Statistics

 array:25 [
  "pii" => "S0021755718301190"
  "issn" => "00217557"
  "doi" => "10.1016/j.jped.2018.05.013"
  "estado" => "S300"
  "fechaPublicacion" => "2019-09-01"
  "aid" => "691"
  "copyright" => "Sociedade Brasileira de Pediatria"
  "copyrightAnyo" => "2018"
  "documento" => "article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "fla"
  "cita" => "J Pediatr (Rio J). 2019;95:600-6"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 791
    "formatos" => array:3 [
      "EPUB" => 64
      "HTML" => 379
      "PDF" => 348
    ]
  ]
  "Traduccion" => array:1 [
    "pt" => array:20 [
      "pii" => "S2255553618301496"
      "issn" => "22555536"
      "doi" => "10.1016/j.jpedp.2018.05.014"
      "estado" => "S300"
      "fechaPublicacion" => "2019-09-01"
      "aid" => "691"
      "copyright" => "Sociedade Brasileira de Pediatria"
      "documento" => "article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "fla"
      "cita" => "J Pediatr (Rio J). 2019;95:600-6"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 852
        "formatos" => array:3 [
          "EPUB" => 64
          "HTML" => 470
          "PDF" => 318
        ]
      ]
      "pt" => array:12 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Artigo Original</span>"
        "titulo" => "Prevalence and causes of congenital microcephaly in the absence of a Zika virus outbreak in southern Brazil"
        "tienePdf" => "pt"
        "tieneTextoCompleto" => "pt"
        "tieneResumen" => array:2 [
          0 => "en"
          1 => "pt"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "600"
            "paginaFinal" => "606"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "pt" => array:1 [
            "titulo" => "Preval&#234;ncia e causas da microcefalia cong&#234;nita sem a presen&#231;a do surto do v&#237;rus Zika no Sul do Brasil"
          ]
        ]
        "contieneResumen" => array:2 [
          "en" => true
          "pt" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "pt" => true
        ]
        "contienePdf" => array:1 [
          "pt" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Silvani Herber, Andr&#233; A&#46; Silva, Maria Teresa V&#46; Sanseverino, Luciana Friedrich, Tani M&#46;S&#46; Ranieri, Catia Favreto, Lucas R&#46; Fraga, Anna P&#46; Terra, Ida V&#46;D&#46; Schwartz, Lav&#237;nia Schuler&#8208;Faccini"
            "autores" => array:10 [
              0 => array:2 [
                "nombre" => "Silvani"
                "apellidos" => "Herber"
              ]
              1 => array:2 [
                "nombre" => "Andr&#233; A&#46;"
                "apellidos" => "Silva"
              ]
              2 => array:2 [
                "nombre" => "Maria Teresa V&#46;"
                "apellidos" => "Sanseverino"
              ]
              3 => array:2 [
                "nombre" => "Luciana"
                "apellidos" => "Friedrich"
              ]
              4 => array:2 [
                "nombre" => "Tani M&#46;S&#46;"
                "apellidos" => "Ranieri"
              ]
              5 => array:2 [
                "nombre" => "Catia"
                "apellidos" => "Favreto"
              ]
              6 => array:2 [
                "nombre" => "Lucas R&#46;"
                "apellidos" => "Fraga"
              ]
              7 => array:2 [
                "nombre" => "Anna P&#46;"
                "apellidos" => "Terra"
              ]
              8 => array:2 [
                "nombre" => "Ida V&#46;D&#46;"
                "apellidos" => "Schwartz"
              ]
              9 => array:2 [
                "nombre" => "Lav&#237;nia"
                "apellidos" => "Schuler&#8208;Faccini"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "pt"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S0021755718301190"
          "doi" => "10.1016/j.jped.2018.05.013"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0021755718301190?idApp=UINPBA000049"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2255553618301496?idApp=UINPBA000049"
      "url" => "/22555536/0000009500000005/v1_201910010646/S2255553618301496/v1_201910010646/pt/main.assets"
    ]
  ]
  "itemSiguiente" => array:20 [
    "pii" => "S0021755718300792"
    "issn" => "00217557"
    "doi" => "10.1016/j.jped.2018.05.015"
    "estado" => "S300"
    "fechaPublicacion" => "2019-09-01"
    "aid" => "693"
    "copyright" => "Sociedade Brasileira de Pediatria"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "J Pediatr &#40;Rio J&#41;. 2019;95:607-13"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 761
      "formatos" => array:3 [
        "EPUB" => 81
        "HTML" => 475
        "PDF" => 205
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Does height catch-up in schoolchildren have an effect on bone mass in adolescents&#63; Analysis in a Brazilian birth cohort"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "607"
          "paginaFinal" => "613"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "<span class="elsevierStyleItalic">Catch-up</span> de estatura em escolares tem efeito sobre massa &#243;ssea em adolescentes&#63; An&#225;lise em uma coorte brasileira de nascimento"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1707
              "Ancho" => 2577
              "Tamanyo" => 370297
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Nearest neighbor-type theoretical model of the association between height catch-up and bone mass developed by the authors&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Livia dos Santos Rodrigues, Ros&#226;ngela F&#46;L&#46; Batista, Vanda M&#46;F&#46; Sim&#245;es, Mariz&#233;lia R&#46;C&#46; Rodrigues, Marco A&#46; Barbieri, Helo&#237;sa Bettiol, Antonio A&#46;M&#46; da Silva"
          "autores" => array:7 [
            0 => array:2 [
              "nombre" => "Livia dos Santos"
              "apellidos" => "Rodrigues"
            ]
            1 => array:2 [
              "nombre" => "Ros&#226;ngela F&#46;L&#46;"
              "apellidos" => "Batista"
            ]
            2 => array:2 [
              "nombre" => "Vanda M&#46;F&#46;"
              "apellidos" => "Sim&#245;es"
            ]
            3 => array:2 [
              "nombre" => "Mariz&#233;lia R&#46;C&#46;"
              "apellidos" => "Rodrigues"
            ]
            4 => array:2 [
              "nombre" => "Marco A&#46;"
              "apellidos" => "Barbieri"
            ]
            5 => array:2 [
              "nombre" => "Helo&#237;sa"
              "apellidos" => "Bettiol"
            ]
            6 => array:2 [
              "nombre" => "Antonio A&#46;M&#46; da"
              "apellidos" => "Silva"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "pt" => array:9 [
        "pii" => "S2255553618301617"
        "doi" => "10.1016/j.jpedp.2018.08.017"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "pt"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2255553618301617?idApp=UINPBA000049"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0021755718300792?idApp=UINPBA000049"
    "url" => "/00217557/0000009500000005/v1_201910010656/S0021755718300792/v1_201910010656/en/main.assets"
  ]
  "itemAnterior" => array:20 [
    "pii" => "S0021755718301657"
    "issn" => "00217557"
    "doi" => "10.1016/j.jped.2018.05.003"
    "estado" => "S300"
    "fechaPublicacion" => "2019-09-01"
    "aid" => "675"
    "copyright" => "Sociedade Brasileira de Pediatria"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "J Pediatr &#40;Rio J&#41;. 2019;95:593-9"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 667
      "formatos" => array:3 [
        "EPUB" => 71
        "HTML" => 415
        "PDF" => 181
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Vascular endothelial growth factor and pulmonary hypertension in children with beta thalassemia major"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "593"
          "paginaFinal" => "599"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Fator de crescimento endotelial vascular e hipertens&#227;o pulmonar em crian&#231;as com talassemia beta maior"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1433
              "Ancho" => 1408
              "Tamanyo" => 74927
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">ROC curve study in which serum level of VEGF at cutoff point of &#62;169<span class="elsevierStyleHsp" style=""></span>pg&#47;mL with area under the curve 0&#46;956 had sensitivity of 93&#46;1&#37; and specificity of 93&#46;1&#37; for the presence of PAH in children with &#946;-thalassemia major&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Usama M&#46; Alkholy, Soma Abdalla Mohamed, Marwa Elhady, Shahinaz El Attar, Nermin Abdalmonem, Ahmed Zaki"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "Usama M&#46;"
              "apellidos" => "Alkholy"
            ]
            1 => array:2 [
              "nombre" => "Soma Abdalla"
