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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0007">Introduction</span><p id="para0005" class="elsevierStylePara elsevierViewall">Premature birth is currently configured as a public health problem in the world&#46; It is known that preterm newborns &#40;PTNB&#41; have a higher risk of death&#44; due to pathologies such as necrotizing enterocolitis&#44; neonatal septicemia&#44; and pneumonia associated with mechanical ventilation<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a> and&#44; when they survive&#44; they may develop long-term disabilities&#46;</p><p id="para0006" class="elsevierStylePara elsevierViewall">It is in this cycle of premature birth&#44; risk of morbidities&#44; neonatal mortality&#44; and disabilities in the short and long term that oropharyngeal colostrum immunotherapy &#40;OCI&#41; has been suggested as an intervention to promote the clinical improvement of these newborns&#44; especially those with very low birth weight &#40;VLW&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a> This therapy is based on the expectation of absorption of bioactive factors present in colostrum&#44; by the oropharyngeal mucosa&#44; with an amplified response to various devices&#44; with systemic bacteriostatic&#44; bactericidal&#44; antiviral&#44; anti-inflammatory&#44; and immunomodulatory effects&#46;<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a></p><p id="para0007" class="elsevierStylePara elsevierViewall">It is important to highlight that PTNB-VLW present immunological immaturity and of devices and systems&#44; especially of the gastrointestinal tract&#46; It has been reported that the institution of OCI practice favored positive clinical outcomes&#44; such as a reduction in the incidence of necrotizing enterocolitis&#44; pneumonia associated with mechanical ventilation&#44; and late septicemia&#44; in addition to a decrease in the time for PTNB to reach full enteral feeding and hospital stay&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a> Despite the biological plausibility&#44; the evidence for OCI in reducing the risk of mortality in very low birth weight preterm is insufficient&#44;<a class="elsevierStyleCrossRefs" href="#bib0004"><span class="elsevierStyleSup">4-12</span></a> and the present study intends to further elucidate the role of OCI through a clinical trial&#46;</p></span><span id="sec0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0008">Methods</span><p id="para0008" class="elsevierStylePara elsevierViewall">This manuscript was written under the guidance of CONSORT 2010&#46;<a class="elsevierStyleCrossRef" href="#bib0013"><span class="elsevierStyleSup">13</span></a></p><span id="sec0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0009">Study design</span><p id="para0009" class="elsevierStylePara elsevierViewall">The study consists of a non-randomized&#44; superiority&#44; ambispective clinical trial&#44; with an intervention group consisting of VLBW-PT admitted to the neonatal unit of a maternity hospital who used OCI &#40;treatment&#41;&#59; and a historical control group&#44; composed of VLBW-PT who were born in the same maternity hospital before the protocol implementation&#44; i&#46;e&#46;&#44; without the use of this immunotherapy &#40;Brazilian Clinical Trial Registry &#40;ReBEC&#41;&#44; under n&#46; U1111-1222-0598&#44; <a href="http://www.ensaiosclinicos.gov.br/rg/RBR-2cyp7c/">http&#58;&#47;&#47;www&#46;ensaiosclinicos&#46;gov&#46;br&#47;rg&#47;RBR-2cyp7c&#47;</a>&#41;&#46; The allocation ratio was 1&#58;1 with participants entering sequentially&#44; and there were no deviations from the study protocol&#46;</p><p id="para0010" class="elsevierStylePara elsevierViewall">Historical control was defined in compliance with the opinion of the Research Ethics Committee of the <span class="elsevierStyleItalic">Universidade Estadual de Feira de Santana</span> &#40;CAAE no&#46; 93056218&#46;0&#46;0000&#46;0053&#41;&#44; considering that not offering colostrum to PTNB in the control group violates the principle of beneficence&#44; since the positive effects of colostrum are already established in the literature&#46;</p></span><span id="sec0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0010">Participants</span><p id="para0011" class="elsevierStylePara elsevierViewall">VLBW-PT &#40;&#8804; 1&#44;500g&#41;&#44; born with gestational age &#8804; 37 weeks&#44; regardless of the type of diet &#40;zero&#44; enteral by orogastric tube or parenteral&#41;&#44; and clinically stable in the last three hours before starting immunotherapy were included&#46; The beginning of the OCI protocol occurred within 72 hours of life&#46;</p><p id="para0012" class="elsevierStylePara elsevierViewall">Maternal exclusion criteria were reports of substance or drug abuse&#44; psychological disorder&#44; multiparity &#40;triplets and more&#41;&#44; and medical contraindications for breastfeeding &#40;retrovirus and cytomegalovirus&#41;&#46; With regard to newborns&#44; they were not included when they were using vasopressor medication &#62; 10 mcg&#47;Kg&#47;min&#44; in need of immediate surgical intervention and presence of syndromes or malformations&#46;</p><p id="para0013" class="elsevierStylePara elsevierViewall">The study was conducted in the neonatal unit of the <span class="elsevierStyleItalic">Hospital In&#225;cia Pinto dos Santos</span> &#40;Women&#39;s Hospital&#41; in Feira de Santana&#44; Bahia&#44; Brazil&#44; a medium-sized public maternity hospital accredited by the Baby-Friendly Hospital Initiative&#44; linked to the Unified Health System &#40;SUS - <span class="elsevierStyleItalic">Sistema &#218;nico de Sa&#250;de</span>&#41;&#44; maintained by the <span class="elsevierStyleItalic">Funda&#231;&#227;o Hospitalar de Feira de Santana</span>&#46; Also noteworthy is the assistance provided by the Human Milk Bank &#40;HMB&#41; linked to the Brazilian Network of Human Milk Banks&#44; the sector responsible for complying with part of this protocol&#44; such as welcoming mothers of PTNB&#44; extracting colostrum&#44; and distributing of colostrum-destined for OCI&#46;</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0011">Intervention</span><p id="para0014" class="elsevierStylePara elsevierViewall">The OCI intervention consisted of using raw colostrum&#44; from mother to child&#44; initiated in the treatment group within 72&#160;h of life of VLBW-PT&#44; after medical prescription by the neonatal team&#46; Treatment was offered until the 7<span class="elsevierStyleSup">th</span> full day of life of newborns &#40;totaling up to 56 syringes&#41;&#44; with 8 &#40;eight&#41; daily administrations of 0&#46;2&#160;ml &#40;04 drops&#41; of dripped colostrum within 10 &#40;ten&#41; seconds in the oropharyngeal mucosa&#44; with 0&#46;1&#160;ml &#40;two drops&#41; in the tissue of the right oral mucosa in the first 5 &#40;five&#41; seconds and the other two drops in the tissue of the left oral mucosa in the remaining seconds&#46; Newborns&#8217; vital conditions were monitored during the procedure&#46; Therapy was considered complete when more than 75&#37; of planned doses were administered for each PTNB&#44; and clinical evolution was monitored until hospital discharge&#46;</p><p id="para0015" class="elsevierStylePara elsevierViewall">When the neonatal team identified changes in newborns&#8217; clinical stability criteria&#44; at the time of treatment or periodic follow-up&#44; the intervention was immediately interrupted&#44; being resumed as soon as clinical stability was restored&#46; Complete interruption of treatment occurred upon justifiable medical prerogative&#44; especially in severe cases of VLBW-PT&#46;</p><p id="para0016" class="elsevierStylePara elsevierViewall">Immunotherapy did not occur in the control group&#44; since this group consisted of VLBW-PT admitted to the neonatal intensive and intermediate care units from 2015 to 2016&#44; that is&#44; the period prior to OCI implementation in the institution &#40;historical control&#41;&#46; For data collection&#44; the records of the Medical Archive and Statistics Service &#40;SAME - <span class="elsevierStyleItalic">Servi&#231;o de Arquivo M&#233;dico e Estat&#237;stica</span>&#41; of the institution were consulted&#46; More details of the intervention are described in the study by da Cruz Martins et al&#46; &#40;2020&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a></p></span><span id="sec0006" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0012">Outcomes</span><p id="para0017" class="elsevierStylePara elsevierViewall">The main independent variable was OCI use&#44; defined in this study as the use of colostrum for immunological and not nutritional supplementation purposes by VLBW-PT during hospitalization in the neonatal unit and with follow-up of clinical evolution&#46; As an outcome &#40;dependent variable&#41;&#44; death was assessed&#44; verified by the permanent disappearance of all signs of life&#44; at any time after birth&#44; with no possibility of resuscitation&#44; as defined by the World Health Organization&#44;<a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a> and with a medical record and&#47;or Death Certificate&#46; Other variables were investigated in both groups such as&#58; maternal sociodemographic characteristics&#59; prenatal and childbirth variables and variables related to newborns&#46;</p></span><span id="sec0007" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0013">Sample size</span><p id="para0018" class="elsevierStylePara elsevierViewall">In the protocol&#44; an &#945;&#160;&#61;&#160;5&#37; was defined for sample size calculation&#44; &#223;&#160;&#61;&#160;80&#37;&#44; with an incidence of death in the intervention group &#61; 12&#46;5&#37; and control&#160;&#61;&#160;25&#37;&#44; in a 1&#58; 1 ratio&#44; obtained in the study by Lee et al&#46; &#40;2015&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0007"><span class="elsevierStyleSup">7</span></a> A fixed sample was calculated for an infinite population&#44; using the Bioestat 5&#46;3 software&#44; which resulted in 152 participants in each group&#44; with an increase of 15&#37; to cover possible losses&#44; totaling 350 participants&#46;<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a></p><p id="para0019" class="elsevierStylePara elsevierViewall">However&#44; as this is a finite population&#44; without replacement and with a mean admission to the neonatal unit of 68 VLBW-PT in the last five years &#40;136 individuals&#41;&#44; it was possible to readjust the sample calculation through the population correction factor&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">15</span></a> Thus&#44; the final sample size estimate was around 76 &#40;seventy-six&#41; participants&#46; 15&#37; were also added for possible losses&#44; totaling 88 &#40;eighty-eight&#41; participants&#44; 