Predictive factors for premature birth and respiratory exacerbation in pregnancies of women with cystic fibrosis

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=> "Ferrari" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0003" ] ] ] 3 => array:3 [ "nombre" => "Paulo de Tarso Roth" "apellidos" => "Dalcin" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0002" ] 1 => array:2 [ "etiqueta" => "d" "identificador" => "aff0004" ] ] ] 4 => array:4 [ "nombre" => "Bruna" "apellidos" => "Ziegler" "email" => array:1 [ 0 => "brunaziegler@yahoo.com.br" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0002" ] 1 => array:2 [ "etiqueta" => "c" "identificador" => "aff0003" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0001" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Hospital de Clínicas de Porto Alegre (HCPA), Fisioterapeuta Residente em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil" "etiqueta" => "a" "identificador" => "aff0001" ] 1 => array:3 [ "entidad" => "Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Ciências Pneumológicas, Porto Alegre, RS, Brazil" "etiqueta" => "b" "identificador" => "aff0002" ] 2 => array:3 [ "entidad" => "Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Fisioterapia, Porto Alegre, RS, Brazil" "etiqueta" => "c" "identificador" => "aff0003" ] 3 => array:3 [ "entidad" => "Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Pneumologia, Porto Alegre, RS, Brazil" "etiqueta" => "d" "identificador" => "aff0004" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0001" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "textoCompleto" => "IntroductionCystic fibrosis (CF) is an autosomal recessive, multisystemic genetic disease of chronic and progressive evolution that is more common in the Caucasian population.<a class="elsevierStyleCrossRef" href="#bib0001">1</a> Gene mutations cause a dysfunction in the cystic fibrosis transmembrane conductance regulator protein, consequently hampering ion transport on the surface of epithelial cells; this results in the thickening of secretions produced by exocrine glands.<a class="elsevierStyleCrossRef" href="#bib0002">2</a> Clinical presentations of this disease may include a high concentration of electrolytes in sweat, deterioration of lung function, and exocrine pancreatic insufficiency.<a class="elsevierStyleCrossRef" href="#bib0003">3</a>Recent advances in diagnosis and treatment have provided a significant increase in life expectancy for patients with CF.<a class="elsevierStyleCrossRef" href="#bib0004">4</a> The median survival, in several countries, can exceed 40 years<a class="elsevierStyleCrossRefs" href="#bib0005">5-7</a>; currently, the median survival of patients with CF in Brazil is 43.8 years.<a class="elsevierStyleCrossRef" href="#bib0008">8</a>In view of the aging of this population, issues related to family genetics, fertility, and pregnancy are increasingly frequent.<a class="elsevierStyleCrossRef" href="#bib0009">9</a> In 2018, 280 pregnancies were reported in the Cystic Fibrosis Foundation registry, representing approximately 4 live births per 100 women of reproductive age.<a class="elsevierStyleCrossRef" href="#bib0010">10</a>Previous studies have shown that pregnancies in women with CF may be associated with an increased number of respiratory exacerbations, premature delivery, cesarean delivery, and low birth weight. Women with forced expiratory volume in the first second (FEV1) < 60% of the predicted values also face higher death rates 3.2 years after delivery <a class="elsevierStyleCrossRef" href="#bib0009">9</a>,<a class="elsevierStyleCrossRef" href="#bib0011">11</a>; better results were observed in women with FEV1 > 50%, adequate nutritional status, and controlled diabetes mellitus (DM).<a class="elsevierStyleCrossRef" href="#bib0009">9</a>Despite these findings, maternal-fetal outcomes in women with CF have not yet been exhaustively explored,<a class="elsevierStyleCrossRef" href="#bib0012">12</a> and few Brazilian studies are available for building an arsenal of evidence capable of leading to strong conclusions.<a class="elsevierStyleCrossRef" href="#bib0013">13</a>Improving the understanding of the impacts of pregnancy in women with CF may assist in the counseling and management of these patients. Therefore, the present study aimed to retrospectively assess predictive factors for poor maternal-fetal outcomes of pregnancies in women with CF followed up at a CF referral center for adults in southern Brazil.MethodsThis is a retrospective cohort study that included all cases of pregnant women diagnosed with CF followed by the Program for Adolescents and Adults with CF at Hospital de Clínicas de Porto Alegre (HCPA) from January 1998 to July 2020. The study was approved by the HCPA Research Ethics Committee (number 42537415700005327) and all participants signed an informed consent form.Data collectionPatients in this program are usually evaluated by a multidisciplinary team every 3 months. Clinical data were collected from medical records regarding the year prior to the start date of pregnancy.Lung function data were measured using spirometry and included forced vital capacity (FVC), FEV1, and FEV1/FVC ratio expressed as a percentage of the predicted results according to age, height, and gender.<a class="elsevierStyleCrossRef" href="#bib0014">14</a> Spirometry techniques were based on the guidelines for pulmonary function tests by the Brazilian Society of Pulmonology and Tisiology, <a class="elsevierStyleCrossRef" href="#bib0015">15</a> and the pre-gestational examination with the best results in the last 6 months before delivery was considered.The authors collected results of the last 3 sputum bacteriology tests in the year prior to the pregnancy. The presence of Pseudomonas aeruginosa, methicillin-sensitive Staphylococcus aureus (MSSA), methicillin-resistant S. aureus (MRSA), and Burkholderia cepacia was assessed. Body mass index (BMI) was obtained by dividing weight (in kilograms) by height squared (in meters): BMI = weight/height2.Information related to age, ethnicity, age at CF diagnosis, and comorbidities (DM related to CF, pancreatic insufficiency) was collected. In order to measure maternal outcomes during pregnancy, the patient's age, whether or not she received counseling by the CF team, as well as complications (gestational DM, eclampsia/pre-eclampsia, hospitalization, respiratory exacerbation, and conception route) were recorded.The analysis of neonatal outcomes was performed through the collection of data on gestational age (GA), weight, fifth minute Apgar score, investigation for CF, breastfeeding, complications at birth, and length of stay (days). The GA was measured in weeks and classified as preterm birth (GA < 37 weeks) or term birth (GA between 37 and 42 weeks).<a class="elsevierStyleCrossRef" href="#bib0016">16</a> The fifth minute Apgar score considered values ≤ 6 as a risk for the newborn.<a class="elsevierStyleCrossRef" href="#bib0017">17</a>In the study's consultations, women who have a desire to gestate are routinely informed about the clinical factors that increase the likelihood of complications during pregnancy, such as inadequate nutritional status, the decline in lung function, the presence of liver disease, and CF-related DM.Statistical analysisData were organized in an Excel (version 16.0) spreadsheet and analyzes were performed using SPSS version 20.0. Continuous variables were presented as means ± standard deviations when data presented normal distributions or as median and interquartile range in case of non-normal distributions. Categorical variables were expressed in absolute and relative frequencies.Considering the particularity of the variable “age of diagnosis”, it was analyzed only once in the case of multiparous women. The other clinical variables are changeable over time and for this reason, were analyzed separately for the 39 pregnancies.Prevalence ratio, estimated by using Poisson regression with robust variance, was used to verify the association between clinical variables and negative maternal-fetal outcomes.<a class="elsevierStyleCrossRef" href="#bib0018">18</a> Analyzes based on receiver operating characteristic (ROC) curves were used to determine the cutoff points for each variable for better sensitivity and specificity. A statistical significance level of less than 5% (p < 0.05) was adopted for all models.Results41 pregnancies were studied in 25 women with CF between January 1998 and July 2020. One woman had twin pregnancies and one pregnancy was conceived by in vitro fertilization.Two cases of spontaneous abortion were excluded from the study. There was no abortion or termination of pregnancy for medical reasons. There were two neonatal deaths and no maternal deaths related to pregnancy.The sample consisted of 94.9% Caucasian women, with a mean age of 25.7 years, a mean FEV1 of 62% the predicted value, and a mean BMI of 21.2 Kg/m2. The general characteristics of women with CF included in this study in the pre-pregnancy period are shown in <a class="elsevierStyleCrossRef" href="#tbl0001">Table 1</a>.<elsevierMultimedia ident="tbl0001"></elsevierMultimedia>The most prevalent neonatal outcome was birth with a GA of fewer than 37 weeks, characterizing premature delivery in 38.5% of cases. Fourteen newborns presented some type of complication at birth, the most prevalent being related to the cardiorespiratory system (71.42%). <a class="elsevierStyleCrossRef" href="#tbl0002">Table 2</a> shows the fetal outcomes of neonates included in the sample.<elsevierMultimedia ident="tbl0002"></elsevierMultimedia>The first case of fetal death occurred with a newborn at 540 days of life. The mother had preeclampsia during pregnancy, which occurred in the first year after a bilateral lung transplant. The neonate was born at 35 weeks, weighing 1752 g, had surgical meconium ileus and respiratory symptoms that required mechanical ventilation was diagnosed with cystic fibrosis, and remained hospitalized from birth until the date of death. The second case of death involved a newborn with 34 weeks of GA who developed cardiac arrest shortly after birth.During the gestational period, the most common negative maternal outcome was respiratory exacerbation (84.6%), requiring oral antibiotics in 10 cases (25.6%) and intravenous antibiotics in 11 cases (28.2%). Three women were admitted to an intensive care unit during pregnancy, one of whom required invasive mechanical ventilation. The hospital length of stay ranged from 3 to 180 days. Only 3 pregnancies (7.7%) were accompanied by the occurrence of pre-eclampsia, and 1 (2.6%) woman presented gestational DM. The most prevalent mode of delivery was cesarean section (56.4%).The associations between dependent variables (premature birth and maternal respiratory exacerbation) and covariables are shown in <a class="elsevierStyleCrossRef" href="#tbl0003">Table 3</a>. The BMI cutoff point of 20.8 kg/m2 was established through the ROC curve for predicting premature birth, with a specificity of 0.300 and sensitivity of 0.692.