              "apellidos" => "Mohamed"
            ]
            2 => array:2 [
              "nombre" => "Marwa"
              "apellidos" => "Elhady"
            ]
            3 => array:2 [
              "nombre" => "Shahinaz El"
              "apellidos" => "Attar"
            ]
            4 => array:2 [
              "nombre" => "Nermin"
              "apellidos" => "Abdalmonem"
            ]
            5 => array:2 [
              "nombre" => "Ahmed"
              "apellidos" => "Zaki"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "pt" => array:9 [
        "pii" => "S2255553618301162"
        "doi" => "10.1016/j.jpedp.2018.06.015"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "pt"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2255553618301162?idApp=UINPBA000049"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0021755718301657?idApp=UINPBA000049"
    "url" => "/00217557/0000009500000005/v1_201910010656/S0021755718301657/v1_201910010656/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
    "titulo" => "Prevalence and causes of congenital microcephaly in the absence of a Zika virus outbreak in southern Brazil"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "600"
        "paginaFinal" => "606"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Silvani Herber, Andr&#233; A&#46; Silva, Maria Teresa V&#46; Sanseverino, Luciana Friedrich, Tani M&#46;S&#46; Ranieri, Catia Favreto, Lucas R&#46; Fraga, Anna P&#46; Terra, Ida V&#46;D&#46; Schwartz, Lav&#237;nia Schuler-Faccini"
        "autores" => array:10 [
          0 => array:3 [
            "nombre" => "Silvani"
            "apellidos" => "Herber"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Andr&#233; A&#46;"
            "apellidos" => "Silva"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Maria Teresa V&#46;"
            "apellidos" => "Sanseverino"
            "referencia" => array:4 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
              3 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">i</span>"
                "identificador" => "aff0045"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Luciana"
            "apellidos" => "Friedrich"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">f</span>"
                "identificador" => "aff0030"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Tani M&#46;S&#46;"
            "apellidos" => "Ranieri"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">j</span>"
                "identificador" => "aff0050"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Catia"
            "apellidos" => "Favreto"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">j</span>"
                "identificador" => "aff0050"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "Lucas R&#46;"
            "apellidos" => "Fraga"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">g</span>"
                "identificador" => "aff0035"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "Anna P&#46;"
            "apellidos" => "Terra"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
          8 => array:3 [
            "nombre" => "Ida V&#46;D&#46;"
            "apellidos" => "Schwartz"
            "referencia" => array:3 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">i</span>"
                "identificador" => "aff0045"
              ]
            ]
          ]
          9 => array:4 [
            "nombre" => "Lav&#237;nia"
            "apellidos" => "Schuler-Faccini"
            "email" => array:1 [
              0 => "lavinia.faccini@ufrgs.br"
            ]
            "referencia" => array:6 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">g</span>"
                "identificador" => "aff0035"
              ]
              3 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">h</span>"
                "identificador" => "aff0040"
              ]
              4 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">i</span>"
                "identificador" => "aff0045"
              ]
              5 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:10 [
          0 => array:3 [
            "entidad" => "Universidade Federal do Rio Grande do Sul &#40;UFRGS&#41;&#44; Programa de P&#243;s-gradua&#231;&#227;o em Medicina em Ci&#234;ncias M&#233;dicas&#44; Porto Alegre&#44; RS&#44; Brazil"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Universidade do Vale do Taquari &#40;UNIVATES&#41;&#44; Faculdade de Medicina&#44; Lajeado&#44; RS&#44; Brazil"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Sistema Nacional de Informa&#231;&#227;o sobre Agentes Teratog&#234;nicos &#40;SIAT&#41;&#44; Porto Alegre&#44; RS&#44; Brazil"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Hospital de Cl&#237;nicas de Porto Alegre&#44; Servi&#231;o de Gen&#233;tica M&#233;dica&#44; Porto Alegre&#44; RS&#44; Brazil"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
          4 => array:3 [
            "entidad" => "Pontif&#237;cia Universidade Cat&#243;lica do Rio Grande do Sul &#40;PUCRS&#41;&#44; Faculdade de Medicina&#44; Porto Alegre&#44; RS&#44; Brazil"
            "etiqueta" => "e"
            "identificador" => "aff0025"
          ]
          5 => array:3 [
            "entidad" => "Universidade Federal do Rio Grande do Sul &#40;UFRGS&#41;&#44; Servi&#231;o de Pediatria&#44; Porto Alegre&#44; RS&#44; Brazil"
            "etiqueta" => "f"
            "identificador" => "aff0030"
          ]
          6 => array:3 [
            "entidad" => "Universidade Federal do Rio Grande do Sul &#40;UFRGS&#41;&#44; Programa de P&#243;s-gradu&#231;&#227;o em Gen&#233;tica e Biologia Molecular&#44; Porto Alegre&#44; RS&#44; Brazil"
            "etiqueta" => "g"
            "identificador" => "aff0035"
          ]
          7 => array:3 [
            "entidad" => "Instituto Nacional de Ci&#234;ncia e Tecnologia de Gen&#233;tica M&#233;dica Populacional &#40;INaGeMP&#41;&#44; Porto Alegre&#44; RS&#44; Brazil"
            "etiqueta" => "h"
            "identificador" => "aff0040"
          ]
          8 => array:3 [
            "entidad" => "Universidade Federal do Rio Grande do Sul &#40;UFRGS&#41;&#44; Departamento de Gen&#233;tica&#44; Porto Alegre&#44; RS&#44; Brazil"
            "etiqueta" => "i"
            "identificador" => "aff0045"
          ]
          9 => array:3 [
            "entidad" => "Secretaria de Sa&#250;de do Estado do Rio Grande do Sul &#40;SES&#47;RS&#41;&#44; Centro Estadual de Vigil&#226;ncia em Sa&#250;de &#40;CEVS&#41;&#44; Porto Alegre&#44; RS&#44; Brazil"
            "etiqueta" => "j"
            "identificador" => "aff0050"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "pt" => array:1 [
        "titulo" => "Preval&#234;ncia e causas da microcefalia cong&#234;nita sem a presen&#231;a do surto do v&#237;rus Zika no Sul do Brasil"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">In February 2016&#44; the World Health Organization &#40;WHO&#41; declared a Public Health Emergency of International Concern &#40;PHEIC&#41; regarding the Zika virus &#40;ZIKV&#41; infection in Latin America and its possible association with clusters of microcephaly&#46; Earlier&#44; in November 2015&#44; the Brazilian Ministry of Health &#40;MoH&#41; had implemented mandatory reporting of neonatal microcephaly and&#47;or other central nervous system &#40;CNS&#41; abnormalities&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">1</span></a> The association between CNS abnormalities including microcephaly and prenatal infection to ZIKV was proved in 2016&#44;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">2&#44;3</span></a> and a congenital ZIKV syndrome was defined&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">However&#44; congenital microcephaly is a heterogeneous diagnosis based on a measure of head circumference&#44; with a number of genetic and environmental causes described to date&#44; including congenital infections&#44; genetic syndromes&#44; and isolated CNS malformations&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">1&#44;5&#44;6</span></a> Most current guidelines define microcephaly as an occipitofrontal circumference &#40;OFC&#41;&#44; or head circumference &#40;HC&#41;&#44; more than two standard deviations &#40;SDs&#41; below the population mean&#44; and severe microcephaly as HC &#60;3 SD below the mean&#46; HC is an indirect measure of brain size and may be a predictor of abnormal cerebral development&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">1&#44;7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The causes of microcephaly often remain unknown&#46; In retrospective studies&#44; no etiology was identified in 40&#8211;70&#37; of cases&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">5&#44;6</span></a> Mandatory reporting of microcephaly enables a more in-depth assessment of those cases&#46; However&#44; there is a well-established association