44 &#40;forty-four&#41; for each group&#46;</p><p id="para0020" class="elsevierStylePara elsevierViewall">The results of this study are based on the already published protocol&#44; whose analysis was planned to verify the occurrence of treatment damage&#47;benefits between the compared groups&#44; in the second year of OCI follow-up&#46;<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a></p></span><span id="sec0008" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0014">Recruitment</span><p id="para0021" class="elsevierStylePara elsevierViewall">Study recruitment to the intervention group was from October 2018 to August 2020&#59; for the control group&#44; medical records of VLBW-PT hospitalized between May 2015 and November 2016 were assessed&#46; Losses to follow-up were monitored during recruitment &#40;<a class="elsevierStyleCrossRef" href="#fig0001">Figure 1</a>&#41;&#44; as described in protocol&#46;<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a> The intention-to-treat analysis strategy was adopted&#46;</p><elsevierMultimedia ident="fig0001"></elsevierMultimedia></span><span id="sec0009" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0015">Statistical methods</span><p id="para0022" class="elsevierStylePara elsevierViewall">Data were entered by previously trained health professionals&#44; into two different databases&#44; with subsequent comparison and validation using the EPIDATA software&#46; Data analysis procedures were developed with IBM-SPSS &#40;version 24&#46;0&#44; Chicago&#44; IL&#44; USA&#44; serial number&#58; 10101181103&#41; and STATA 15&#46;1 &#40;serial number&#58; 401506208261&#41; software&#46;</p><p id="para0023" class="elsevierStylePara elsevierViewall">Descriptive analysis was performed for all variables according to comparison groups&#46; The Kolmogorov-Smirnov test was applied and the histogram was inspected to verify the normality of continuous variables&#46; Student&#39;s t test or Mann-Whitney U test was used&#44; according to the normality test&#44; using measures of central tendency and variability to verify differences between groups&#46; Categorical covariates were assessed using chi-square or Fisher&#39;s exact tests&#44; and a significance level of 5&#37; was adopted&#46;</p><p id="para0024" class="elsevierStylePara elsevierViewall">Initially&#44; relative risk &#40;unadjusted and adjusted&#41; was estimated as a measure of effect&#44; with respective 95&#37; confidence intervals and 5&#37; significance levels&#46; For this purpose&#44; logistic regression was used with the backward strategy and&#44; subsequently&#44; conversion was performed using the method by Zhang and Yu &#40;1998&#41;<a class="elsevierStyleCrossRef" href="#bib0016"><span class="elsevierStyleSup">16</span></a> to obtain the appropriate measure for the study design&#46;</p><p id="para0025" class="elsevierStylePara elsevierViewall">Potential confounders were selected in stratified analysis&#46; A covariate was considered confounding when&#44; after being eliminated in the saturated model&#44; there was a variation in the effect measure greater than 10&#37;&#46; Moreover&#44; the criterion of epidemiological importance was used for the selection of confounding during modeling&#44; adopting a theoretical-conceptual model to guide said selection&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0017"><span class="elsevierStyleSup">17</span></a></p><p id="para0026" class="elsevierStylePara elsevierViewall">The impact of effect magnitude was further assessed by the Number Needed to Treat &#40;NNT&#41; and Cohen&#39;s h index&#44; which assessed the effect size &#40;h&#41; based on mortality risks in the groups studied&#46; Cohen&#39;s h index is interpreted as follows&#58; small &#40;h&#160;&#61;&#160;0&#46;20&#41;&#44; medium &#40;h&#160;&#61;&#160;0&#46;50&#41;&#44; and large &#40;h&#160;&#61;&#160;0&#46;80&#41; effect&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0018"><span class="elsevierStyleSup">18</span></a></p><p id="para0027" class="elsevierStylePara elsevierViewall">Finally&#44; a survival analysis was performed to estimate the effect measure as a function of time &#40;unadjusted and adjusted hazard ratio and their respective confidence intervals&#41;&#46; For this purpose&#44; the Kaplan-Meier method was used in order to assess the size size on survival over time between the comparison groups&#46; The crude survival effect was estimated at the beginning of the curve by the logrank test &#40;Mantel-Cox&#41; and from the middle to the end by the Breslow test &#40;generalized wilcoxon&#41;&#44; with a 5&#37; significance level&#46; The Cox regression model estimated the hazard ratio&#44; duly adjusted for confounding variables selected based on the theoretical-conceptual model adopted to assess the effect of therapy on the study&#46;</p></span></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0016">Results</span><span id="sec0011" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0017">Participant flow</span><p id="para0028" class="elsevierStylePara elsevierViewall">The study participant flow is described in the flow diagram &#40;<a class="elsevierStyleCrossRef" href="#fig0001">Figure 1</a>&#41; as well as the total number of exclusions and losses in each stage of follow-up&#44; with the respective justifications&#46;</p></span><span id="sec0012" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0018">Baseline characteristics and auxiliary analyses</span><p id="para0029" class="elsevierStylePara elsevierViewall">A total of 138 &#40;one hundred and thirty-eight&#41; mothers&#47;children were assessed&#44; 66 &#40;sixty-six&#41; in the treatment group and 72 &#40;seventy-two&#41; in the control group&#46; The total number of doses administered was 2735 &#40;two thousand&#44; seven hundred and thirty-five&#41; syringes containing 0&#46;2&#160;ml of colostrum each&#44; 32 &#40;48&#46;5&#37;&#41; of VLBW-PT started treatment within 24 hours of life and 42 &#40;63&#46;6&#37;&#41; VLBW-PT received &#62; 90&#37; of planned treatment&#44; demonstrating adherence and compliance with the protocol in the unit&#46;</p><p id="para0030" class="elsevierStylePara elsevierViewall">Maternal and neonatal characteristics associated with treatment are described in <a class="elsevierStyleCrossRef" href="#tbl0001">Table 1</a> and demonstrated similarities between the groups&#44; except for the marital status covariate&#44; which was demonstrated by stratified analysis as a possible confounder and inserted in the final analysis model&#44; along with other variables justified by the literature&#46;</p><elsevierMultimedia ident="tbl0001"></elsevierMultimedia><p id="para0031" class="elsevierStylePara elsevierViewall">The magnitude of the intervention effect was calculated with the data presented in <a class="elsevierStyleCrossRef" href="#tbl0002">Table 2</a>&#44; both unadjusted and adjusted&#44; the latter by the following confounders&#58; maternal age&#44; marital status&#44; gestational hypertension&#44; childbirth type&#44; number of prenatal consultations&#44; and birth weight&#46;</p><elsevierMultimedia ident="tbl0002"></elsevierMultimedia><p id="para0032" class="elsevierStylePara elsevierViewall">The adjusted relative risk &#40;RR&#41; was 0&#46;26 &#40;95&#37; CI&#160;&#61;&#160;0&#46;07&#8211;0&#46;67&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;00&#41;&#44; relative risk reduction &#40;RRR&#41; of 35&#37; &#40;95&#37; CI&#160;&#61;&#160;0&#46;33&#8211;0&#46;93&#41;&#44; the absolute risk for the treatment group of 37&#46;9&#37; and control group of 58&#46;3&#37;&#44; and absolute risk reduction &#40;ARR&#41; of 20&#46;4&#37; &#40;95&#37; CI&#160;&#61;&#160;0&#46;19&#8211;0&#46;54&#41;&#46; Calculation of NNT showed a probability of survival throughout the study of 4&#46;9 &#40;95&#37; CI&#160;&#61;&#160;1&#46;84&#8211;5&#46;20&#41;&#44; with an effect size estimated by Cohen&#39;s h index of 0&#46;41&#44; which indicates a medium effect&#46; At 50&#44; 100&#44; and 150 days the NNT was 4&#46;0&#44; 4&#46;0 and 3&#46;0&#44; respectively&#46;</p><p id="para0033" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0002">Figure 2</a> shows the layout of the survival curves over time for the treatment and control groups&#46; Equality logrank &#40;Mantel-Cox&#41; and Breslow tests &#40;Generalized Wilcoxon&#41; between the survival functions showed&#44; respectively&#44; X2&#160;&#61;&#160;6&#46;81&#59; gl&#160;&#61;&#160;1&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;02 and X2&#160;&#61;&#160;6&#46;98&#59; gl&#160;&#61;&#160;1&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;02&#46; The survival rate was higher in the treatment group along the curve&#46; For instance&#44; the point referring to the 50 &#40;fifty&#41; days of follow-up survival in the treatment group was 68&#46;2&#37; &#40;45 VLBW-PT&#41; compared to the control&#44; which was 52&#46;7&#37; &#40;38 VLBW-PT&#41;&#46;</p><elsevierMultimedia ident="fig0002"></elsevierMultimedia><p id="para0034" class="elsevierStylePara elsevierViewall">The Cox regression model showed that the hazard ratio &#40;HR&#41; of death cumulative incidence in the treatment group compared to the control group was 0&#46;33 &#40;95&#37; CI 0&#46;17&#8211;0&#46;60&#59; p 0&#46;00&#41;&#44; after adjusting for maternal age&#44; marital status&#44; gestational hypertension&#44; childbirth type&#44; number of prenatal consultations and birth weight &#40;<a class="elsevierStyleCrossRef" href="#tbl0002">Table 2</a>&#41;&#44; i&#46;e&#46;&#44; OCI reduced&#44; on average&#44; 67&#37; the risk of VLBW-PT dying during the study period when compared to the control group&#44; adjusted for the covariates&#46;</p><p id="para0035" class="elsevierStylePara elsevierViewall">With regard to damage&#44; no VLBW-PT had an adverse effect on treatment&#44; either during or after the administration of therapy doses&#44; according to records in hospital records&#46;</p></span></span><span id="sec0013" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0019">Discussion</span><p id="para0036" class="elsevierStylePara elsevierViewall">OCI proved to be beneficial in reducing the risk of death in VLBW-PT in this study when adjusted for maternal age&#44; marital status&#44; gestational hypertension&#44; childbirth type&#44; number of prenatal consultations&#44; and birth weight&#46; The RR of death of patients in the intervention group in relation to the control group was 0&#46;26&#44; i&#46;e&#46;&#44; there was a 74&#37; reduction in the mortality of patients who received OCI&#46; The ARR calculation showed that VLBW-PT in the intervention group had a 20&#46;4&#37; reduction in the probability of death&#46;</p><p id="para0037" class="elsevierStylePara elsevierViewall">Most clinical trials conducted with the same objective as the current study found no association