<elsevierMultimedia ident="tbl0003"></elsevierMultimedia>DiscussionThe present study analyzed the maternal-fetal outcomes of 39 pregnancies monitored by the HCPA team. The present study's results indicated high prevalence rates of premature birth and maternal respiratory exacerbation outcomes (38.5% and 84.6%, respectively). In addition, BMI values below 20.8 kg/m2 and early CF diagnosis increased the risk of premature birth. The presence of MRSA, absence of MSSA, and younger age of diagnosis contributed to an increased risk of respiratory exacerbation during pregnancy.In the present study, the adverse fetal outcome with the highest prevalence rate was premature birth (38.5%). A similar result was found in a retrospective cohort of 2 178 954 pregnancies, of which 77 involved women with CF. In the comparative analysis, results indicated that women with CF were more susceptible to giving birth to newborns with less than 37 weeks of GA (18.2% versus 8.9%, p = 0.008).<a class="elsevierStyleCrossRef" href="#bib0019">19</a> This seems to be a frequent finding since previous studies have reported rates of premature birth ranging from 10% to 48%.<a class="elsevierStyleCrossRef" href="#bib0020">20</a>,<a class="elsevierStyleCrossRef" href="#bib0021">21</a>The association analyses demonstrated that women with lower BMI values in the pre-conception period had a higher risk of premature delivery. For each additional unit in terms of maternal BMI, the risk of premature birth was reduced by 19.3%. The nutritional recommendation for women with CF is to maintain a BMI ≥ of 22 kg/m2<a class="elsevierStyleCrossRef" href="#bib0022">22</a> for better management and prevention of respiratory infections. Additionally, evidence suggests that severe malnutrition, determined by a BMI < 18 kg/m2, is considered a relative contraindication for pregnancy in this population.<a class="elsevierStyleCrossRef" href="#bib0023">23</a> The authors’ findings corroborate the current guidelines, as BMI values < 20.8 kg/m2 showed better sensitivity and specificity for predicting the occurrence of premature birth.The main adverse maternal outcome observed in the present study was respiratory exacerbation during pregnancy (84.6% prevalence rate). Similar results have been reported by previous studies,<a class="elsevierStyleCrossRef" href="#bib0013">13</a>,<a class="elsevierStyleCrossRef" href="#bib0024">24</a> and only one case-control study indicated no difference (p > 0.2) between rates of respiratory exacerbation between pregnant and non-pregnant women with CF. However, the sample size was small and modest differences between these groups may have been lost.<a class="elsevierStyleCrossRef" href="#bib0012">12</a>Spontaneous vaginal delivery is indicated in clinical guidelines for women with CF, except for maternal or fetal complications. In the present study, the rate of cesarean sections was high (56.4%). This finding is justified by the increased frequency of exacerbations, pulmonary complications, and complications related to pregnancy (gestational DM, pre-eclampsia) in this population.<a class="elsevierStyleCrossRef" href="#bib0025">25</a>The age of early CF diagnosis acted as a risk factor for exacerbations and premature birth; each additional year in the age of diagnosis reduced the risk of exacerbation by 2.3% and premature delivery by 5.8%. Such findings can be explained by the direct association between late diagnosis and atypical forms of the disease, which have milder clinical presentations. In these cases, symptoms are usually manifested in only one organ and the number of hospitalizations throughout life is significantly lower when compared to patients diagnosed early with the typical forms.<a class="elsevierStyleCrossRef" href="#bib0026">26</a>The National Neonatal Screening Program was only instituted in Brazil in 2011, a fact that influences the highest average age of diagnosis found in the present study (21.3). As screening in the country expands, diagnoses become more precocious and this ceases to act as a risk factor for negative outcomes in the population.<a class="elsevierStyleCrossRef" href="#bib0027">27</a>In general, women with CF with FEV1 > 60% tolerate pregnancy well.<a class="elsevierStyleCrossRef" href="#bib0009">9</a> In the present study, the mean FEV1 of 62% and the small sample size may justify the absence of associations between lung function and negative maternal-fetal outcomes.Similarly, the authors’ findings indicated that pregnant women colonized by MSSA had a lower risk of respiratory exacerbation. In contrast, those colonized by MRSA had a higher risk of presenting the same outcome. Colonization by MRSA has been associated with several negative clinical outcomes in patients with CF, including an accelerated decline in lung function, an increased number of hospitalizations, and early mortality.<a class="elsevierStyleCrossRef" href="#bib0028">28</a>,<a class="elsevierStyleCrossRef" href="#bib0029">29</a> Bacterial colonization by Burkholderia cepacia has also been associated with a rapid decline in lung function in previous studies conducted with pregnant women with CF.<a class="elsevierStyleCrossRef" href="#bib0020">20</a>,<a class="elsevierStyleCrossRef" href="#bib0030">30</a>Altogether, it is known that sepsis of respiratory origin can generate potential complications for pregnant women and fetal development. Therefore, the authors believe that the present study's findings strengthen the current consensus recommendations and clinical guidelines to closely monitor pregnant patients with CF and introduce, early and rigorously, treatment of respiratory exacerbations.<a class="elsevierStyleCrossRef" href="#bib0009">9</a>,<a class="elsevierStyleCrossRef" href="#bib0030">30</a>This study was retrospective, of small sample size, and single-centered, which may limit the applicability of the present study's findings to different populations. Additional studies and larger sample sizes are needed to identify long-term adverse outcomes for pregnant women with CF. Despite these limitations, this is the first study that examined the predictors of adverse outcomes in pregnant women with CF in Brazil.The authors conclude that the present study's findings add to the current body of evidence that indicates that conception in women with CF is often associated with maternal and fetal complications. Continuous monitoring by a multidisciplinary team must emphasize the appropriate nutritional status, as well as investigate bacterial colonization and provide immediate attention to respiratory exacerbations." "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 0 => array:3 [ "identificador" => "xres1653738" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abss0001" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abss0002" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abss0003" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abss0004" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1470020" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0001" "titulo" => "Introduction" ] 3 => array:3 [ "identificador" => "sec0002" "titulo" => "Methods" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0003" "titulo" => "Data collection" ] 1 => array:2 [ "identificador" => "sec0004" "titulo" => "Statistical analysis" ] ] ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Results" ] 5 => array:2 [ "identificador" => "sec0006" "titulo" => "Discussion" ] 6 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-12-06" "fechaAceptado" => "2021-02-04" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1470020" "palabras" => array:4 [ 0 => "Cystic fibrosis" 1 => "Pregnancy" 2 => "High-risk pregnancy" 3 => "Obstetric complications" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveIn this present study, the authors evaluated the predictive factors for adverse maternal-fetal outcomes in pregnancies of women with cystic fibrosis (CF). Patients were followed up by a referral center for adults in southern Brazil. MethodsThis is a retrospective cohort study that used data from electronic medical records regarding pregnancies of women diagnosed with CF. ResultsThe study included 39 pregnancies related to 20 different women. The main adverse outcomes were high prevalence rates of premature birth (38.5%) and maternal respiratory exacerbation (84.6%). Lower body mass index (BMI) values (< 20.8) and younger ages of CF diagnosis increased the risk of premature birth. The presence of methicillin-resistant and absence of methicillin-sensitive Staphylococcus aureus, as well as a younger age of diagnosis, increased the risk of maternal respiratory exacerbation during pregnancy. ConclusionsConception in women with CF is often associated with maternal and fetal complications. Continuous monitoring by a multidisciplinary team should emphasize appropriate nutritional status, investigation of bacterial colonization, and immediate attention to respiratory exacerbations." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abss0001" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abss0002" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abss0003" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abss0004" "titulo" => "Conclusions" ] ] ] ] "NotaPie" => array:1 [ 0 => array:1 [ "nota" => "This work was performed at Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil." ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "tbl0001" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0001" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "SD, standard deviation; BMI, body mass index; CFRD, cystic fibrosis-related diabetes; FVC, forced vital capacity; FEV1, forced expiratory volume in the first second; MSSA, methicillin-sensitive Staphylococcus aureus (oxacillin); MRSA, methicillin-resistant S. aureus (oxacillin)." "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"><a name="en0001"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristics \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0002"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n = 39 \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0003"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Age, mean ± SD \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0004"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">25.7 ± 5.