between microcephaly and maternal infections&#44; especially those occurring in the first 12 weeks of pregnancy&#44; which can lead to characteristic forms of brain damage&#46; Besides microcephaly&#44; the manifestations include hydrocephalus&#44; cerebral calcifications&#44; ventriculomegaly&#44; cortical migration disorders&#44; white-matter abnormalities&#44; and cerebellar hypoplasia&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Before 2015&#44; the estimated prevalence of severe microcephaly at birth in Brazil was 0&#46;5 per 10<span class="elsevierStyleHsp" style=""></span>000 live births&#46; After identification of the possible association between ZIKV infection and microcephaly in northeast Brazil&#44; this prevalence rose to around 20 cases per 10<span class="elsevierStyleHsp" style=""></span>000 live births&#46; The northeastern states of Brazil had the highest incidence of ZIKV disease among the general population &#40;34&#47;10<span class="elsevierStyleHsp" style=""></span>000 in the state of Bahia in 2016&#41;&#46; Conversely&#44; in Rio Grande do Sul &#40;RS&#41;&#44; Brazil&#39;s southernmost state&#44; no outbreak occurred&#44; even though autochthonous cases were identified at the beginning of 2016&#44; and the peak incidence was only 1&#46;7 cases per 100<span class="elsevierStyleHsp" style=""></span>000 people&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">9</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Study design</span><p id="par0025" class="elsevierStylePara elsevierViewall">We conducted a cross-sectional study where all notifications for congenital microcephaly in the state of Rio Grande do Sul from 1 December 2015 to 31 December 2016 &#40;56 epidemiological weeks&#41; were included&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Case definition and study protocol</span><p id="par0030" class="elsevierStylePara elsevierViewall">During the first 3 months of the study&#44; notification was mandatory as per the Ministry of Health for all babies born with an HC equal to or less than 32<span class="elsevierStyleHsp" style=""></span>cm&#46; A review for case notification was made by the Ministry of Health in February 2016&#44; when microcephaly was defined by HC<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>2Z scores below the mean for sex and gestational age &#40;GA&#41;&#44; according to the Intergrowth curves&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">10</span></a> Assessment of cases followed the guidelines of the Surveillance and Response Protocol published by the Ministry of Health&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">1</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Case reporting</span><p id="par0035" class="elsevierStylePara elsevierViewall">Neonates were reported to the Registry of Public Health Events &#40;<span class="elsevierStyleItalic">Registro de Eventos de Sa&#250;de P&#250;blica</span> &#8211; RESP&#41; by the first physician to identify microcephaly&#46; Clinicians were required to enter data on birth and delivery &#40;including HC&#44; weight&#44; and GA&#41;&#44; abnormal clinical and imaging findings&#44; maternal and gestational conditions&#44; and potential infections and exposures during pregnancy&#44; including travels to ZIKV-endemic areas&#46; Cases were subsequently classified by us as &#40;1&#41; &#8220;non-confirmed&#8221; cases of microcephaly&#58; proportionate premature babies with no other anomalies &#40;they were excluded as microcephaly cases when adjusting sex and gestational age by applying the intergrowth charts&#41;&#59; small HC in proportionately small-for-gestational-age babies&#44; with normal development and no associated anomaly&#59; HC of 32<span class="elsevierStyleHsp" style=""></span>cm at birth &#40;criteria for inclusion only in the first three months of mandatory report&#41; with no other anomalies and normal development at the follow-up&#59; &#40;2&#41; &#8220;confirmed&#8221; or true cases of microcephaly&#58; all remaining reported cases&#46; Confirmed cases were subsequently classified by etiology&#59; congenital infections were diagnosed using the following criteria&#58; &#40;1&#41; ZIKV &#8211; confirmed by maternal history of traveling to endemic areas&#44; cutaneous rash&#44; and joint pain&#59; and neonatal history of CNS imaging findings&#44; physical examination findings&#44; or a ZIKV polymerase chain reaction &#40;PCR&#41; result &#40;in blood&#41; consistent with the Zika virus disease&#59; &#40;2&#41; CMV &#8211; confirmed by positive PCR in urine&#59; &#40;3&#41; toxoplasmosis and rubella &#8211; confirmed by positive immunoglobulin &#40;IgM&#41; serology in blood&#59; &#40;4&#41; syphilis &#8211; confirmed by positive Venereal Disease Research Laboratory &#40;VDRL&#41; screening in a neonatal blood or cerebrospinal fluid &#40;CSF&#41; sample or a positive fluorescent treponemal antibody &#40;FTAAbs&#41; test&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Toxoplasmosis and rubella serology tests and ZIKV PCR in maternal and neonatal samples were performed at the State Central Laboratory &#40;<span class="elsevierStyleItalic">Laborat&#243;rio Central do Estado</span>&#44; LACEN&#41;&#46; Syphilis screening by VDRL&#44; CMV PCR and neuroimaging &#40;ultrasound&#44; CT&#44; or MRI&#41; were performed at the patients&#8217; municipalities of origin&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> describes the distribution of diagnostic tests performed in the sample&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Data analysis</span><p id="par0045" class="elsevierStylePara elsevierViewall">Maternal and neonatal data were analyzed by the Rio Grande do Sul State Health Surveillance Center &#40;<span class="elsevierStyleItalic">Centro Estadual de Vigil&#226;ncia em Sa&#250;de</span>&#44; CEVS&#41;&#46; Records were reviewed jointly by the CEVS staff and the Teratogen Information Service &#40;<span class="elsevierStyleItalic">Servi&#231;o de Informa&#231;&#245;es sobre Agentes Teratog&#234;nicos</span>&#44; SIAT&#41;&#46; The SIAT is staffed with a multidisciplinary team of specifically trained medical geneticists&#44; pediatricians&#44; and nurses &#8211; including some of the authors of the present report &#8211; and is affiliated with the Medical Genetics Service at Hospital de Cl&#237;nicas de Porto Alegre &#40;HCPA&#41;&#44; a tertiary care center and major referral hospital in Rio Grande do Sul&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Patient care</span><p id="par0050" class="elsevierStylePara elsevierViewall">All patients initially received care at their municipalities of origin&#46; All cases of confirmed microcephaly were referred to our hospital &#40;HCPA&#41; for clinical evaluation and&#44; when necessary&#44; additional investigation&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Investigation of genetic causes or isolated CNS malformations</span><p id="par0055" class="elsevierStylePara elsevierViewall">Neonates with a family history of genetic anomalies&#44; consanguinity&#44; abnormal imaging findings&#44; or clinical manifestations &#40;morphological changes&#41; suggestive of genetic conditions underwent specific genetic testing &#40;including karyotyping and screening for inborn errors of metabolism&#41; and a detailed physical examination&#44; performed by a medical geneticist&#44; in tandem with the investigation of potential infectious causes&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">HC percentiles were calculated using the Intergrowth charts&#44; corrected by sex and GA&#46; Analysis of the sample was carried out in SPSS version 20&#46;0&#46; The prevalence of microcephaly was calculated using the number of live births from December 2015 to December 2016&#46; This study was approved by the HCPA Research Ethics Committee &#40;protocol n&#46; 16-0577&#41;&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">Overall&#44; 148 neonates were reported in the state of Rio Grande do Sul during the 56 epidemiological weeks of interest&#44; among 153<span class="elsevierStyleHsp" style=""></span>744 registered live births &#40;prevalence&#58; 9&#46;6&#47;10<span class="elsevierStyleHsp" style=""></span>000&#41;&#46; Neuroimaging scan was performed in 60&#46;8&#37; of the cases&#44; and the tests for congenital infections were conducted from 20&#37; to 73&#37; of the neonates &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Maternal demographic and newborn anthropometric characteristics are presented in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; Overall&#44; 18 mothers &#40;18&#46;3&#37;&#41; reported having consumed alcohol during pregnancy &#40;of those&#44; 5 had given birth to neonates with CNS abnormalities of undefined etiology&#41;&#44; and 30 reported smoking&#59; 14 reported use of illegal drugs&#46; Seventy-seven neonates &#40;62&#46;1&#37;&#41; had low birth weight&#44; 35 &#40;23&#46;6&#37;&#41; were born premature&#44; and 48 &#40;32&#46;4&#37;&#41; were small for gestational age&#46; Neuroimaging findings were abnormal in 48&#46;9&#37; of cases &#40;<span class="elsevierStyleItalic">n</span> &#61; 44&#47;90&#41;&#44; when available&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">A detailed analysis of the 148 reported babies led to 90 &#40;60&#46;8&#37;&#41; cases considered as &#8220;non-confirmed&#8221; microcephaly&#58; 20 with an HC of 32<span class="elsevierStyleHsp" style=""></span>cm at birth and normal development at follow-up&#59; and 70 born with an HC of less than 32<span class="elsevierStyleHsp" style=""></span>cm but excluded after the Intergrowth charts &#40;adjusted for gestational age and sex&#41; were applied&#44; or proportionately small for gestational age and without any brain or neurological abnormality detected&#46; In this group&#44; some risk factors known for being related to prematurity&#47;small for gestational age were detected&#44; such as HIV infection &#40;2 cases&#41;&#44; alcohol intake &#40;5 cases&#41;&#44; use of crack cocaine &#40;2 cases&#41;&#44; smoking tobacco&#44; and maternal hypertension&#59; however&#44; a definite cause could not be established&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">In the 58 confirmed cases of microcephaly &#40;prevalence &#61; 3&#46;8&#47;10<span class="elsevierStyleHsp" style=""></span>000 live births&#41;&#44; congenital infections were the leading causal factor identified &#40;<span class="elsevierStyleItalic">n</span> &#61; 29&#59; 50&#46;0&#37;&#41;&#58; syphilis &#40;<span class="elsevierStyleItalic">n</span> &#61; 13&#59; 22&#46;4&#37;&#41;&#44; toxoplasmosis &#40;<span class="elsevierStyleItalic">n</span> &#61; 7&#59; 12&#46;1&#37;&#41;&#44; CMV &#40;<span class="elsevierStyleItalic">n</span> &#61; 6&#59; 10&#46;3&#37;&#41;&#44; and ZIKV &#40;<span class="elsevierStyleItalic">n</span> &#61; 3&#59; 5&#46;2&#37;&#41;&#46; Nine cases &#40;15&#46;5&#37;&#41; were classified as isolated CNS malformations &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41; and consisted of encephalocele &#40;5&#46;2&#37;&#41; and corpus callosum agenesis &#40;5&#46;2&#37;&#41;&#44; among others&#46; Genetic syndromes were diagnosed in six patients &#40;10&#46;3&#37;&#41;&#44; but in 11 cases a genetic condition was suspected without confirmation of any specific syndrome&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Congenital Zika syndrome case description</span><p id="par0085" class="elsevierStylePara elsevierViewall">Case 1&#58; female&#44; born in 2015 from a nonconsanguineous healthy young couple&#59; family history negative for congenital anomalies&#59; gestational age &#40;GA&#41; 38 weeks&#59; weight&#44; 2&#44;436<span class="elsevierStyleHsp" style=""></span>g&#59; length&#44; 44<span class="elsevierStyleHsp" style=""></span>cm&#59; HC&#44; 27<span class="elsevierStyleHsp" style=""></span>cm &#40;&#60;3 <span class="elsevierStyleItalic">Z</span>-score&#41;&#46; The mother had traveled to northeast Brazil &#40;Recife&#44; Pernambuco&#41; during her second month of pregnancy&#44; when she had pruriginous rash&#44; conjunctivitis&#44; and arthralgia&#46; She was not tested&#44; since at the time she had the infection&#44; ZIKV was not considered an infection of concern&#46; Clinical examination of the baby was performed by our team at three months of age&#44; when we observed a significant craniofacial disproportion with small head circumference and prominent occipital bone&#44; collapsed skull&#44; redundant skin in the scalp and nuchal region&#44; spasticity&#44; hyperactivity&#44; swallowing difficulties&#44; and inconsolable crying&#46; Eye fundus was not evaluated since the patient was lost for follow-up&#46; RT-PCR was negative in the baby&#39;s LCR and serum&#46; Neuro Magnetic Resonance&#58; microcalcifications&#44; ventricular enlargement&#44; pachygyria&#44; cortical atrophy&#46; STORCH was negative&#46; Case concluded as CZS based on clinical and epidemiological criteria&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Case 2&#58; male&#44; born in 2015 from a nonconsanguineous healthy young couple&#59; family history negative for congenital anomalies&#59; gestational age &#40;GA&#41; 37 weeks&#59; weight&#44; 2740<span class="elsevierStyleHsp" style=""></span>g&#59; length&#44; 43<span class="elsevierStyleHsp" style=""></span>cm&#59; HC&#44; 31<span class="elsevierStyleHsp" style=""></span>cm &#40;&#60;2 <span class="elsevierStyleItalic">Z</span>-score&#41;&#46; Mother traveled to Campinas&#44; S&#227;o Paulo&#44; and immediately after her return she had a pruriginous rash and arthralgia but was not tested by PCR&#46; Clinical examination by our team was performed at 20 months of age&#46; At that time HC was 39&#46;5<span class="elsevierStyleHsp" style=""></span>cm &#40;&#60;3 <span class="elsevierStyleItalic">Z</span>-scores&#41;&#46; We observed marked craniofacial disproportion&#44; narrow forehead with bifrontal depression&#44; overlapped sutures&#44; epicanthal folds&#44; strabismus&#44; club feet&#44; and arthrogryposis in the knees&#46; Marked hypertonia&#44; irritability and neuromotor delay were noted at neurological examination&#46; Neuro Magnetic Resonance&#58; calcifications&#44; ventricular enlargement&#44; polymicrogyria&#46; STORCH was negative&#46; Case concluded as CZS based on clinical and epidemiological criteria&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Case 3&#58; female&#44; born in 2016 from a nonconsanguineous healthy young couple&#59; family history negative for congenital anomalies&#59; gestational age &#40;GA&#41; 37 weeks&#59; weight&#44; 2100<span class="elsevierStyleHsp" style=""></span>g&#59; length&#44; 43<span class="elsevierStyleHsp" style=""></span>cm&#59; HC&#44; 26&#46;5<span class="elsevierStyleHsp" style=""></span>cm &#40;&#60;3 <span class="elsevierStyleItalic">Z</span>-score&#41;&#46; Mother reported mild fever&#44; pruriginous rash&#44; and arthralgia on her second month of pregnancy&#46; She did not travel but was in a town where dengue fever is endemic&#46; Not tested during her pregnancy&#46; Clinical examination by our team was performed at 11 months of age&#58; HC&#44; 33<span class="elsevierStyleHsp" style=""></span>cm &#40;&#60;3 <span class="elsevierStyleItalic">Z</span>-score&#41; craniofacial disproportion&#44; narrow forehead with bifrontal depression&#44; prominent occipital bone&#44; collapsed skull&#44; scalp skin folds&#44; hands with contractures&#44; arthrogryposis&#46; Neurological examination&#58; spasticity&#44; irritability&#44; swallowing difficulties and inconsolable crying&#46; Delayed neurodevelopment&#46; Eye fundus normal&#46; RT-PCR was negative in the baby&#39;s LCR and serum&#46; CT scan&#58; bilateral brain calcifications&#44; ventricular enlargement&#44; simplified gyral pattern&#46; STORCH was negative&#46; Case concluded as CZS based on clinical and epidemiological criteria&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><p id="par0100" class="elsevierStylePara elsevierViewall">In Rio Grande do Sul&#44; Brazil&#39;s southernmost state&#44; the autochthonous circulation of ZIKV was restricted to some geographical regions and to the summer period&#44; since this part of Brazil registers average winter temperatures below 20<span class="elsevierStyleHsp" style=""></span>&#176;C&#44; thus inhibiting <span class="elsevierStyleItalic">Aedes egyptii</span> activity&#46; However&#44; the prevalence of microcephaly in the present study was 3&#46;8&#47;10<span class="elsevierStyleHsp" style=""></span>000&#44; which far exceeds the pre-2015 Brazilian estimate of 0&#46;5 cases per 10<span class="elsevierStyleHsp" style=""></span>000 live births&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">9</span></a> For comparative purposes&#44; in a study that evaluated live births from January 2015 to January 2016&#44; the highest prevalence rates were observed in states in northeast Brazil&#58; Pernambuco &#40;16&#46;6&#47;10<span class="elsevierStyleHsp" style=""></span>000 CI &#61; 12&#46;3&#8211;17&#46;2&#41; and Para&#237;ba &#40;10&#46;8&#47;10&#46;000&#59; CI &#61; 8&#46;86&#8211;13&#46;04&#41; versus 0&#46;60&#47;10<span class="elsevierStyleHsp" style=""></span>000 &#40;CI 0&#46;22&#8211;1&#46;31&#41; in four states without ZIKV transmission&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">11</span></a> Therefore&#44; those observations show that there was an increase in reports of microcephaly compared to previous years in Rio Grande do Sul&#44; albeit not as high as in the Northeast&#44; where there was a true ZIKV epidemics&#46; The increase in reports in Rio Grande do Sul is most probably related to the broader definition of microcephaly &#40;HC &#60;2 <span