between OCI and reduced risk of neonatal mortality&#46;<a class="elsevierStyleCrossRefs" href="#bib0004"><span class="elsevierStyleSup">4-12</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRefs" href="#bib0019"><span class="elsevierStyleSup">19-21</span></a> However&#44; two meta-analyses reported a trend towards a positive effect of OCI in reducing mortality in the treatment group&#44;<a class="elsevierStyleCrossRef" href="#bib0022"><span class="elsevierStyleSup">22</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0023"><span class="elsevierStyleSup">23</span></a> although others did not find an association&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRefs" href="#bib0024"><span class="elsevierStyleSup">24-26</span></a> Meta-analysis was recently published that reported a positive association between OCI and reduced mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0027"><span class="elsevierStyleSup">27</span></a></p><p id="para0038" class="elsevierStylePara elsevierViewall">It is expected that OCI reduces mortality risk in PTNB&#44; especially in those with VLW at birth&#44; since morbidities related to prematurity&#44; which are frequent causes of neonatal death&#44; can be prevented by this intervention&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a> In this aspect&#44; the literature has documented a lower risk of ventilator-associated pneumonia&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a> necrotizing enterocolitis&#44;<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> septicemia&#44;<a class="elsevierStyleCrossRef" href="#bib0007"><span class="elsevierStyleSup">7</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0019"><span class="elsevierStyleSup">19</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0021"><span class="elsevierStyleSup">21</span></a><span class="elsevierStyleSup">&#44;</span><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> intraventricular hemorrhage&#44;<a class="elsevierStyleCrossRef" href="#bib0029"><span class="elsevierStyleSup">29</span></a> extrauterine growth restriction&#44;<a class="elsevierStyleCrossRef" href="#bib0028"><span class="elsevierStyleSup">28</span></a> reduction in antibiotic use duration<span class="elsevierStyleSup">7</span> and reduction in length of hospitalization&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">10</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">20</span></a></p><p id="para0039" class="elsevierStylePara elsevierViewall">In addition to infections related to immune system immaturity&#44; premature infants&#8217; nutrition is another challenge&#44; due to gastrointestinal tract immaturity that delays the start of enteral feeding&#44; a characteristic that contributes to mortality&#44; since long periods of absence of enteral feeding favor morbidity appearance that leads to death&#46; Studies show that OCI has beneficial effects in reducing the time to start enteral nutrition&#44;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a> the time to reach full enteral nutrition&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a><span class="elsevierStyleSup">&#44;</span><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><span class="elsevierStyleSup">&#44;</span><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> the clinical manifestations of food intolerance<a class="elsevierStyleCrossRef" href="#bib0021"><span class="elsevierStyleSup">21</span></a> and the time to reach oral feeding&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a> in addition to providing better average weight gain<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">20</span></a> and accelerating the growth rate of VLW PTNB&#46;<a class="elsevierStyleCrossRef" href="#bib0028"><span class="elsevierStyleSup">28</span></a></p><p id="para0040" class="elsevierStylePara elsevierViewall">The originality of the results found in the current study is likely to be related to some characteristics that strengthen OCI&#39;s internal validity and biological plausibility such as protocol use in the form of an algorithm&#44; with systematization of care provided to the VLBW-PT and the puerperal women&#44; through standardized clinical practice&#59; maintenance of treatment until the seventh full day of life of VLBW-PT&#44; a conduct that may have allowed greater absorption and systemic effects of bioactive factors present in colostrum&#44; such as serum IgA&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">30</span></a> important immunoglobulin that rises between the fourth and fifth day after childbirth&#59; in addition to the HMB support in the uninterrupted supply of colostrum for 24 hours&#46;</p><p id="para0041" class="elsevierStylePara elsevierViewall">Regarding the variables used in the regression model adjustment&#44; such as maternal age &#60; 18 years&#44; marital status without the presence of a companion&#44; gestational hypertension&#44; artificial childbirth type&#44; and a number of prenatal consultations &#60; 6 consultations&#44; are characterized as biological and social determinations for prematurity and&#47;or neonatal death since women exposed to these conditions are at greater risk of the clinical worsening of PTNB after birth&#46;<a class="elsevierStyleCrossRef" href="#bib0017"><span class="elsevierStyleSup">17</span></a> A fact also observed with the birth weight variable&#44; which is inversely proportional to better clinical prognoses presented by newborns&#44; i&#46;e&#46;&#44; the lower the birth weight&#44; the greater the risk of morbidities and mortality&#46;</p><p id="para0042" class="elsevierStylePara elsevierViewall">It is necessary to comment on the magnitude of the association between OCI and VLBW-PT death&#44; seen by calculating the NNT at 50 and 100 days&#44; which showed that it was necessary to treat 4 &#40;four&#41; newborns to avoid the death of one of them&#46; At 150 days&#44; for every 3 &#40;three&#41; individuals treated&#44; one death was prevented&#46; Still on the magnitude of the association&#44; despite the h-index of 0&#46;41 indicating a mean effect size of the intervention on the treatment group compared to the control&#44; from a clinical point of view&#44; this finding is extremely important&#44; as the assessed outcome means a reduction in risk of death&#46; Thus&#44; we can conclude that NNT and the calculated effect size reinforce the conduct of using OCI as a measure to prevent mortality risk in VLBW-PT&#46;</p><p id="para0043" class="elsevierStylePara elsevierViewall">The main limitation of this study was the historical control design&#44; as it could impact the quality of the data collected and prevent their comparability due to information bias&#46; This limitation was minimized&#44; as the variables selected to integrate the database were taken from the form applied to pregnant women in the maternity hospital&#39;s medical routine&#46; Another limitation concerns changes in characteristics between the groups over time&#44; but we consider that the short period between hospitalization in treatment and control groups &#40;two years&#41; did not cause significant changes in the determinants&#46; Furthermore&#44; the researched outcome &#40;death&#41; was well defined&#44; based on parameters that do not depend on changes in methods and diagnoses for its assessment&#46; Another precaution was the survival analysis adjusted for multiple variables&#46;</p><p id="para0044" class="elsevierStylePara elsevierViewall">Generalizability &#40;external validity&#41; of the current study&#39;s clinical findings to other populations is permitted&#44; since the association&#39;s biological plausibility applies to similar populations likely to receive the intervention&#44; and the death outcome is easy to measure&#44; in addition to the statistical care instituted with the aim of guaranteeing internal validity&#46; Added to this is the fact that OCI is a strategy that is easy to apply&#44; cheap&#44; viable&#44; safe and well tolerated by PTNB&#44; which can be implemented in neonatal units&#44; through a protocol adapted to different realities of public or private maternity hospitals&#44; especially those that can count on the HMB support&#46;<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a></p><p id="para0045" class="elsevierStylePara elsevierViewall">Thus&#44; the institution of OCI in clinical practice&#44; a modifiable variable&#44; associated with other measures&#44; such as access improvement and quality of health care provided in prenatal&#44; childbirth&#44; and puerperium and efficient and immediate clinical care to the VLBW-PT can contribute to achieving the goal set by the United Nations Sustainable Development Goals &#40;SDGs&#41; of reducing mortality incidence and complications arising from prematurity by 2030&#46;</p></span><span id="sec0014" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0020">Source of financing</span><p id="para0046" class="elsevierStylePara elsevierViewall">Bahia State Research Support Foundation &#40;FAPESB - <span class="elsevierStyleItalic">Funda&#231;&#227;o de Amparo &#224; Pesquisa do Estado da Bahia</span>&#41;&#44; in Public Notice 003&#47;2017 &#8211; Research Program for SUS&#58; Shared Management in Health &#8211; PPSUS&#47;BA &#8211; FAPESB&#47;SESAB&#47;CNPQ&#47;MS &#40;&#60; grant number 4996&#47;2017 &#91;to VIEIRA&#44; G&#46;O&#46;&#93;&#41;&#44; regarding the acquisition of permanent materials and consumables for the protocol implementation&#44; playing an indirect role in data collection&#46; The institution is under public law and only the right to incorporate the name of the funding agency on all research products is required&#46;</p><p id="para0047" class="elsevierStylePara elsevierViewall">Dean of Research and Graduate Studies at the <span class="elsevierStyleItalic">Universidade Estadual de Feira de Santana</span> &#40;PPPG&#47;UEFS&#41; through the Graduate Support Program &#40;Proap&#41; of the Higher Education Personnel Improvement Coordination &#40;CAPES - <span class="elsevierStyleItalic">Coordena&#231;&#227;o de Aperfei&#231;oamento de Pessoal de N&#237;vel Superior</span>&#41;&#44; provided funding for manuscript translation&#46;</p></span></span>"