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0005"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Parity, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0006"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0007"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Nulliparous \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0008"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">15 (38.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0009"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Multiparous \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0010"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">24 (61.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0011"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Age at diagnosis (years), mean ± SD \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0012"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">21.3 ± 11.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0013"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Prenatal care, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0014"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">39 (100) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0015"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Genetic counseling, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0016"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">3 (7.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0017"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Caucasian, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0018"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">37 (94.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0019"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">BMI (Kg/m²), mean ± SD \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0020"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">21.2 ± 2.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0021"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Lung transplant, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0022"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">1 (2.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0023"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">FC comorbidities, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0024"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0025"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">CFRD \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0026"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0027"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Pancreatic insufficiency \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0028"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">22 (56.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0029"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Oxygen therapy \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0030"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">3 (7.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0031"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Osteopenia / osteoporosis \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0032"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">11 (28.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0033"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Spirometry (% predicted), mean ± SD \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0034"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0035"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">FVC \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0036"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">72.4 ± 22.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0037"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">FEV1 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0038"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">62 ± 22.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0039"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">FEV1/FCV \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0040"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">83.9 ± 16.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0041"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Bacteriology, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0042"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0043"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">MSSA \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0044"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">19 (48.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0045"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">MRSA \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0046"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">6 (15.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0047"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Pseudomonas aeruginosa \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0048"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">23 (59) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0049"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Burkholderia cepacian \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0050"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">4 (10.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2810640.png" ] ] ] ] "descripcion" => array:1 [ "en" => "General characteristics of women with cystic fibrosis included in the study in the pre-pregnancy period." ] ] 1 => array:8 [ "identificador" => "tbl0002" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0002" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "GA, gestational age; SD, standard deviation; II, interquartile range; CF, cystic fibrosis." "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"><a name="en0051"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristics \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0052"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n = 39 \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0053"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">GA (weeks), median (II) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0054"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">38 (21– 42) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0055"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">GA classification, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0056"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0057"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Pre-term \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0058"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">15 (38.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0059"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Term \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0060"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">24 (61.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0061"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Birth weight (g), median (II) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0062"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">2845 (2425 – 3200) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0063"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Length (cm), mean ± SD \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0064"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">46.6 (4.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0065"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Fifth minute Apgar score, median (II) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0066"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">9 (3 – 10) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0067"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Complications at birth, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0068"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">14 (35.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0069"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Acute respiratory failure \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0070"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0071"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Bronchiolitis \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0072"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0073"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Cardiorespiratory arrest \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0074"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0075"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Meconium ileus \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0076"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0077"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Meconium aspiration \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0078"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0079"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Jaundice \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0080"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0081"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Length of stay (days), median (II) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0082"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">3 (2 – 10) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0083"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">CF investigation, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0084"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">30 (76.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0085"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Breastfeeding, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0086"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">29 (74.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2810641.