class="elsevierStyleItalic">Z</span>-scores below the mean&#41; as well as to the active search and reporting of newborns with a small head&#44; irrespective of its etiology&#46; This hypothesis is consistent with observations in hospitals participating in the ECLAMC &#40;Latin American Study of Congenital Malformations&#41; in the period between 2005 and 2014&#44; where a population base prevalence for microcephaly was estimated at 3&#46;0&#47;10<span class="elsevierStyleHsp" style=""></span>000 &#40;CI 95 2&#46;7&#8211;3&#46;4&#47;10<span class="elsevierStyleHsp" style=""></span>000&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">12</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">In the present study&#44; 50&#46;0&#37; of the microcephaly cases were infection-related&#44; but only 10&#46;4&#37; were secondary do ZIKV&#46; A nationwide study investigated the prevalence of infection-related microcephaly in Brazil in 2015&#8211;2016 using secondary information from the Brazilian&#39;s Ministry of Health Surveillance Systems&#46; It concluded that among 5968 cases of microcephaly reported in Brazil 1950 &#40;32&#46;7&#37;&#41; were infection-related &#40;30&#46;3&#37; were still under investigation&#41;&#46; ZIKV infection was the etiology in 15&#46;6&#37; of cases&#44; predominantly in the northeast&#46; STORCH infections could be only confirmed in 5&#46;4&#37; of cases&#44; and this small percentage is probably due to lack of availability of laboratory tests&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">11</span></a> In Piau&#237;&#44; northeast Brazil&#44; a prevalence of 13&#46;6&#47;10<span class="elsevierStyleHsp" style=""></span>000 cases of microcephaly during the Zika virus epidemic was observed in 2015&#8211;2016&#44; with 45&#46;3&#37; &#40;34&#47;75&#41; of them possibly related to Zika&#44; since STORCH in those was negative&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">13</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Syndromic genetic conditions accounted for 10&#37; of cases in the present study&#59; 19&#37; were still under investigation for a possible genetic condition&#59; and 15&#37; were associated to central nervous system malformations&#46; A similar rate was reported in the USA&#44; in a sample of newborns with microcephaly&#44; with 13&#37; of cases attributable to confirmed genetic conditions&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">14</span></a> In South American hospitals&#44; in the ECLAMC study&#44;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">12</span></a> 23&#37; of the microcephalic babies were diagnosed with a genetic syndrome&#44; and 12&#37; of cases were associated with neural malformations&#44; not too different from our study&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">In our series&#44; 61&#37; were discarded on clinical grounds&#46; In their work analyzing the first 1501 livebirths with complete investigation in Brazil&#44; Franca et al&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">15</span></a> also discarded 59&#37; of the notifications&#44; most frequently because they had no obvious abnormalities such as neurological symptoms&#44; or because they were proportionately small newborn babies &#40;e&#46;g&#46; with low birthweight&#41;&#46; One of the reasons of this high percentage of exclusion on clinical grounds is the adoption of the &#60;2 <span class="elsevierStyleItalic">Z</span>-scores as a threshold for notification&#44; which is less specific to detect congenital anomalies and includes many &#8220;normal&#8221; babies with HC in the lowest distribution of the normal curve&#46; Before the ZIKV emergence&#44; the clinical definition of microcephaly was generally restricted to &#60;3 <span class="elsevierStyleItalic">Z</span>-scores&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">12</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">This study is subjected to several limitations&#46; First&#44; due to the nature of the ZIKV health emergency&#44; the occasional unavailability of some diagnostic modalities&#44; and the inability of some patients to travel to HCPA&#44; not all clinical assessments were performed by the same team&#46; Second&#44; HC measurement may not have been performed in a consistently correct manner&#44; and neuroimaging was only available to approximately 60&#37; of newborns&#46; Third&#44; retrospective recall bias applies to some maternal conditions&#44; including treatments and exposures during pregnancy &#40;especially concerning alcohol intake&#41;&#46; Fourth&#44; CMV serology was available for only 29&#37; of cases&#44; and herpes screening was not included at all&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Finally&#44; the unavailability of truly reliable diagnostic tests for ZIKV is another limitation of this study&#46; As noted in other studies&#44; ZIKV PCR in neonatal or maternal serum is often negative as little as 7 days after infection&#46; Immunological tests for population screening are susceptible to cross-reactivity with other flavivirus infections&#44; and were not performed systematically in our sample&#46; Within this context&#44; a thorough&#44; targeted clinical examination based on the textbook case description of congenital Zika syndrome plays a decisive role in the diagnosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">8&#44;16&#44;17</span></a> Thus&#44; less severe cases of ZIKV infection may have been underreported&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Despite those limitations&#44; this study provides an important estimate of the etiology of microcephaly in a region adjacent to but not directly affected by a ZIKV outbreak&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">In conclusion&#44; congenital infections have the highest impact in the etiology of microcephaly in Rio Grande do Sul&#44; although the contribution of ZIKV was comparatively lower than that observed in northeast Brazil&#46; Therefore&#44; despite efforts by the Brazilian Ministry of Health to improve care and prevention of gestational diseases&#44; much work remains to be done in terms of education and public health to improve the efficacy of preventive measures and ensure that they reach the majority of the population&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Funding</span><p id="par0140" class="elsevierStylePara elsevierViewall">This work was funded by the Fundo de Incentivo &#224; Pesquisa de Eventos do Hospital de Cl&#237;nicas de Porto Alegre &#40;FIPE-HCPA&#41; and the Conselho Nacional de Desenvolvimento Cientifico e Tecnol&#243;gico &#40;CNPq&#41;&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflicts of interest</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:12 [
        0 => array:3 [
          "identificador" => "xres1250819"
          "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" => "xpalclavsec1159766"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres1250820"
          "titulo" => "Resumo"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Objetivo"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "M&#233;todos"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclus&#227;o"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1159767"
          "titulo" => "Palavras-Chave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Methods"
          "secciones" => array:6 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Study design"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Case definition and study protocol"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Case reporting"
            ]
            3 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Data analysis"
            ]
            4 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Patient care"
            ]
            5 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Investigation of genetic causes or isolated CNS malformations"
            ]
          ]
        ]
        6 => array:3 [
          "identificador" => "sec0045"
          "titulo" => "Results"
          "secciones" => array:1 [
            0 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Congenital Zika syndrome case description"
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0060"
          "titulo" => "Funding"
        ]
        9 => array:2 [
          "identificador" => "sec0065"
          "titulo" => "Conflicts of interest"
        ]
        10 => array:2 [
          "identificador" => "xack428424"
          "titulo" => "Acknowledgements"
        ]
        11 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2018-01-28"
    "fechaAceptado" => "2018-05-08"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1159766"
          "palabras" => array:3 [
            0 => "Microcephaly"
            1 => "ZIKV"
            2 => "Congenital infection"
          ]
        ]