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        "resumen" => "<span id="abss0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0002">Objective</span><p id="spara006" class="elsevierStyleSimplePara elsevierViewall">To evaluate the effect of oropharyngeal colostrum immunotherapy &#40;OCI&#41; on the mortality of preterm newborns &#40;PTNB&#41; with very low birth weight &#40;VLBW&#41;&#46;</p></span> <span id="abss0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0003">Method</span><p id="spara007" class="elsevierStyleSimplePara elsevierViewall">Non-randomized clinical trial&#44; carried out with 138 mother-child pairs attended at a public maternity hospital&#46; The treatment group used raw colostrum&#44; dripping 4 drops &#40;0&#46;2&#160;ml&#41; into the oropharyngeal mucosa&#44; totaling 8 administrations in 24&#160;h&#44; up to the 7th complete day of life &#40;OCI&#41;&#46; The control group was composed of newborns admitted to the same maternity hospital before the implementation of the OCI&#46; Analyzes were performed&#58; descriptive&#44; bivariate&#44; multiple logistic regression&#44; and survival analysis&#44; with a significance level of 5&#37; and 95&#37; CI&#46;</p></span> <span id="abss0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0004">Results</span><p id="spara008" class="elsevierStyleSimplePara elsevierViewall">The treatment group had an RR of death of 0&#46;26 &#40;95&#37; CI&#160;&#61;&#160;0&#46;07&#8211;0&#46;67&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;00&#41;&#44; adjusted for maternal age&#44; marital status&#44; gestational hypertension&#44; type of delivery&#44; number of prenatal visits&#44; and birth weight&#46; Number Needed to Treat &#40;NNT&#41; demonstrated that for every 5 individuals treated with OCI&#44; one death was prevented NNT&#160;&#61;&#160;4&#46;9 &#40;95&#37; CI&#160;&#61;&#160;1&#46;84&#8211;5&#46;20&#41;&#59; however&#44; for PTNB with VLBW who remained hospitalized for 50&#44; 100 and 150 days&#44; the NNT reduces to 4&#44; 4 and 3&#44; respectively&#46;</p></span> <span id="abss0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0005">Conclusion</span><p id="spara009" class="elsevierStyleSimplePara elsevierViewall">The OCI proved to be a beneficial intervention&#44; since it reduced the risk of mortality in PTNB with VLBW when compared to the control group&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abss0001"
            "titulo" => "Objective"
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            "titulo" => "Method"
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            "identificador" => "abss0003"
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          "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">Flow diagram of study participants according to CONSORT 2020&#46;</p>"
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        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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        "figura" => array:1 [
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                  \t\t\t\t  " align="char" valign="top">59 &#40;89&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Non-black&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="top">2 &#40;2&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Without a companion&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>With a companion&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Not paid&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="top">40 &#40;63&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top">0&#46;84&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Paid&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">23 &#40;36&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0055"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">23 &#40;34&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0056"></a><td class="td" title="\n
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                  \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><a name="en0060"></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="en0061"></a><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Rural&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="top">15 &#40;22&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">19 &#40;26&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top">0&#46;62&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"><span class="elsevierStyleHsp" style=""></span>Urban&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">51 &#40;77&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0067"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">53 &#40;73&#46;6&#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">&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
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                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">Gestational age</span>&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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0071"></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><a name="en0072"></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="en0073"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60; 28 weeks&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="char" valign="top">39 &#40;60&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0075"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">53 &#40;73&#46;6&#41;&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">0&#46;09&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"><span class="elsevierStyleHsp" style=""></span>&#8805; 28 weeks&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="char" valign="top">26 &#40;40&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0079"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">19 &#40;26&#46;4&#41;&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">&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"><span class="elsevierStyleBold">Number of pregnancies</span>&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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0083"></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><a name="en0084"></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="en0085"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Primiparous&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="char" valign="top">31 &#40;47&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0087"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">30 &#40;42&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0088"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0089"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Other situation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0090"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">35 &#40;53&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0091"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">41 &#40;57&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0092"></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="en0093"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">Number of prenatal care consultations</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0094"></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><a name="en0095"></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><a name="en0096"></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="en0097"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60; 6 consultations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0098"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">17 &#40;26&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0099"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">15 &#40;21&#46;1&#41;&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="" valign="top">0&#46;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0101"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8805; 6 consultations&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="top">47 &#40;73&#46;4&#41;&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="top">56 &#40;78&#46;9&#41;&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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0105"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">Childbirth type</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0106"></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><a name="en0107"></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><a name="en0108"></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="en0109"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Artifitial&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="top">14 &#40;21&#46;2&#41;&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="char" valign="top">21 &#40;29&#46;2&#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;28&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" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Normal&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="top">52 &#40;78&#46;8&#41;&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="char" valign="top">51 &#40;70&#46;8&#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="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0117"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">Infection during pregnancy</span>&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">&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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0120"></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="en0121"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&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="char" valign="top">23 &#40;36&#46;5&#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="top">14 &#40;26&#46;4&#41;&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="" valign="top">0&#46;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0125"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>No&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="char" valign="top">40 &#40;63&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0127"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">39 &#40;73&#46;6&#41;&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="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0129"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">Membrane rupture</span>&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="" valign="top">&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="" valign="top">&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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0133"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8804; 24 hours&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0134"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">19 &#40;86&#46;4&#41;&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="top">9 &#40;90&#46;0&#41;&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">1&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0137"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62; 24 hours&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="top">3 &#40;13&#46;6&#41;&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="char" valign="top">1 &#40;10&#46;0&#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">&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" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">Gestational