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Fetal outcomes of neonates included in the sample." ] ] 2 => array:8 [ "identificador" => "tbl0003" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0003" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "CF, cystic fibrosis; β, standardized regression coefficient; PR, prevalence ratio; CI, confidence interval; BMI, body mass index; FVC, forced vital capacity; FEV1, forced expiratory volume in the first second; MSSA, methicillin-sensitive Staphylococcus aureus (oxacillin); MRSA, methicillin-resistant S. aureus (oxacillin). p-values of less than 0.001 are highlighted in bold." "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"><a name="en0087"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0088"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0089"></a><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Premature birth</th><a name="en0090"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0091"></a><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Respiratory exacerbation</th></tr><tr title="table-row"><a name="en0092"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Covariables \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0093"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">β \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0094"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PR (CI 95%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0095"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p-value \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0096"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">β \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0097"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PR (CI 95%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0098"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p-value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0099"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">BMI \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0100"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.214 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0101"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.807 (0.717–0.908) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0102"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">< 0.001 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0103"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.012 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0104"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.988 (0.900–1.083) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0105"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.793 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0106"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Age of CF diagnosis \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0107"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.060 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0108"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.942 (0.909- 0.976) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0109"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.001 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0110"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.023 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0111"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.977 (0.960–0.994) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0112"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.007 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0113"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Mother's age at pregnancy \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0114"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.062 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0115"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.940 (0.878–1.006) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0116"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.074 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0117"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.024 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0118"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">1.024 (0.983- 1.066) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0119"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.251 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0120"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Pseudomonas aeruginosa \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0121"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.229 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0122"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.795 (0.361–1.749) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0123"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.569 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0124"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.140 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0125"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.870 (0.576- 1.312) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0126"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.505 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0127"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">MSSA \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0128"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.354 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0129"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.702 (0.309–1.594) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0130"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.397 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0131"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.479 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0132"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.619 (0.389- 0.985) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0133"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.043 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0134"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">MRSA \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0135"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.693 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0136"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">2.000 (0.951–4.207) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0137"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.068 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0138"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.452 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0139"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">1.571 (1.214- 2.034) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0140"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0141"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">CVF% \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0142"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.007 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0143"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.993 (0.972–1.013) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0144"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.477 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0145"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.008 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0146"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.992 (0.983- 1.002) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0147"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.099 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0148"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">FEV1% \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0149"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.005 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0150"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.995 (0.975–1.015) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0151"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.612 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0152"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.011 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0153"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.989 (0.979- 1.000) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0154"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.054 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0155"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">FEV1/FVC% \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0156"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.008 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0157"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">1.008 (0.978–1.039) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0158"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.622 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0159"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.005 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0160"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.995 (0.981- 1.010) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0161"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.528 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2810642.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Results of the Poisson regression for premature birth and maternal respiratory exacerbation as dependent variables during the gestational period." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "cebibsec1" "bibliografiaReferencia" => array:30 [ 0 => array:3 [ "identificador" => "bib0001" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "State of progress in treating cystic fibrosis respiratory disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P.A. 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Vanessa de Souza Vieiraa, Taiane dos Santos Feitenb, Renata Salatti Ferraric, Paulo de Tarso Roth Dalcinb,d, Bruna Zieglerb,c,

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brunaziegler@yahoo.com.br

Corresponding author.

a Hospital de Clínicas de Porto Alegre (HCPA), Fisioterapeuta Residente em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil

b Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Ciências Pneumológicas, Porto Alegre, RS, Brazil

c Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Fisioterapia, Porto Alegre, RS, Brazil

d Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Pneumologia, Porto Alegre, RS, Brazil

