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;217&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;059&#8211;0&#46;794&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;021&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Height&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Follow-up I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ROP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;067&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;008&#8211;0&#46;571&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">MBD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;089&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;010&#8211;0&#46;783&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;029&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Follow-up I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">MBD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;026&#8211;0&#46;383&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Period II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Follow-up III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Intern II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;130&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;030&#8211;0&#46;563&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Period III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Follow-up III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Intern III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;151&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;036&#8211;0&#46;641&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1077218.png"
              ]
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          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn2005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar2005">Explanatory variables of the outpatient follow-up period up to 12 months of corrected age&#58; GER&#44; ROP&#44; BPD&#44; oxygen at the time of hospital discharge&#44; BMD&#44; and hospitalization during the outpatient follow-up period&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Outpatient follow-up variables<a class="elsevierStyleCrossRef" href="#tblfn2005"><span class="elsevierStyleSup">a</span></a> and growth failure in the follow-up of very low birth weight preterm infants&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Period I&#44; up to 3 months corrected age&#59; Period II&#44; 4&#8211;6 months corrected age&#59; Period III&#44; 7&#8211;12 months corrected age&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Specificity &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Hospitalization period models</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Weight Z discharge&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">79&#46;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Weight Z I&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65&#46;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&#46;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Weight Z II&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85&#46;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&#46;77&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73&#46;91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Height Z I&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65&#46;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>HC Z I&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">98&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78&#46;26&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">91&#46;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">71&#46;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Weight Z II&#8211;I&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&#46;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78&#46;87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Height Z I&#8211;I&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">93&#46;94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">71&#46;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>HC Z I&#8211;I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&#46;91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">81&#46;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>HC Z III&#8211;I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&#46;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Follow-up period II models</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>HC Z III&#8211;II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85&#46;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Follow-up period III models</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>HC Z III&#8211;III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85&#46;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Specificity&#44; sensitivity&#44; and explanatory power of variables during the hospital stay and follow-up periods&#46;</p>"
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      "titulo" => "References"
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                0 => array:2 [
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;G&#46; Oliveira"
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                  "host" => array:1 [
                    0 => array:2 [
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Article information

ISSN: 00217557
Original language: English

DOI:10.1016/j.jped.2015.09.006

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Year/Month	Html	Pdf	Total

2024 November	1	1	2
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2024 August	35	25	60
2024 July	35	35	70
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2024 March	20	13	33
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2022 August	60	23	83
2022 July	52	27	79
2022 June	58	28	86
2022 May	58	30	88
2022 April	41	23	64
2022 March	23	21	44
2022 February	10	19	29
2022 January	11	22	33
2021 December	14	16	30
2021 November	8	13	21
2021 October	10	14	24
2021 September	3	5	8
2021 August	7	9	16
2021 July	4	9	13
2021 June	6	5	11
2021 May	11	13	24
2021 April	13	3	16
2021 March	10	7	17
2021 February	10	4	14
2021 January	10	12	22
2020 December	7	6	13
2020 November	16	10	26
2020 October	8	8	16
2020 September	10	10	20
2020 August	2	6	8
2020 July	8	4	12
2020 June	14	5	19
2020 May	11	6	17
2020 April	15	8	23
2020 March	8	4	12
2020 February	12	11	23
2020 January	18	14	32
2019 December	15	5	20
2019 November	17	4	21
2019 October	12	11	23
2019 September	14	8	22
2019 August	11	9	20
2019 July	15	7	22
2019 June	8	10	18
2019 May	14	7	21
2019 April	14	11	25
2019 March	11	7	18
2019 February	5	3	8
2019 January	6	8	14
2018 December	11	9	20
2018 November	7	7	14
2018 October	23	20	43
2018 September	10	10	20
2018 August	7	4	11
2018 July	10	6	16
2018 June	10	5	15
2018 May	23	32	55
2018 April	9	1	10
2018 March	15	3	18
2018 February	2	1	3
2018 January	6	1	7
2017 December	1	2	3
2017 November	5	2	7
2017 October	8	0	8
2017 September	9	2	11
2017 August	2	0	2
2017 July	1	0	1
2017 June	9	2	11
2017 May	3	1	4
2017 April	5	1	6
2017 March	5	5	10
2017 February	3	5	8
2017 January	8	3	11
2016 December	5	12	17
2016 November	11	10	21
2016 October	16	16	32
2016 September	11	8	19
2016 August	16	5	21
2016 July	43	14	57
2016 June	36	10	46
2016 May	15	13	28
2016 April	7	6	13
2016 March	10	6	16

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