hypertension</span>&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="" valign="top">&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">&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="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0145"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&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="char" valign="top">15 &#40;22&#46;7&#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="char" valign="top">14 &#40;25&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0148"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0149"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\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="char" valign="top">51 &#40;77&#46;3&#41;&nbsp;\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="top">41 &#40;74&#46;6&#41;&nbsp;\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="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0153"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">Corticosteroid use during pregnancy</span>&nbsp;\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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0155"></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><a name="en0156"></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="en0157"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\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="top">15 &#40;23&#46;4&#41;&nbsp;\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="top">12 &#40;25&#46;5&#41;&nbsp;\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&#46;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0161"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0162"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">49 &#40;76&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0163"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">35 &#40;74&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0164"></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="en0165"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">Newborn&#39;s sex</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0166"></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><a name="en0167"></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><a name="en0168"></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="en0169"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0170"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">34 &#40;51&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0171"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">28 &#40;40&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0172"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0173"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0174"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">32 &#40;48&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0175"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">42 &#40;60&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0176"></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="en0177"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">Weight at birth</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0178"></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><a name="en0179"></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><a name="en0180"></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="en0181"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8804; 1&#44;000 grams&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0182"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">28 &#40;42&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0183"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">26 &#40;36&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0184"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0185"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62; 1&#44;000 grams&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0186"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">38 &#40;57&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0187"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">46 &#40;63&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0188"></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="en0189"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">5-minute Apgar score</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0190"></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><a name="en0191"></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><a name="en0192"></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="en0193"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8804; 5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0194"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">6 &#40;9&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0195"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">12 &#40;17&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0196"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0197"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62; 5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0198"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">58 &#40;90&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0199"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">56 &#40;82&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0200"></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="en0201"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">ICU length of stay &#40;days&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0202"></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><a name="en0203"></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><a name="en0204"></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="en0205"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Median &#40;1<span class="elsevierStyleSup">st</span> quartile&#59; 3<span class="elsevierStyleSup">rd</span> quartile&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0206"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">15&#46;0 &#40;10&#46;0&#59; 41&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0207"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">14&#46;0 &#40;5&#46;0&#59; 34&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0208"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab3479315.png"
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        "descripcion" => array:1 [
          "en" => "<p id="spara003" class="elsevierStyleSimplePara elsevierViewall">Maternal characteristics and very low birth weight preterm newborns according to colostrum oropharyngeal immunotherapy &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;138&#41;&#46;</p>"
        ]
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        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
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          0 => array:3 [
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            "detalle" => "Table "
            "rol" => "short"
          ]
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        "tabla" => array:2 [
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            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="en0209"></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">Death&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0210"></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">Treatment n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0211"></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">Control n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0212"></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">Relative risk<span class="elsevierStyleSup">a</span> Unadjusted hazard ratio<span class="elsevierStyleSup">b</span> &#40;<span class="elsevierStyleInf">95&#37;</span>CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0213"></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">p-value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0214"></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">Relative risk<span class="elsevierStyleSup">a</span> Adjusted hazard ratio<span class="elsevierStyleSup">b</span> &#40;<span class="elsevierStyleInf">95&#37;</span>CI&#41;<a class="elsevierStyleCrossRef" href="#tb2fn1">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0215"></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">p-value <a class="elsevierStyleCrossRef" href="#tb2fn1">&#42;</a>&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="en0216"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0217"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">41 &#40;62&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0218"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">30 &#40;41&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0219"></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><a name="en0220"></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><a name="en0221"></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><a name="en0222"></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="en0223"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0224"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">25 &#40;37&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0225"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">42 &#40;58&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0226"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;65 &#40;0&#46;40&#59; 0&#46;94&#41;<span class="elsevierStyleSup">a</span>0&#46;56 &#40;0&#46;34&#59; 0&#46;93&#41;<span class="elsevierStyleSup">b</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0227"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;020&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0228"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;26 &#40;0&#46;07&#59; 0&#46;67&#41;<span class="elsevierStyleSup">a</span>0&#46;33 &#40;0&#46;17&#59; 0&#46;60&#41;<span class="elsevierStyleSup">b</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0229"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;000&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tb2fn1"
              "etiqueta" => "&#8270;"
              "nota" => "<p class="elsevierStyleNotepara" id="notep0002">Adjusted for maternal age&#44; marital status&#44; gestational hypertension&#44; childbirth type&#44; number of prenatal visits and birth weight&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara005" class="elsevierStyleSimplePara elsevierViewall">Unadjusted and adjusted association of the effect of oropharyngeal colostrum immunotherapy on death risk in very low birth weight preterm newborns&#44; with respective 95&#37; confidence intervals &#40;<span class="elsevierStyleInf">95&#37;</span>CI&#41;&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "cebibsec1"