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0007">Introduction</span><p id="para0006" class="elsevierStylePara elsevierViewall">Cystic fibrosis &#40;CF&#41; is an autosomal recessive&#44; multisystemic genetic disease of chronic and progressive evolution that is more common in the Caucasian population&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a> Gene mutations cause a dysfunction in the cystic fibrosis transmembrane conductance regulator protein&#44; consequently hampering ion transport on the surface of epithelial cells&#59; this results in the thickening of secretions produced by exocrine glands&#46;<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a> Clinical presentations of this disease may include a high concentration of electrolytes in sweat&#44; deterioration of lung function&#44; and exocrine pancreatic insufficiency&#46;<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a></p><p id="para0007" class="elsevierStylePara elsevierViewall">Recent advances in diagnosis and treatment have provided a significant increase in life expectancy for patients with CF&#46;<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a> The median survival&#44; in several countries&#44; can exceed 40 years<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">5-7</span></a>&#59; currently&#44; the median survival of patients with CF in Brazil is 43&#46;8 years&#46;<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a></p><p id="para0008" class="elsevierStylePara elsevierViewall">In view of the aging of this population&#44; issues related to family genetics&#44; fertility&#44; and pregnancy are increasingly frequent&#46;<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a> In 2018&#44; 280 pregnancies were reported in the Cystic Fibrosis Foundation registry&#44; representing approximately 4 live births per 100 women of reproductive age&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">10</span></a></p><p id="para0009" class="elsevierStylePara elsevierViewall">Previous studies have shown that pregnancies in women with CF may be associated with an increased number of respiratory exacerbations&#44; premature delivery&#44; cesarean delivery&#44; and low birth weight&#46; Women with forced expiratory volume in the first second &#40;FEV<span class="elsevierStyleInf">1</span>&#41; &#60;&#160;60&#37; of the predicted values also face higher death rates 3&#46;2 years after delivery <a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0011"><span class="elsevierStyleSup">11</span></a>&#59; better results were observed in women with FEV<span class="elsevierStyleInf">1</span>&#160;&#62;&#160;50&#37;&#44; adequate nutritional status&#44; and controlled diabetes mellitus &#40;DM&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a></p><p id="para0010" class="elsevierStylePara elsevierViewall">Despite these findings&#44; maternal-fetal outcomes in women with CF have not yet been exhaustively explored&#44;<a class="elsevierStyleCrossRef" href="#bib0012"><span class="elsevierStyleSup">12</span></a> and few Brazilian studies are available for building an arsenal of evidence capable of leading to strong conclusions&#46;<a class="elsevierStyleCrossRef" href="#bib0013"><span class="elsevierStyleSup">13</span></a></p><p id="para0011" class="elsevierStylePara elsevierViewall">Improving the understanding of the impacts of pregnancy in women with CF may assist in the counseling and management of these patients&#46; Therefore&#44; the present study aimed to retrospectively assess predictive factors for poor maternal-fetal outcomes of pregnancies in women with CF followed up at a CF referral center for adults in southern Brazil&#46;</p></span><span id="sec0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0008">Methods</span><p id="para0012" class="elsevierStylePara elsevierViewall">This is a retrospective cohort study that included all cases of pregnant women diagnosed with CF followed by the Program for Adolescents and Adults with CF at Hospital de Cl&#237;nicas de Porto Alegre &#40;HCPA&#41; from January 1998 to July 2020&#46; The study was approved by the HCPA Research Ethics Committee &#40;number 42537415700005327&#41; and all participants signed an informed consent form&#46;</p><span id="sec0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0009">Data collection</span><p id="para0013" class="elsevierStylePara elsevierViewall">Patients in this program are usually evaluated by a multidisciplinary team every 3 months&#46; Clinical data were collected from medical records regarding the year prior to the start date of pregnancy&#46;</p><p id="para0014" class="elsevierStylePara elsevierViewall">Lung function data were measured using spirometry and included forced vital capacity &#40;FVC&#41;&#44; FEV<span class="elsevierStyleInf">1&#44;</span> and FEV<span class="elsevierStyleInf">1</span>&#47;FVC ratio expressed as a percentage of the predicted results according to age&#44; height&#44; and gender&#46;<a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a> Spirometry techniques were based on the guidelines for pulmonary function tests by the Brazilian Society of Pulmonology and Tisiology&#44; <a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">15</span></a> and the pre-gestational examination with the best results in the last 6 months before delivery was considered&#46;</p><p id="para0015" class="elsevierStylePara elsevierViewall">The authors collected results of the last 3 sputum bacteriology tests in the year prior to the pregnancy&#46; The presence of Pseudomonas aeruginosa&#44; methicillin-sensitive Staphylococcus aureus &#40;MSSA&#41;&#44; methicillin-resistant S&#46; aureus &#40;MRSA&#41;&#44; and Burkholderia cepacia was assessed&#46; Body mass index &#40;BMI&#41; was obtained by dividing weight &#40;in kilograms&#41; by height squared &#40;in meters&#41;&#58; BMI&#160;&#61;&#160;weight&#47;height<span class="elsevierStyleSup">2</span>&#46;</p><p id="para0016" class="elsevierStylePara elsevierViewall">Information related to age&#44; ethnicity&#44; age at CF diagnosis&#44; and comorbidities &#40;DM related to CF&#44; pancreatic insufficiency&#41; was collected&#46; In order to measure maternal outcomes during pregnancy&#44; the patient&#39;s age&#44; whether or not she received counseling by the CF team&#44; as well as complications &#40;gestational DM&#44; eclampsia&#47;pre-eclampsia&#44; hospitalization&#44; respiratory exacerbation&#44; and conception route&#41; were recorded&#46;</p><p id="para0017" class="elsevierStylePara elsevierViewall">The analysis of neonatal outcomes was performed through the collection of data on gestational age &#40;GA&#41;&#44; weight&#44; fifth minute Apgar score&#44; investigation for CF&#44; breastfeeding&#44; complications at birth&#44; and length of stay &#40;days&#41;&#46; The GA was measured in weeks and classified as preterm birth &#40;GA &#60;&#160;37 weeks&#41; or term birth &#40;GA between 37 and 42 weeks&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0016"><span class="elsevierStyleSup">16</span></a> The fifth minute Apgar score considered values &#8203;&#8203;&#8804; 6 as a risk for the newborn&#46;<a class="elsevierStyleCrossRef" href="#bib0017"><span class="elsevierStyleSup">17</span></a></p><p id="para0018" class="elsevierStylePara elsevierViewall">In the study&#39;s consultations&#44; women who have a desire to gestate are routinely informed about the clinical factors that increase the likelihood of complications during pregnancy&#44; such as inadequate nutritional status&#44; the decline in lung function&#44; the presence of liver disease&#44; and CF-related DM&#46;</p></span><span id="sec0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0010">Statistical analysis</span><p id="para0019" class="elsevierStylePara elsevierViewall">Data were organized in an Excel &#40;version 16&#46;0&#41; spreadsheet and analyzes were performed using SPSS version 20&#46;0&#46; Continuous variables were presented as means &#177; standard deviations when data presented normal distributions or as median and interquartile range in case of non-normal distributions&#46; Categorical variables were expressed in absolute and relative frequencies&#46;</p><p id="para0020" class="elsevierStylePara elsevierViewall">Considering the particularity of the variable &#8220;age of diagnosis&#8221;&#44; it was analyzed only once in the case of multiparous women&#46; The other clinical variables are changeable over time and for this reason&#44; were analyzed separately for the 39 pregnancies&#46;</p><p id="para0021" class="elsevierStylePara elsevierViewall">Prevalence ratio&#44; estimated by using Poisson regression with robust variance&#44; was used to verify the association between clinical variables and negative maternal-fetal outcomes&#46;<a class="elsevierStyleCrossRef" href="#bib0018"><span class="elsevierStyleSup">18</span></a> Analyzes based on receiver operating characteristic &#40;ROC&#41; curves were used to determine the cutoff points for each variable for better sensitivity and specificity&#46; A statistical significance level of less than 5&#37; &#40;p&#160;&#60;&#160;0&#46;05&#41; was adopted for all models&#46;</p></span></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0011">Results</span><p id="para0022" class="elsevierStylePara elsevierViewall">41 pregnancies were studied in 25 women with CF between January 1998 and July 2020&#46; One woman had twin pregnancies and one pregnancy was conceived by in vitro fertilization&#46;</p><p id="para0023" class="elsevierStylePara elsevierViewall">Two cases of spontaneous abortion were excluded from the study&#46; There was no abortion or termination of pregnancy for medical reasons&#46; There were two neonatal deaths and no maternal deaths related to pregnancy&#46;</p><p id="para0024" class="elsevierStylePara elsevierViewall">The sample consisted of 94&#46;9&#37; Caucasian women&#44; with a mean age of 25&#46;7 years&#44; a mean FEV1 of 62&#37; the predicted value&#44; and a mean BMI of 21&#46;2 Kg&#47;m<span class="elsevierStyleSup">2</span>&#46; The general characteristics of women with CF included in this study in the pre-pregnancy period are shown in <a class="elsevierStyleCrossRef" href="#tbl0001">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0001"></elsevierMultimedia><p id="para0025" class="elsevierStylePara elsevierViewall">The most prevalent neonatal outcome was birth with a GA of fewer than 37 weeks&#44; characterizing premature delivery in 38&#46;5&#37; of cases&#46; Fourteen newborns presented some type of complication at birth&#44; the most prevalent being related to the cardiorespiratory system &#40;71&#46;42&#37;&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0002">Table 2</a> shows the fetal outcomes of neonates included in the sample&#46;</p><elsevierMultimedia ident="tbl0002"></elsevierMultimedia><p id="para0026" class="elsevierStylePara elsevierViewall">The first case of fetal death occurred with a newborn at 540 days of life&#46; The mother had preeclampsia during pregnancy&#44; which occurred in the first year after a bilateral lung transplant&#46; The neonate was born at 35 weeks&#44; weighing 1752&#160;g&#44; had surgical meconium ileus and respiratory symptoms that required mechanical ventilation was diagnosed with cystic fibrosis&#44; and&#160;remained hospitalized from birth until the date of death&#46; The second case of death involved a newborn with 34 weeks of GA who developed cardiac arrest shortly after birth&#46;</p><p id="para0027" class="elsevierStylePara elsevierViewall">During the gestational period&#44; the most common negative maternal outcome was respiratory exacerbation &#40;84&#46;6&#37;&#41;&#44; requiring