      ]
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-Chave"
          "identificador" => "xpalclavsec1159767"
          "palabras" => array:3 [
            0 => "Microcefalia"
            1 => "ZIKV"
            2 => "Infec&#231;&#227;o cong&#234;nita"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The aim of this study was to identify the causes of congenital microcephaly in Rio Grande do Sul&#44; a state in southern Brazil&#44; where no ZIKV outbreak was detected&#44; from December 2015 to December 2016&#44; which was the period when ZIKV infection was at its peak in northeast Brazil&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This was a cross-sectional study where all notifications of congenital microcephaly in the state of Rio Grande do Sul were included for analysis&#46; Evaluation of cases followed the guidelines of the Brazilian Ministry of Health&#46; Dysmorphological and neurological evaluations were performed by a specialized team&#44; and genetic tests and neuroimaging were performed when clinically indicated&#46; STORCH infections were diagnosed using standard tests&#46; ZIKV infection was diagnosed through maternal serum RT-PCR and&#47;or neuroimaging associated with clinical&#47;epidemiological criteria&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">From 153<span class="elsevierStyleHsp" style=""></span>744 registered live births in the study period&#44; 148 cases were notified&#44; but 90 &#40;60&#46;8&#37;&#41; of those were later excluded as &#8220;non-confirmed&#8221; microcephaly&#46; In the 58 confirmed cases of microcephaly &#40;prevalence &#61; 3&#46;8&#47;10<span class="elsevierStyleHsp" style=""></span>000 live births&#41;&#44; congenital infections &#40;syphilis&#44; toxoplasmosis&#44; cytomegalovirus&#44; and ZIKV&#41; constituted the predominant etiology &#40;50&#46;0&#37;&#41;&#44; followed by isolated CNS &#40;15&#46;5&#37;&#41;&#44; and genetic syndromes &#40;10&#46;3&#37;&#41;&#46; Congenital ZIKV syndrome &#40;CZS&#41; with typical phenotype was diagnosed in three cases &#40;5&#46;2&#37; of all confirmed microcephaly cases or 10&#46;4&#37; of all congenital infections&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In Rio Grande do Sul&#44; where no outbreak of ZIKV infection was recorded&#44; congenital infections were the leading cause of congenital microcephaly&#44; and the attributable risk for CZS in the etiology of microcephaly was 5&#46;2&#37;&#46;</p></span>"
        "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" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Identificar as causas da microcefalia cong&#234;nita no Rio Grande do Sul&#44; Regi&#227;o Sul do Brasil&#44; onde n&#227;o foi detectado surto de ZIKV&#44; de dezembro de 2015 a dezembro de 2016&#46; Esse foi o per&#237;odo em que a infec&#231;&#227;o por ZIKV estava em seu auge no Nordeste do Brasil&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Este &#233; um estudo transversal no qual todas as notifica&#231;&#245;es de microcefalia cong&#234;nita no estado do Rio Grande do Sul foram inclu&#237;das para an&#225;lise&#46; A avalia&#231;&#227;o dos casos seguiu as orienta&#231;&#245;es do Minist&#233;rio da Sa&#250;de&#46; A avalia&#231;&#227;o dismorfol&#243;gica e neurol&#243;gica foi feita por uma equipe especializada e os testes gen&#233;ticos e as neuroimagens foram feitos quando indicado clinicamente&#46; As infec&#231;&#245;es STORCH &#40;S&#237;filis&#44; Toxoplasmose&#44; Rub&#233;ola&#44; Citomegalov&#237;rus e Herpes simples&#41; foram diagnosticadas utilizando testes padr&#227;o&#46; A infec&#231;&#227;o por ZIKV foi diagnosticada por meio da transcriptase reversa seguida de rea&#231;&#227;o em cadeia da polimerase &#40;RT-PCR&#41; no soro materno e&#47;ou neuroimagem associada a crit&#233;rios cl&#237;nicos&#47;epidemiol&#243;gicos&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">De 153&#46;744 nascidos vivos registrados no per&#237;odo do estudo&#44; 148 beb&#234;s foram casos notificados&#44; por&#233;m 90 &#40;60&#44;8&#37;&#41; casos foram exclu&#237;dos posteriormente como microcefalia &#8220;n&#227;o confirmada&#8221;&#46; Nos 58 casos confirmados de microcefalia &#40;preval&#234;ncia &#61; 3&#44;8&#47;10&#46;000 nascidos vivos&#41;&#44; as infec&#231;&#245;es cong&#234;nitas &#40;s&#237;filis&#44; toxoplasmose&#44; citomegalov&#237;rus e ZIKV&#41; constitu&#237;ram a etiologia predominante &#40;50&#44;0&#37;&#41;&#44; seguidas de doen&#231;as ligadas ao SNC isolado &#40;15&#44;5&#37;&#41; e s&#237;ndromes gen&#233;ticas &#40;10&#44;3&#37;&#41;&#46; A s&#237;ndrome cong&#234;nita do ZIKV &#40;SCZ&#41; com fen&#243;tipo t&#237;pico foi diagnosticada em tr&#234;s casos &#40;5&#44;2&#37; de todos os casos confirmados de microcefalia ou 10&#44;4&#37; de todas as infec&#231;&#245;es cong&#234;nitas&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#227;o</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">No Rio Grande do Sul&#44; Brasil&#44; onde n&#227;o foi registrado surto de infec&#231;&#227;o por ZIKV&#44; a principal causa de microcefalia cong&#234;nita foram infec&#231;&#245;es cong&#234;nitas e o risco atribu&#237;vel para SCZ na etiologia de microcefalia foi de 5&#44;2&#37;&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclus&#227;o"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Please cite this article as&#58; Herber S&#44; Silva AA&#44; Sanseverino MT&#44; Friedrich L&#44; Ranieri TM&#44; Favreto C&#44; et al&#46; Prevalence and causes of congenital microcephaly in the absence of a Zika virus outbreak in southern Brazil&#46; J Pediatr &#40;Rio J&#41;&#46; 2019&#59;95&#58;600&#8211;6&#46;</p>"
      ]
    ]
    "multimedia" => array:3 [
      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "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="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Neuroimaging<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Toxoplasmosis serology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">107&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rubella serology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">101&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Zika virus polymerase chain reaction&#44; blood&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">105&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Syphilis screening &#40;VDRL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">108&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cytomegalovirus polymerase chain reaction&#44; urine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2139716.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Ultrasonography&#44; computed tomography&#44; or magnetic resonance imaging&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Laboratory and imaging investigation of 148 notified cases of microcephaly in Rio Grande do Sul&#44; Brazil&#44; from 01 Dec 2015 to 31 Dec 2016&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "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="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Neonatal characteristics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sex</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Birth weight</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Very low &#40;&#60;1500<span class="elsevierStyleHsp" style=""></span>g&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Low &#40;1500&#8211;2500<span class="elsevierStyleHsp" style=""></span>g&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Normal &#40;&#62;2500<span class="elsevierStyleHsp" style=""></span>g&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Small for gestational age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prematurity &#40;&#60;37 weeks&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Maternal characteristics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Age</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Up to 20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>20&#8211;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Over 35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Ethnicity</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>White&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mixed-race&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Black&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Gestational exposures</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Alcohol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Smoking&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Illicit drugs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2139715.