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Original article
Oropharyngeal colostrum immunotherapy and risk reduction of mortality in very low birth weight premature newborns: a clinical trial
Camilla da C. Martinsa,
Corresponding author
camilladacruzmartins@gmail.com

Corresponding author.
, Michelle de S.X. Ramosb, Amanda O. Lyrioc, Tatiana de O. Vieiraa, Simone S. da Cruzb, Graciete O. Vieiraa
a Universidade Estadual de Feira de Santana, Departamento de Saúde, Feira de Santana, BA, Brazil
b Universidade Federal do Recôncavo da Bahia, Centro de Ciências da Saúde, Santo Antônio de Jesus, BA, Brazil
c Universidade de Brasília, Programa de Pós-Graduação em Ciências Médicas, Brasília, DF, Brazil
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0007">Introduction</span><p id="para0005" class="elsevierStylePara elsevierViewall">Premature birth is currently configured as a public health problem in the world&#46; It is known that preterm newborns &#40;PTNB&#41; have a higher risk of death&#44; due to pathologies such as necrotizing enterocolitis&#44; neonatal septicemia&#44; and pneumonia associated with mechanical ventilation<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a> and&#44; when they survive&#44; they may develop long-term disabilities&#46;</p><p id="para0006" class="elsevierStylePara elsevierViewall">It is in this cycle of premature birth&#44; risk of morbidities&#44; neonatal mortality&#44; and disabilities in the short and long term that oropharyngeal colostrum immunotherapy &#40;OCI&#41; has been suggested as an intervention to promote the clinical improvement of these newborns&#44; especially those with very low birth weight &#40;VLW&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a> This therapy is based on the expectation of absorption of bioactive factors present in colostrum&#44; by the oropharyngeal mucosa&#44; with an amplified response to various devices&#44; with systemic bacteriostatic&#44; bactericidal&#44; antiviral&#44; anti-inflammatory&#44; and immunomodulatory effects&#46;<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a></p><p id="para0007" class="elsevierStylePara elsevierViewall">It is important to highlight that PTNB-VLW present immunological immaturity and of devices and systems&#44; especially of the gastrointestinal tract&#46; It has been reported that the institution of OCI practice favored positive clinical outcomes&#44; such as a reduction in the incidence of necrotizing enterocolitis&#44; pneumonia associated with mechanical ventilation&#44; and late septicemia&#44; in addition to a decrease in the time for PTNB to reach full enteral feeding and hospital stay&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a> Despite the biological plausibility&#44; the evidence for OCI in reducing the risk of mortality in very low birth weight preterm is insufficient&#44;<a class="elsevierStyleCrossRefs" href="#bib0004"><span class="elsevierStyleSup">4-12</span></a> and the present study intends to further elucidate the role of OCI through a clinical trial&#46;</p></span><span id="sec0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0008">Methods</span><p id="para0008" class="elsevierStylePara elsevierViewall">This manuscript was written under the guidance of CONSORT 2010&#46;<a class="elsevierStyleCrossRef" href="#bib0013"><span class="elsevierStyleSup">13</span></a></p><span id="sec0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0009">Study design</span><p id="para0009" class="elsevierStylePara elsevierViewall">The study consists of a non-randomized&#44; superiority&#44; ambispective clinical trial&#44; with an intervention group consisting of VLBW-PT admitted to the neonatal unit of a maternity hospital who used OCI &#40;treatment&#41;&#59; and a historical control group&#44; composed of VLBW-PT who were born in the same maternity hospital before the protocol implementation&#44; i&#46;e&#46;&#44; without the use of this immunotherapy &#40;Brazilian Clinical Trial Registry &#40;ReBEC&#41;&#44; under n&#46; U1111-1222-0598&#44; <a href="http://www.ensaiosclinicos.gov.br/rg/RBR-2cyp7c/">http&#58;&#47;&#47;www&#46;ensaiosclinicos&#46;gov&#46;br&#47;rg&#47;RBR-2cyp7c&#47;</a>&#41;&#46; The allocation ratio was 1&#58;1 with participants entering sequentially&#44; and there were no deviations from the study protocol&#46;</p><p id="para0010" class="elsevierStylePara elsevierViewall">Historical control was defined in compliance with the opinion of the Research Ethics Committee of the <span class="elsevierStyleItalic">Universidade Estadual de Feira de Santana</span> &#40;CAAE no&#46; 93056218&#46;0&#46;0000&#46;0053&#41;&#44; considering that not offering colostrum to PTNB in the control group violates the principle of beneficence&#44; since the positive effects of colostrum are already established in the literature&#46;</p></span><span id="sec0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0010">Participants</span><p id="para0011" class="elsevierStylePara elsevierViewall">VLBW-PT &#40;&#8804; 1&#44;500g&#41;&#44; born with gestational age &#8804; 37 weeks&#44; regardless of the type of diet &#40;zero&#44; enteral by orogastric tube or parenteral&#41;&#44; and clinically stable in the last three hours before starting immunotherapy were included&#46; The beginning of the OCI protocol occurred within 72 hours of life&#46;</p><p id="para0012" class="elsevierStylePara elsevierViewall">Maternal exclusion criteria were reports of substance or drug abuse&#44; psychological disorder&#44; multiparity &#40;triplets and more&#41;&#44; and medical contraindications for breastfeeding &#40;retrovirus and cytomegalovirus&#41;&#46; With regard to newborns&#44; they were not included when they were using vasopressor medication &#62; 10 mcg&#47;Kg&#47;min&#44; in need of immediate surgical intervention and presence of syndromes or malformations&#46;</p><p id="para0013" class="elsevierStylePara elsevierViewall">The study was conducted in the neonatal unit of the <span class="elsevierStyleItalic">Hospital In&#225;cia Pinto dos Santos</span> &#40;Women&#39;s Hospital&#41; in Feira de Santana&#44; Bahia&#44; Brazil&#44; a medium-sized public maternity hospital accredited by the Baby-Friendly Hospital Initiative&#44; linked to the Unified Health System &#40;SUS - <span class="elsevierStyleItalic">Sistema &#218;nico de Sa&#250;de</span>&#41;&#44; maintained by the <span class="elsevierStyleItalic">Funda&#231;&#227;o Hospitalar de Feira de Santana</span>&#46; Also noteworthy is the assistance provided by the Human Milk Bank &#40;HMB&#41; linked to the Brazilian Network of Human Milk Banks&#44; the sector responsible for complying with part of this protocol&#44; such as welcoming mothers of PTNB&#44; extracting colostrum&#44; and distributing of colostrum-destined for OCI&#46;</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0011">Intervention</span><p id="para0014" class="elsevierStylePara elsevierViewall">The OCI intervention consisted of using raw colostrum&#44; from mother to child&#44; initiated in the treatment group within 72&#160;h of life of VLBW-PT&#44; after medical prescription by the neonatal team&#46; Treatment was offered until the 7<span class="elsevierStyleSup">th</span> full day of life of newborns &#40;totaling up to 56 syringes&#41;&#44; with 8 &#40;eight&#41; daily administrations of 0&#46;2&#160;ml &#40;04 drops&#41; of dripped colostrum within 10 &#40;ten&#41; seconds in the oropharyngeal mucosa&#44; with 0&#46;1&#160;ml &#40;two drops&#41; in the tissue of the right oral mucosa in the first 5 &#40;five&#41; seconds and the other two drops in the tissue of the left oral mucosa in the remaining seconds&#46; Newborns&#8217; vital conditions were monitored during the procedure&#46; Therapy was considered complete when more than 75&#37; of planned doses were administered for each PTNB&#44; and clinical evolution was monitored until hospital discharge&#46;</p><p id="para0015" class="elsevierStylePara elsevierViewall">When the neonatal team identified changes in newborns&#8217; clinical stability criteria&#44; at the time of treatment or periodic follow-up&#44; the intervention was immediately interrupted&#44; being resumed as soon as clinical stability was restored&#46; Complete interruption of treatment occurred upon justifiable medical prerogative&#44; especially in severe cases of VLBW-PT&#46;</p><p id="para0016" class="elsevierStylePara elsevierViewall">Immunotherapy did not occur in the control group&#44; since this group consisted of VLBW-PT admitted to the neonatal intensive and intermediate care units from 2015 to 2016&#44; that is&#44; the period prior to OCI implementation in the institution &#40;historical control&#41;&#46; For data collection&#44; the records of the Medical Archive and Statistics Service &#40;SAME - <span class="elsevierStyleItalic">Servi&#231;o de Arquivo M&#233;dico e Estat&#237;stica</span>&#41; of the institution were consulted&#46; More details of the intervention are described in the study by da Cruz Martins et al&#46; &#40;2020&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a></p></span><span id="sec0006" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0012">Outcomes</span><p id="para0017" class="elsevierStylePara elsevierViewall">The main independent variable was OCI use&#44; defined in this study as the use of colostrum for immunological and not nutritional supplementation purposes by VLBW-PT during hospitalization in the neonatal unit and with follow-up of clinical evolution&#46; As an outcome &#40;dependent variable&#41;&#44; death was assessed&#44; verified by the permanent disappearance of all signs of life&#44; at any time after birth&#44; with no possibility of resuscitation&#44; as defined by the World Health Organization&#44;<a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a> and with a medical record and&#47;or Death Certificate&#46; Other variables were investigated in both groups such as&#58; maternal sociodemographic characteristics&#59; prenatal and childbirth variables and variables related to newborns&#46;</p></span><span id="sec0007" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0013">Sample size</span><p id="para0018" class="elsevierStylePara elsevierViewall">In the protocol&#44; an &#945;&#160;&#61;&#160;5&#37; was defined for sample size calculation&#44; &#223;&#160;&#61;&#160;80&#37;&#44; with an incidence of death in the intervention group &#61; 12&#46;5&#37; and control&#160;&#61;&#160;25&#37;&#44; in a 1&#58; 1 ratio&#44; obtained in the study by Lee et al&#46; &#40;2015&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0007"><span class="elsevierStyleSup">7</span></a> A fixed sample was calculated for an infinite population&#44; using the Bioestat 5&#46;3 software&#44; which resulted in 152 participants