oral antibiotics in 10 cases &#40;25&#46;6&#37;&#41; and intravenous antibiotics in 11 cases &#40;28&#46;2&#37;&#41;&#46; Three women were admitted to an intensive care unit during pregnancy&#44; one of whom required invasive mechanical ventilation&#46; The hospital length of stay ranged from 3 to 180 days&#46; Only 3 pregnancies &#40;7&#46;7&#37;&#41; were accompanied by the occurrence of pre-eclampsia&#44; and 1 &#40;2&#46;6&#37;&#41; woman presented gestational DM&#46; The most prevalent mode of delivery was cesarean section &#40;56&#46;4&#37;&#41;&#46;</p><p id="para0028" class="elsevierStylePara elsevierViewall">The associations between dependent variables &#40;premature birth and maternal respiratory exacerbation&#41; and covariables are shown in <a class="elsevierStyleCrossRef" href="#tbl0003">Table 3</a>&#46; The BMI cutoff point of 20&#46;8&#160;kg&#47;m<span class="elsevierStyleSup">2</span> was established through the ROC curve for predicting premature birth&#44; with a specificity of 0&#46;300 and sensitivity of 0&#46;692&#46;</p><elsevierMultimedia ident="tbl0003"></elsevierMultimedia></span><span id="sec0006" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0012">Discussion</span><p id="para0029" class="elsevierStylePara elsevierViewall">The present study analyzed the maternal-fetal outcomes of 39 pregnancies monitored by the HCPA team&#46; The present study&#39;s results indicated high prevalence rates of premature birth and maternal respiratory exacerbation outcomes &#40;38&#46;5&#37; and 84&#46;6&#37;&#44; respectively&#41;&#46; In addition&#44; BMI values &#8203;&#8203;below 20&#46;8&#160;kg&#47;m<span class="elsevierStyleSup">2</span> and early CF diagnosis increased the risk of premature birth&#46; The presence of MRSA&#44; absence of MSSA&#44; and younger age of diagnosis contributed to an increased risk of respiratory exacerbation during pregnancy&#46;</p><p id="para0030" class="elsevierStylePara elsevierViewall">In the present study&#44; the adverse fetal outcome with the highest prevalence rate was premature birth &#40;38&#46;5&#37;&#41;&#46; A similar result was found in a retrospective cohort of 2 178 954 pregnancies&#44; of which 77 involved women with CF&#46; In the comparative analysis&#44; results indicated that women with CF were more susceptible to giving birth to newborns with less than 37 weeks of GA &#40;18&#46;2&#37; versus 8&#46;9&#37;&#44; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;008&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0019"><span class="elsevierStyleSup">19</span></a> This seems to be a frequent finding since previous studies have reported rates of premature birth ranging from 10&#37; to 48&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">20</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0021"><span class="elsevierStyleSup">21</span></a></p><p id="para0031" class="elsevierStylePara elsevierViewall">The association analyses demonstrated that women with lower BMI values &#8203;&#8203;in the pre-conception period had a higher risk of premature delivery&#46; For each additional unit in terms of maternal BMI&#44; the risk of premature birth was reduced by 19&#46;3&#37;&#46; The nutritional recommendation for women with CF is to maintain a BMI &#8805;&#160;of 22&#160;kg&#47;m<span class="elsevierStyleSup">2</span><a class="elsevierStyleCrossRef" href="#bib0022"><span class="elsevierStyleSup">22</span></a> for better management and prevention of respiratory infections&#46; Additionally&#44; evidence suggests that severe malnutrition&#44; determined by a BMI &#60;&#160;18&#160;kg&#47;m<span class="elsevierStyleSup">2</span>&#44; is considered a relative contraindication for pregnancy in this population&#46;<a class="elsevierStyleCrossRef" href="#bib0023"><span class="elsevierStyleSup">23</span></a> The authors&#8217; findings corroborate the current guidelines&#44; as BMI values &#8203;&#8203;&#60;&#160;20&#46;8&#160;kg&#47;m<span class="elsevierStyleSup">2</span> showed better sensitivity and specificity for predicting the occurrence of premature birth&#46;</p><p id="para0032" class="elsevierStylePara elsevierViewall">The main adverse maternal outcome observed in the present study was respiratory exacerbation during pregnancy &#40;84&#46;6&#37; prevalence rate&#41;&#46; Similar results have been reported by previous studies&#44;<a class="elsevierStyleCrossRef" href="#bib0013"><span class="elsevierStyleSup">13</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0024"><span class="elsevierStyleSup">24</span></a> and only one case-control study indicated no difference &#40;p&#160;&#62;&#160;0&#46;2&#41; between rates of respiratory exacerbation between pregnant and non-pregnant women with CF&#46; However&#44; the sample size was small and modest differences between these groups may have been lost&#46;<a class="elsevierStyleCrossRef" href="#bib0012"><span class="elsevierStyleSup">12</span></a></p><p id="para0033" class="elsevierStylePara elsevierViewall">Spontaneous vaginal delivery is indicated in clinical guidelines for women with CF&#44; except for maternal or fetal complications&#46; In the present study&#44; the rate of cesarean sections was high &#40;56&#46;4&#37;&#41;&#46; This finding is justified by the increased frequency of exacerbations&#44; pulmonary complications&#44; and complications related to pregnancy &#40;gestational DM&#44; pre-eclampsia&#41; in this population&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">25</span></a></p><p id="para0034" class="elsevierStylePara elsevierViewall">The age of early CF diagnosis acted as a risk factor for exacerbations and premature birth&#59; each additional year in the age of diagnosis reduced the risk of exacerbation by 2&#46;3&#37; and premature delivery by 5&#46;8&#37;&#46; Such findings can be explained by the direct association between late diagnosis and atypical forms of the disease&#44; which have milder clinical presentations&#46; In these cases&#44; symptoms are usually manifested in only one organ and the number of hospitalizations throughout life is significantly lower when compared to patients diagnosed early with the typical forms&#46;<a class="elsevierStyleCrossRef" href="#bib0026"><span class="elsevierStyleSup">26</span></a></p><p id="para0035" class="elsevierStylePara elsevierViewall">The National Neonatal Screening Program was only instituted in Brazil in 2011&#44; a fact that influences the highest average age of diagnosis found in the present study &#40;21&#46;3&#41;&#46; As screening in the country expands&#44; diagnoses become more precocious and this ceases to act as a risk factor for negative outcomes in the population&#46;<a class="elsevierStyleCrossRef" href="#bib0027"><span class="elsevierStyleSup">27</span></a></p><p id="para0036" class="elsevierStylePara elsevierViewall">In general&#44; women with CF with FEV<span class="elsevierStyleInf">1</span>&#160;&#62; 60&#37; tolerate pregnancy well&#46;<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a> In the present study&#44; the mean FEV<span class="elsevierStyleInf">1</span> of 62&#37; and the small sample size may justify the absence of associations between lung function and negative maternal-fetal outcomes&#46;</p><p id="para0037" class="elsevierStylePara elsevierViewall">Similarly&#44; the authors&#8217; findings indicated that pregnant women colonized by MSSA had a lower risk of respiratory exacerbation&#46; In contrast&#44; those colonized by MRSA had a higher risk of presenting the same outcome&#46; Colonization by MRSA has been associated with several negative clinical outcomes in patients with CF&#44; including an accelerated decline in lung function&#44; an increased number of hospitalizations&#44; and early mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0028"><span class="elsevierStyleSup">28</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0029"><span class="elsevierStyleSup">29</span></a> Bacterial colonization by Burkholderia cepacia has also been associated with a rapid decline in lung function in previous studies conducted with pregnant women with CF&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">20</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">30</span></a></p><p id="para0038" class="elsevierStylePara elsevierViewall">Altogether&#44; it is known that sepsis of respiratory origin can generate potential complications for pregnant women and fetal development&#46; Therefore&#44; the authors believe that the present study&#39;s findings strengthen the current consensus recommendations and clinical guidelines to closely monitor pregnant patients with CF and introduce&#44; early and rigorously&#44; treatment of respiratory exacerbations&#46;<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">30</span></a></p><p id="para0039" class="elsevierStylePara elsevierViewall">This study was retrospective&#44; of small sample size&#44; and single-centered&#44; which may limit the applicability of the present study&#39;s findings to different populations&#46; Additional studies and larger sample sizes are needed to identify long-term adverse outcomes for pregnant women with CF&#46; Despite these limitations&#44; this is the first study that examined the predictors of adverse outcomes in pregnant women with CF in Brazil&#46;</p><p id="para0040" class="elsevierStylePara elsevierViewall">The authors conclude that the present study&#39;s findings add to the current body of evidence that indicates that conception in women with CF is often associated with maternal and fetal complications&#46; Continuous monitoring by a multidisciplinary team must emphasize the appropriate nutritional status&#44; as well as investigate bacterial colonization and provide immediate attention to respiratory exacerbations&#46;</p></span></span>"