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Data available for 98 cases&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Maternal and neonatal characteristics of 148 notified cases of microcephaly in Rio Grande do Sul&#44; Brazil&#44; from 01 Dec 2015 to 31 Dec 2016&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "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="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Total &#8220;confirmed&#8221; cases of microcephaly</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&#47;148&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Congenital infections</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Syphilis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Toxoplasmosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cytomegalovirus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Zika virus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Confirmed genetic conditions</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Down syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cornelia de Lange syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Possible genetic conditions under investigation</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Isolated CNS malformations</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Encephalocele&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Corpus callosum agenesis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dandy&#8211;Walker malformation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Porencephaly and corpus callosum agenesis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lissencephaly&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Familial microcephaly</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Total &#8220;non-confirmed&#8221; cases of microcephaly</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90&#47;148&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>HC 32<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a> with normal development&#47;no brain anomaly&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Microcephaly related to obstetric reasons<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">82&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2139714.png"
              ]
            ]
          ]
          "notaPie" => array:2 [
            0 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Criteria for notification from Dec 2015 to Feb 2016 only&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0020"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Includes prematurity &#40;excluded after the use of intergrowth charts&#41;&#44; proportionately small for gestational age&#59; no other anomalies&#59; normal development at the follow-up&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Description of causes of 148 notified cases of microcephaly in Rio Grande do Sul&#44; Brazil&#44; from 01 Dec 2015 to 31 Dec 2016&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:17 [
            0 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Brazil&#46; Protocolo de Vigil&#226;ncia e Resposta a Ocorr&#234;ncia de Microcefalia e&#47;ou Altera&#231;&#245;es do Sistema Nervoso Central &#40;SNC&#41;&#46; Brazilian Ministry of Health&#59; 2016&#46;"
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Zika virus&#58; a new human teratogen&#63; Implications for women of reproductive age"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Schuler-Faccini"
                            1 => "M&#46; Sanseverino"
                            2 => "F&#46; Vianna"
                            3 => "A&#46; da Silva"
                            4 => "M&#46; Larrandaburu"
                            5 => "C&#46; Marcolongo-Pereira"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/cpt.386"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Pharmacol Ther"
                        "fecha" => "2016"
                        "volumen" => "100"
                        "paginaInicial" => "28"
                        "paginaFinal" => "30"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27090438"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Zika Virus and birth defects &#8211; reviewing the evidence for causality"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46;A&#46; Rasmussen"
                            1 => "D&#46;J&#46; Jamieson"
                            2 => "A&#46;H&#46; Margaret"
                            3 => "L&#46;R&#46; Petersen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMsr1604338"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2016"
                        "volumen" => "374"
                        "paginaInicial" => "1981"
                        "paginaFinal" => "1987"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27074377"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The phenotypic spectrum of congenital Zika syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Del-Campo"
                            1 => "I&#46;M&#46; Feitosa"
                            2 => "E&#46;M&#46; Ribeiro"
                            3 => "D&#46;D&#46; Horovitz"
                            4 => "A&#46;L&#46; Pessoa"
                            5 => "G&#46;V&#46; Fran&#231;a"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/ajmg.a.38170"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Med Genet"
                        "fecha" => "2017"
                        "volumen" => "173"
                        "paginaInicial" => "841"
                        "paginaFinal" => "857"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28328129"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Population-based microcephaly surveillance in the United States&#44; 2009 to 2013&#58; an analysis of potential sources of variation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;D&#46; Cragan"
                            1 => "J&#46;L&#46; Isenburg"
                            2 => "S&#46;E&#46; Parker"
                            3 => "C&#46;J&#46; Alverson"
                            4 => "R&#46;E&#46; Meyer"
                            5 => "E&#46;B&#46; Stallings"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/bdra.23587"
                      "Revista" => array:6 [
                        "tituloSerie" => "Birth Defects Res A Clin Mol Teratol"
                        "fecha" => "2016"
                        "volumen" => "106"
                        "paginaInicial" => "972"
                        "paginaFinal" => "982"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27891783"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnostic approach to microcephaly in childhood&#58; a two-center study and review of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Von der Hagen"
                            1 => "M&#46; Pivarcsi"
                            2 => "J&#46; Liebe"
                            3 => "H&#46; Von Bernuth"
                            4 => "N&#46; Didonato"
                            5 => "J&#46;B&#46; Hennermann"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/dmcn.12425"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dev Med Child Neurol"
                        "fecha" => "2014"
                        "volumen" => "56"
                        "paginaInicial" => "732"
                        "paginaFinal" => "741"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24617602"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Practice parameter&#58; evaluation of the child with microcephaly &#40;an evidence-based review&#41;&#58; report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46; Ashwal"
                            1 => "D&#46; Michelson"
                            2 => "L&#46; Plawner"
                            3 => "W&#46;B&#46; Dobyns"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1212/WNL.0b013e3181b783f7"
                      "Revista" => array:6 [
                        "tituloSerie" => "Neurology"
                        "fecha" => "2009"
                        "volumen" => "73"
                        "paginaInicial" => "887"
                        "paginaFinal" => "897"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19752457"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Possible Association Between Zika Virus Infection and Microcephaly &#8211; Brazil"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Schuler-Faccini"
                            1 => "E&#46;M&#46; Ribeiro"
                            2 => "I&#46;M&#46; Feitosa"
                            3 => "D&#46;D&#46;G&#46; Horovitz"
                            4 => "D&#46;P&#46; Cavalcanti"
                            5 => "A&#46; Pessoa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.15585/mmwr.mm6503e2"
                      "Revista" => array:6 [
                        "tituloSerie" => "MMWR Morb Mortal Wkly Rep"
                        "fecha" => "2016"
                        "volumen" => "65"
                        "paginaInicial" => "59"