in each group&#44; with an increase of 15&#37; to cover possible losses&#44; totaling 350 participants&#46;<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a></p><p id="para0019" class="elsevierStylePara elsevierViewall">However&#44; as this is a finite population&#44; without replacement and with a mean admission to the neonatal unit of 68 VLBW-PT in the last five years &#40;136 individuals&#41;&#44; it was possible to readjust the sample calculation through the population correction factor&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">15</span></a> Thus&#44; the final sample size estimate was around 76 &#40;seventy-six&#41; participants&#46; 15&#37; were also added for possible losses&#44; totaling 88 &#40;eighty-eight&#41; participants&#44; 44 &#40;forty-four&#41; for each group&#46;</p><p id="para0020" class="elsevierStylePara elsevierViewall">The results of this study are based on the already published protocol&#44; whose analysis was planned to verify the occurrence of treatment damage&#47;benefits between the compared groups&#44; in the second year of OCI follow-up&#46;<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a></p></span><span id="sec0008" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0014">Recruitment</span><p id="para0021" class="elsevierStylePara elsevierViewall">Study recruitment to the intervention group was from October 2018 to August 2020&#59; for the control group&#44; medical records of VLBW-PT hospitalized between May 2015 and November 2016 were assessed&#46; Losses to follow-up were monitored during recruitment &#40;<a class="elsevierStyleCrossRef" href="#fig0001">Figure 1</a>&#41;&#44; as described in protocol&#46;<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a> The intention-to-treat analysis strategy was adopted&#46;</p><elsevierMultimedia ident="fig0001"></elsevierMultimedia></span><span id="sec0009" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0015">Statistical methods</span><p id="para0022" class="elsevierStylePara elsevierViewall">Data were entered by previously trained health professionals&#44; into two different databases&#44; with subsequent comparison and validation using the EPIDATA software&#46; Data analysis procedures were developed with IBM-SPSS &#40;version 24&#46;0&#44; Chicago&#44; IL&#44; USA&#44; serial number&#58; 10101181103&#41; and STATA 15&#46;1 &#40;serial number&#58; 401506208261&#41; software&#46;</p><p id="para0023" class="elsevierStylePara elsevierViewall">Descriptive analysis was performed for all variables according to comparison groups&#46; The Kolmogorov-Smirnov test was applied and the histogram was inspected to verify the normality of continuous variables&#46; Student&#39;s t test or Mann-Whitney U test was used&#44; according to the normality test&#44; using measures of central tendency and variability to verify differences between groups&#46; Categorical covariates were assessed using chi-square or Fisher&#39;s exact tests&#44; and a significance level of 5&#37; was adopted&#46;</p><p id="para0024" class="elsevierStylePara elsevierViewall">Initially&#44; relative risk &#40;unadjusted and adjusted&#41; was estimated as a measure of effect&#44; with respective 95&#37; confidence intervals and 5&#37; significance levels&#46; For this purpose&#44; logistic regression was used with the backward strategy and&#44; subsequently&#44; conversion was performed using the method by Zhang and Yu &#40;1998&#41;<a class="elsevierStyleCrossRef" href="#bib0016"><span class="elsevierStyleSup">16</span></a> to obtain the appropriate measure for the study design&#46;</p><p id="para0025" class="elsevierStylePara elsevierViewall">Potential confounders were selected in stratified analysis&#46; A covariate was considered confounding when&#44; after being eliminated in the saturated model&#44; there was a variation in the effect measure greater than 10&#37;&#46; Moreover&#44; the criterion of epidemiological importance was used for the selection of confounding during modeling&#44; adopting a theoretical-conceptual model to guide said selection&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0017"><span class="elsevierStyleSup">17</span></a></p><p id="para0026" class="elsevierStylePara elsevierViewall">The impact of effect magnitude was further assessed by the Number Needed to Treat &#40;NNT&#41; and Cohen&#39;s h index&#44; which assessed the effect size &#40;h&#41; based on mortality risks in the groups studied&#46; Cohen&#39;s h index is interpreted as follows&#58; small &#40;h&#160;&#61;&#160;0&#46;20&#41;&#44; medium &#40;h&#160;&#61;&#160;0&#46;50&#41;&#44; and large &#40;h&#160;&#61;&#160;0&#46;80&#41; effect&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0018"><span class="elsevierStyleSup">18</span></a></p><p id="para0027" class="elsevierStylePara elsevierViewall">Finally&#44; a survival analysis was performed to estimate the effect measure as a function of time &#40;unadjusted and adjusted hazard ratio and their respective confidence intervals&#41;&#46; For this purpose&#44; the Kaplan-Meier method was used in order to assess the size size on survival over time between the comparison groups&#46; The crude survival effect was estimated at the beginning of the curve by the logrank test &#40;Mantel-Cox&#41; and from the middle to the end by the Breslow test &#40;generalized wilcoxon&#41;&#44; with a 5&#37; significance level&#46; The Cox regression model estimated the hazard ratio&#44; duly adjusted for confounding variables selected based on the theoretical-conceptual model adopted to assess the effect of therapy on the study&#46;</p></span></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0016">Results</span><span id="sec0011" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0017">Participant flow</span><p id="para0028" class="elsevierStylePara elsevierViewall">The study participant flow is described in the flow diagram &#40;<a class="elsevierStyleCrossRef" href="#fig0001">Figure 1</a>&#41; as well as the total number of exclusions and losses in each stage of follow-up&#44; with the respective justifications&#46;</p></span><span id="sec0012" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0018">Baseline characteristics and auxiliary analyses</span><p id="para0029" class="elsevierStylePara elsevierViewall">A total of 138 &#40;one hundred and thirty-eight&#41; mothers&#47;children were assessed&#44; 66 &#40;sixty-six&#41; in the treatment group and 72 &#40;seventy-two&#41; in the control group&#46; The total number of doses administered was 2735 &#40;two thousand&#44; seven hundred and thirty-five&#41; syringes containing 0&#46;2&#160;ml of colostrum each&#44; 32 &#40;48&#46;5&#37;&#41; of VLBW-PT started treatment within 24 hours of life and 42 &#40;63&#46;6&#37;&#41; VLBW-PT received &#62; 90&#37; of planned treatment&#44; demonstrating adherence and compliance with the protocol in the unit&#46;</p><p id="para0030" class="elsevierStylePara elsevierViewall">Maternal and neonatal characteristics associated with treatment are described in <a class="elsevierStyleCrossRef" href="#tbl0001">Table 1</a> and demonstrated similarities between the groups&#44; except for the marital status covariate&#44; which was demonstrated by stratified analysis as a possible confounder and inserted in the final analysis model&#44; along with other variables justified by the literature&#46;</p><elsevierMultimedia ident="tbl0001"></elsevierMultimedia><p id="para0031" class="elsevierStylePara elsevierViewall">The magnitude of the intervention effect was calculated with the data presented in <a class="elsevierStyleCrossRef" href="#tbl0002">Table 2</a>&#44; both unadjusted and adjusted&#44; the latter by the following confounders&#58; maternal age&#44; marital status&#44; gestational hypertension&#44; childbirth type&#44; number of prenatal consultations&#44; and birth weight&#46;</p><elsevierMultimedia ident="tbl0002"></elsevierMultimedia><p id="para0032" class="elsevierStylePara elsevierViewall">The adjusted relative risk &#40;RR&#41; was 0&#46;26 &#40;95&#37; CI&#160;&#61;&#160;0&#46;07&#8211;0&#46;67&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;00&#41;&#44; relative risk reduction &#40;RRR&#41; of 35&#37; &#40;95&#37; CI&#160;&#61;&#160;0&#46;33&#8211;0&#46;93&#41;&#44; the absolute risk for the treatment group of 37&#46;9&#37; and control group of 58&#46;3&#37;&#44; and absolute risk reduction &#40;ARR&#41; of 20&#46;4&#37; &#40;95&#37; CI&#160;&#61;&#160;0&#46;19&#8211;0&#46;54&#41;&#46; Calculation of NNT showed a probability of survival throughout the study of 4&#46;9 &#40;95&#37; CI&#160;&#61;&#160;1&#46;84&#8211;5&#46;20&#41;&#44; with an effect size estimated by Cohen&#39;s h index of 0&#46;41&#44; which indicates a medium effect&#46; At 50&#44; 100&#44; and 150 days the NNT was 4&#46;0&#44; 4&#46;0 and 3&#46;0&#44; respectively&#46;</p><p id="para0033" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0002">Figure 2</a> shows the layout of the survival curves over time for the treatment and control groups&#46; Equality logrank &#40;Mantel-Cox&#41; and Breslow tests &#40;Generalized Wilcoxon&#41; between the survival functions showed&#44; respectively&#44; X2&#160;&#61;&#160;6&#46;81&#59; gl&#160;&#61;&#160;1&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;02 and X2&#160;&#61;&#160;6&#46;98&#59; gl&#160;&#61;&#160;1&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;02&#46; The survival rate was higher in the treatment group along the curve&#46; For instance&#44; the point referring to the 50 &#40;fifty&#41; days of follow-up survival in the treatment group was 68&#46;2&#37; &#40;45 VLBW-PT&#41; compared to the control&#44; which was 52&#46;7&#37; &#40;38 VLBW-PT&#41;&#46;</p><elsevierMultimedia ident="fig0002"></elsevierMultimedia><p id="para0034" class="elsevierStylePara elsevierViewall">The Cox regression model showed that the hazard ratio &#40;HR&#41; of death cumulative incidence in the treatment group compared to the control group was 0&#46;33 &#40;95&#37; CI 0&#46;17&#8211;0&#46;60&#59; p 0&#46;00&#41;&#44; after adjusting for maternal age&#44; marital status&#44; gestational hypertension&#44; childbirth type&#44; number of prenatal consultations and birth weight &#40;<a class="elsevierStyleCrossRef" href="#tbl0002">Table 2</a>&#41;&#44; i&#46;e&#46;&#44; OCI reduced&#44; on average&#44; 67&#37; the risk of VLBW-PT dying during the study period when compared to the control group&#44; adjusted for the covariates&#46;</p><p id="para0035" class="elsevierStylePara elsevierViewall">With regard to damage&#44; no VLBW-PT had an adverse effect on treatment&#44; either during or after the administration of therapy doses&#44; according to records in hospital records&#46;</p></span></span><span id="sec0013" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0019">Discussion</span><p id="para0036" class="elsevierStylePara elsevierViewall">OCI