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        "resumen" => "<span id="abss0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0002">Objective</span><p id="spara007" class="elsevierStyleSimplePara elsevierViewall">In this present study&#44; the authors evaluated the predictive factors for adverse maternal-fetal outcomes in pregnancies of women with cystic fibrosis &#40;CF&#41;&#46; Patients were followed up by a referral center for adults in southern Brazil&#46;</p></span> <span id="abss0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0003">Methods</span><p id="spara008" class="elsevierStyleSimplePara elsevierViewall">This is a retrospective cohort study that used data from electronic medical records regarding pregnancies of women diagnosed with CF&#46;</p></span> <span id="abss0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0004">Results</span><p id="spara009" class="elsevierStyleSimplePara elsevierViewall">The study included 39 pregnancies related to 20 different women&#46; The main adverse outcomes were high prevalence rates of premature birth &#40;38&#46;5&#37;&#41; and maternal respiratory exacerbation &#40;84&#46;6&#37;&#41;&#46; Lower body mass index &#40;BMI&#41; values &#40;&#60;&#160;20&#46;8&#41; and younger ages of CF diagnosis increased the risk of premature birth&#46; The presence of methicillin-resistant and absence of methicillin-sensitive Staphylococcus aureus&#44; as well as a younger age of diagnosis&#44; increased the risk of maternal respiratory exacerbation during pregnancy&#46;</p></span> <span id="abss0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0005">Conclusions</span><p id="spara010" class="elsevierStyleSimplePara elsevierViewall">Conception in women with CF is often associated with maternal and fetal complications&#46; Continuous monitoring by a multidisciplinary team should emphasize appropriate nutritional status&#44; investigation of bacterial colonization&#44; and immediate attention to respiratory exacerbations&#46;</p></span>"
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          "leyenda" => "<p id="spara002" class="elsevierStyleSimplePara elsevierViewall">SD&#44; standard deviation&#59; BMI&#44; body mass index&#59; CFRD&#44; cystic fibrosis-related diabetes&#59; FVC&#44; forced vital capacity&#59; FEV<span class="elsevierStyleInf">1</span>&#44; forced expiratory volume in the first second&#59; MSSA&#44; methicillin-sensitive Staphylococcus aureus &#40;oxacillin&#41;&#59; MRSA&#44; methicillin-resistant S&#46; aureus &#40;oxacillin&#41;&#46;</p>"
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Age&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0004"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">25&#46;7&#160;&#177;&#160;5&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0005"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Parity&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0006"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0007"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Nulliparous&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0008"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">15 &#40;38&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0009"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Multiparous&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0010"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">24 &#40;61&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0011"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Age at diagnosis &#40;years&#41;&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0012"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">21&#46;3&#160;&#177;&#160;11&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0013"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Prenatal care&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0014"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">39 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0015"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Genetic counseling&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0016"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3 &#40;7&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0017"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Caucasian&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0018"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">37 &#40;94&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0019"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">BMI &#40;Kg&#47;m&#178;&#41;&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0020"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">21&#46;2&#160;&#177;&#160;2&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0021"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Lung transplant&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0022"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1 &#40;2&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0023"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">FC comorbidities&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0024"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0025"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">CFRD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0026"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0027"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Pancreatic insufficiency&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0028"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">22 &#40;56&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0029"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Oxygen therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0030"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3 &#40;7&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0031"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Osteopenia &#47; osteoporosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0032"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">11 &#40;28&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0033"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Spirometry &#40;&#37; predicted&#41;&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0034"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0035"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">FVC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0036"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">72&#46;4&#160;&#177;&#160;22&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0037"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">FEV<span class="elsevierStyleInf">1</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0038"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">62&#160;&#177;&#160;22&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0039"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">FEV<span class="elsevierStyleInf">1</span>&#47;FCV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0040"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">83&#46;9&#160;&#177;&#160;16&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0041"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Bacteriology&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0042"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0043"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">MSSA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0044"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">19 &#40;48&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0045"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">MRSA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0046"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">6 &#40;15&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0047"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Pseudomonas aeruginosa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0048"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">23 &#40;59&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0049"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Burkholderia cepacian&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0050"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4 &#40;10&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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        "descripcion" => array:1 [
          "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">General characteristics of women with cystic fibrosis included in the study in the pre-pregnancy period&#46;</p>"
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      1 => array:8 [
        "identificador" => "tbl0002"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spara004" class="elsevierStyleSimplePara elsevierViewall">GA&#44; gestational age&#59; SD&#44; standard deviation&#59; II&#44; interquartile range&#59; CF&#44; cystic fibrosis&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0051"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0052"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" 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>&#160;&#61;&#160;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0053"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">GA &#40;weeks&#41;&#44; median &#40;II&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0054"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">38 &#40;21&#8211; 42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0055"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">GA classification&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0056"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0057"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Pre-term&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0058"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">15 &#40;38&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0059"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Term&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0060"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">24 &#40;61&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0061"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Birth weight &#40;g&#41;&#44; median &#40;II&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0062"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2845 &#40;2425 &#8211; 3200&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0063"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Length &#40;cm&#41;&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0064"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">46&#46;6 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0065"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Fifth minute Apgar score&#44; median &#40;II&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0066"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">9 &#40;3 &#8211; 10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0067"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Complications at birth&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0068"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">14 &#40;35&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0069"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Acute respiratory failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0070"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0071"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Bronchiolitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0072"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0073"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Cardiorespiratory arrest&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0074"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0075"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Meconium ileus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0076"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0077"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Meconium aspiration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0078"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0079"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Jaundice&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0080"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0081"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Length of stay &#40;days&#41;&#44; median &#40;II&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0082"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3 &#40;2 &#8211; 10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0083"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">CF investigation&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0084"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">30 &#40;76&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0085"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Breastfeeding&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0086"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">29 &#40;74&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2810641.