                        "paginaFinal" => "62"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26820244"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Increase in reported prevalence of microcephaly in infants born to women living in areas with confirmed zika virus transmission during the first trimester of pregnancy &#8211; Brazil"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "W&#46;K&#46; Oliveira"
                            1 => "J&#46; Cortez-Escalante"
                            2 => "W&#46;T&#46;G&#46; De Oliveira"
                            3 => "G&#46;M&#46;I&#46; do Carmo"
                            4 => "C&#46;M&#46;P&#46; Henriques"
                            5 => "G&#46;E&#46; Coelho"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.15585/mmwr.mm6509e2"
                      "Revista" => array:6 [
                        "tituloSerie" => "MMWR Morb Mortal Wkly Rep"
                        "fecha" => "2016"
                        "volumen" => "65"
                        "paginaInicial" => "242"
                        "paginaFinal" => "247"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26963593"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "International standards for newborn weight&#44; length&#44; and head circumference by gestational age and sex&#58; the Newborn Cross-Sectional Study of the INTERGROWTH-21st"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Villar"
                            1 => "L&#46; Cheikh Ismail"
                            2 => "C&#46;G&#46; Victora"
                            3 => "E&#46;O&#46; Ohuma"
                            4 => "E&#46; Bertino"
                            5 => "D&#46;G&#46; Altman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(14)60932-6"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2014"
                        "volumen" => "384"
                        "paginaInicial" => "857"
                        "paginaFinal" => "868"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25209487"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Infection-related microcephaly after the 2015 and 2016 Zika virus outbreaks in Brazil&#58; a surveillance-based analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "W&#46;K&#46; Oliveira"
                            1 => "G&#46;W&#46; Fran&#231;a"
                            2 => "E&#46;H&#46; Carmo"
                            3 => "B&#46;B&#46; Duncan"
                            4 => "R&#46;S&#46; Kuchenbecker"
                            5 => "M&#46;I&#46; Schmidt"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(17)31368-5"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2017"
                        "volumen" => "390"
                        "paginaInicial" => "861"
                        "paginaFinal" => "870"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28647172"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence and clinical profile of microcephaly in South America pre-Zika&#44; 2005&#8211;14&#58; prevalence and case-control study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "I&#46;M&#46; Orioli"
                            1 => "H&#46; Dolk"
                            2 => "J&#46;S&#46; Lopez-Camelo"
                            3 => "D&#46; Mattos"
                            4 => "F&#46;A&#46; Poletta"
                            5 => "M&#46;G&#46; Dutra"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "BMJ"
                        "fecha" => "2017"
                        "volumen" => "359"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Microcephaly in Piau&#237;&#58; a descriptive study during the Zika virus epidemic&#58; 2015&#8211;2016"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "I&#46;G&#46; Ribeiro"
                            1 => "M&#46;R&#46; Andrade"
                            2 => "J&#46;M&#46; Silva"
                            3 => "G&#46;M&#46; Silva"
                            4 => "M&#46;A&#46; Costa"
                            5 => "M&#46;A&#46; Oliveira"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Epidemiol Serc Saude Brasilia"
                        "fecha" => "2018"
                        "volumen" => "27"
                        "paginaInicial" => "e20163692"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence&#160;and&#160;clinical&#160;attributes of congenital microcephaly&#44; New York&#44; 2013&#8211;2015"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46;A&#46; Graham"
                            1 => "D&#46;J&#46; Fox"
                            2 => "A&#46; Talati"
                            3 => "C&#46; Pantea"
                            4 => "L&#46; Brady"
                            5 => "S&#46;L&#46; Carter"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.15585/mmwr.mm6605a1"
                      "Revista" => array:6 [
                        "tituloSerie" => "MMWR Morb Mortal Wkly Rep"
                        "fecha" => "2017"
                        "volumen" => "66"
                        "paginaInicial" => "125"
                        "paginaFinal" => "129"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28182608"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Congenital&#160;Zika virus&#160;syndrome in Brazil&#58; a case series of the first 1501 live births with complete investigation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46;V&#46; Fran&#231;a"
                            1 => "Schuler-Faccini&#160;L"
                            2 => "W&#46;K&#46; Oliveira"
                            3 => "C&#46;M&#46; Henriques"
                            4 => "E&#46;H&#46; Carmo"
                            5 => "V&#46;D&#46; Pedi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(16)30902-3"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2016"
                        "volumen" => "388"
                        "paginaInicial" => "891"
                        "paginaFinal" => "897"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27372398"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Vital signs&#58; update on Zika virus-associated birth defects and evaluation of all U&#46;S&#46; infants with&#160;congenital&#160;Zika virus exposure &#8211; US Zika Pregnancy Registry&#44; 2016"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;R&#46; Reynolds"
                            1 => "A&#46;M&#46; Jones"
                            2 => "E&#46;E&#46; Peterson"
                            3 => "E&#46;H&#46; Lee"
                            4 => "M&#46;E&#46; Rice"
                            5 => "A&#46; Bingham"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.15585/mmwr.mm6613e1"
                      "Revista" => array:6 [
                        "tituloSerie" => "MMWR Morb Mortal Wkly Rep"
                        "fecha" => "2017"
                        "volumen" => "66"
                        "paginaInicial" => "366"
                        "paginaFinal" => "373"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28384133"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Characterizing the Pattern of Anomalies in Congenital Zika Syndrome for Pediatric Clinicians"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Moore"
                            1 => "E&#46; Staples"
                            2 => "W&#46;B&#46; Dobyns"
                            3 => "A&#46; Pessoa"
                            4 => "C&#46;V&#46; Ventura"
                            5 => "E&#46;B&#46; Fonseca"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jamapediatrics.2016.3982"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA Pediatr"
                        "fecha" => "2017"
                        "volumen" => "171"
                        "paginaInicial" => "288"
                        "paginaFinal" => "295"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27812690"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
    "agradecimientos" => array:1 [
      0 => array:4 [
        "identificador" => "xack428424"
        "titulo" => "Acknowledgements"
        "texto" => "<p id="par0150" class="elsevierStylePara elsevierViewall">We thank CEVS for its support in case assessment&#59; SIAT for its work on data investigation&#59; the management of HCPA&#44; which served as the referral hospital for these cases&#59; and the Graduate Program in Medical Sciences at Universidade Federal do Rio Grande do Sul&#46;</p>"
        "vista" => "all"
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/00217557/0000009500000005/v1_201910010656/S0021755718301190/v1_201910010656/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "10179"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/00217557/0000009500000005/v1_201910010656/S0021755718301190/v1_201910010656/en/main.pdf?idApp=UINPBA000049&text.app=https://jped.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0021755718301190?idApp=UINPBA000049"
]