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara003" class="elsevierStyleSimplePara elsevierViewall">Fetal outcomes of neonates included in the sample&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0003"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "alt0003"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spara006" class="elsevierStyleSimplePara elsevierViewall">CF&#44; cystic fibrosis&#59; &#946;&#44; standardized regression coefficient&#59; PR&#44; prevalence ratio&#59; CI&#44; confidence interval&#59; BMI&#44; body mass index&#59; FVC&#44; forced vital capacity&#59; FEV<span class="elsevierStyleInf">1</span>&#44; forced expiratory volume in the first second&#59; MSSA&#44; methicillin-sensitive Staphylococcus aureus &#40;oxacillin&#41;&#59; MRSA&#44; methicillin-resistant S&#46; aureus &#40;oxacillin&#41;&#46; p-values of less than 0&#46;001 are highlighted in bold&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0087"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0088"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0089"></a><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Premature birth</th><a name="en0090"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0091"></a><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Respiratory exacerbation</th></tr><tr title="table-row"><a name="en0092"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Covariables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0093"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#946;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0094"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PR &#40;CI 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0095"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p-value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0096"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#946;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0097"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PR &#40;CI 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0098"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p-value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0099"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">BMI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0100"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;214&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0101"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;807 &#40;0&#46;717&#8211;0&#46;908&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0102"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0103"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0104"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;988 &#40;0&#46;900&#8211;1&#46;083&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0105"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;793&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0106"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Age of CF diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0107"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;060&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0108"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;942 &#40;0&#46;909- 0&#46;976&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0109"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0110"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;023&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0111"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;977 &#40;0&#46;960&#8211;0&#46;994&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0112"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0113"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Mother&#39;s age at pregnancy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0114"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;062&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0115"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;940 &#40;0&#46;878&#8211;1&#46;006&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0116"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;074&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0117"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;024&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0118"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;024 &#40;0&#46;983- 1&#46;066&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0119"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;251&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0120"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Pseudomonas aeruginosa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0121"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;229&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0122"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;795 &#40;0&#46;361&#8211;1&#46;749&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0123"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;569&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0124"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;140&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0125"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;870 &#40;0&#46;576- 1&#46;312&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0126"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;505&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0127"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">MSSA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0128"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;354&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0129"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;702 &#40;0&#46;309&#8211;1&#46;594&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0130"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;397&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0131"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;479&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0132"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;619 &#40;0&#46;389- 0&#46;985&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0133"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;043&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0134"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">MRSA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0135"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;693&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0136"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;000 &#40;0&#46;951&#8211;4&#46;207&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0137"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;068&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0138"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;452&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0139"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;571 &#40;1&#46;214- 2&#46;034&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0140"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0141"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">CVF&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0142"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0143"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;993 &#40;0&#46;972&#8211;1&#46;013&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0144"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;477&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0145"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0146"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;992 &#40;0&#46;983- 1&#46;002&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0147"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;099&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0148"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">FEV<span class="elsevierStyleInf">1</span>&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0149"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;005&nbsp;\t\t\t\t\t\t\n
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Article information

ISSN: 00217557
Original language: English

DOI:10.1016/j.jped.2021.02.009

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	2	3	5
2024 October	27	30	57
2024 September	30	30	60
2024 August	36	34	70
2024 July	37	52	89
2024 June	28	36	64
2024 May	24	12	36
2024 April	29	28	57
2024 March	33	17	50
2024 February	41	27	68
2024 January	76	27	103
2023 December	48	31	79
2023 November	28	37	65
2023 October	84	32	116
2023 September	34	41	75
2023 August	40	20	60
2023 July	30	24	54
2023 June	24	11	35
2023 May	29	25	54
2023 April	25	18	43
2023 March	42	26	68
2023 February	39	32	71
2023 January	27	34	61
2022 December	69	48	117
2022 November	50	31	81
2022 October	70	38	108
2022 September	80	45	125
2022 August	83	37	120
2022 July	72	39	111
2022 June	54	32	86
2022 May	46	31	77
2022 April	107	48	155
2022 March	98	75	173
2022 February	85	40	125
2022 January	80	61	141
2021 December	16	17	33
2021 November	11	12	23
2021 October	18	17	35
2021 September	9	11	20
2021 August	6	10	16
2021 July	14	10	24
2021 June	4	6	10

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