proved to be beneficial in reducing the risk of death in VLBW-PT in this study when adjusted for maternal age&#44; marital status&#44; gestational hypertension&#44; childbirth type&#44; number of prenatal consultations&#44; and birth weight&#46; The RR of death of patients in the intervention group in relation to the control group was 0&#46;26&#44; i&#46;e&#46;&#44; there was a 74&#37; reduction in the mortality of patients who received OCI&#46; The ARR calculation showed that VLBW-PT in the intervention group had a 20&#46;4&#37; reduction in the probability of death&#46;</p><p id="para0037" class="elsevierStylePara elsevierViewall">Most clinical trials conducted with the same objective as the current study found no association between OCI and reduced risk of neonatal mortality&#46;<a class="elsevierStyleCrossRefs" href="#bib0004"><span class="elsevierStyleSup">4-12</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRefs" href="#bib0019"><span class="elsevierStyleSup">19-21</span></a> However&#44; two meta-analyses reported a trend towards a positive effect of OCI in reducing mortality in the treatment group&#44;<a class="elsevierStyleCrossRef" href="#bib0022"><span class="elsevierStyleSup">22</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0023"><span class="elsevierStyleSup">23</span></a> although others did not find an association&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRefs" href="#bib0024"><span class="elsevierStyleSup">24-26</span></a> Meta-analysis was recently published that reported a positive association between OCI and reduced mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0027"><span class="elsevierStyleSup">27</span></a></p><p id="para0038" class="elsevierStylePara elsevierViewall">It is expected that OCI reduces mortality risk in PTNB&#44; especially in those with VLW at birth&#44; since morbidities related to prematurity&#44; which are frequent causes of neonatal death&#44; can be prevented by this intervention&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a> In this aspect&#44; the literature has documented a lower risk of ventilator-associated pneumonia&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a> necrotizing enterocolitis&#44;<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> septicemia&#44;<a class="elsevierStyleCrossRef" href="#bib0007"><span class="elsevierStyleSup">7</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0019"><span class="elsevierStyleSup">19</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0021"><span class="elsevierStyleSup">21</span></a><span class="elsevierStyleSup">&#44;</span><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> intraventricular hemorrhage&#44;<a class="elsevierStyleCrossRef" href="#bib0029"><span class="elsevierStyleSup">29</span></a> extrauterine growth restriction&#44;<a class="elsevierStyleCrossRef" href="#bib0028"><span class="elsevierStyleSup">28</span></a> reduction in antibiotic use duration<span class="elsevierStyleSup">7</span> and reduction in length of hospitalization&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">10</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">20</span></a></p><p id="para0039" class="elsevierStylePara elsevierViewall">In addition to infections related to immune system immaturity&#44; premature infants&#8217; nutrition is another challenge&#44; due to gastrointestinal tract immaturity that delays the start of enteral feeding&#44; a characteristic that contributes to mortality&#44; since long periods of absence of enteral feeding favor morbidity appearance that leads to death&#46; Studies show that OCI has beneficial effects in reducing the time to start enteral nutrition&#44;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a> the time to reach full enteral nutrition&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a><span class="elsevierStyleSup">&#44;</span><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><span class="elsevierStyleSup">&#44;</span><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> the clinical manifestations of food intolerance<a class="elsevierStyleCrossRef" href="#bib0021"><span class="elsevierStyleSup">21</span></a> and the time to reach oral feeding&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a> in addition to providing better average weight gain<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">20</span></a> and accelerating the growth rate of VLW PTNB&#46;<a class="elsevierStyleCrossRef" href="#bib0028"><span class="elsevierStyleSup">28</span></a></p><p id="para0040" class="elsevierStylePara elsevierViewall">The originality of the results found in the current study is likely to be related to some characteristics that strengthen OCI&#39;s internal validity and biological plausibility such as protocol use in the form of an algorithm&#44; with systematization of care provided to the VLBW-PT and the puerperal women&#44; through standardized clinical practice&#59; maintenance of treatment until the seventh full day of life of VLBW-PT&#44; a conduct that may have allowed greater absorption and systemic effects of bioactive factors present in colostrum&#44; such as serum IgA&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">30</span></a> important immunoglobulin that rises between the fourth and fifth day after childbirth&#59; in addition to the HMB support in the uninterrupted supply of colostrum for 24 hours&#46;</p><p id="para0041" class="elsevierStylePara elsevierViewall">Regarding the variables used in the regression model adjustment&#44; such as maternal age &#60; 18 years&#44; marital status without the presence of a companion&#44; gestational hypertension&#44; artificial childbirth type&#44; and a number of prenatal consultations &#60; 6 consultations&#44; are characterized as biological and social determinations for prematurity and&#47;or neonatal death since women exposed to these conditions are at greater risk of the clinical worsening of PTNB after birth&#46;<a class="elsevierStyleCrossRef" href="#bib0017"><span class="elsevierStyleSup">17</span></a> A fact also observed with the birth weight variable&#44; which is inversely proportional to better clinical prognoses presented by newborns&#44; i&#46;e&#46;&#44; the lower the birth weight&#44; the greater the risk of morbidities and mortality&#46;</p><p id="para0042" class="elsevierStylePara elsevierViewall">It is necessary to comment on the magnitude of the association between OCI and VLBW-PT death&#44; seen by calculating the NNT at 50 and 100 days&#44; which showed that it was necessary to treat 4 &#40;four&#41; newborns to avoid the death of one of them&#46; At 150 days&#44; for every 3 &#40;three&#41; individuals treated&#44; one death was prevented&#46; Still on the magnitude of the association&#44; despite the h-index of 0&#46;41 indicating a mean effect size of the intervention on the treatment group compared to the control&#44; from a clinical point of view&#44; this finding is extremely important&#44; as the assessed outcome means a reduction in risk of death&#46; Thus&#44; we can conclude that NNT and the calculated effect size reinforce the conduct of using OCI as a measure to prevent mortality risk in VLBW-PT&#46;</p><p id="para0043" class="elsevierStylePara elsevierViewall">The main limitation of this study was the historical control design&#44; as it could impact the quality of the data collected and prevent their comparability due to information bias&#46; This limitation was minimized&#44; as the variables selected to integrate the database were taken from the form applied to pregnant women in the maternity hospital&#39;s medical routine&#46; Another limitation concerns changes in characteristics between the groups over time&#44; but we consider that the short period between hospitalization in treatment and control groups &#40;two years&#41; did not cause significant changes in the determinants&#46; Furthermore&#44; the researched outcome &#40;death&#41; was well defined&#44; based on parameters that do not depend on changes in methods and diagnoses for its assessment&#46; Another precaution was the survival analysis adjusted for multiple variables&#46;</p><p id="para0044" class="elsevierStylePara elsevierViewall">Generalizability &#40;external validity&#41; of the current study&#39;s clinical findings to other populations is permitted&#44; since the association&#39;s biological plausibility applies to similar populations likely to receive the intervention&#44; and the death outcome is easy to measure&#44; in addition to the statistical care instituted with the aim of guaranteeing internal validity&#46; Added to this is the fact that OCI is a strategy that is easy to apply&#44; cheap&#44; viable&#44; safe and well tolerated by PTNB&#44; which can be implemented in neonatal units&#44; through a protocol adapted to different realities of public or private maternity hospitals&#44; especially those that can count on the HMB support&#46;<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a></p><p id="para0045" class="elsevierStylePara elsevierViewall">Thus&#44; the institution of OCI in clinical practice&#44; a modifiable variable&#44; associated with other measures&#44; such as access improvement and quality of health care provided in prenatal&#44; childbirth&#44; and puerperium and efficient and immediate clinical care to the VLBW-PT can contribute to achieving the goal set by the United Nations Sustainable Development Goals &#40;SDGs&#41; of reducing mortality incidence and complications arising from prematurity by 2030&#46;</p></span><span id="sec0014" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0020">Source of financing</span><p id="para0046" class="elsevierStylePara elsevierViewall">Bahia State Research Support Foundation &#40;FAPESB - <span class="elsevierStyleItalic">Funda&#231;&#227;o de Amparo &#224; Pesquisa do Estado da Bahia</span>&#41;&#44; in Public Notice 003&#47;2017 &#8211; Research Program for SUS&#58; Shared Management in Health &#8211; PPSUS&#47;BA &#8211; FAPESB&#47;SESAB&#47;CNPQ&#47;MS &#40;&#60; grant number 4996&#47;2017 &#91;to VIEIRA&#44; G&#46;O&#46;&#93;&#41;&#44; regarding the acquisition of permanent materials and consumables for the protocol implementation&#44; playing an indirect role in data collection&#46; The institution is under public law and only the right to incorporate the name of the funding agency on all research products is required&#46;</p><p id="para0047" class="elsevierStylePara elsevierViewall">Dean of Research and Graduate Studies at the <span class="elsevierStyleItalic">Universidade Estadual de Feira de Santana</span> &#40;PPPG&#47;UEFS&#41; through the Graduate Support Program &#40;Proap&#41; of the Higher Education Personnel Improvement Coordination &#40;CAPES - <span class="elsevierStyleItalic">Coordena&#231;&#227;o de Aperfei&#231;oamento de Pessoal de N&#237;vel Superior</span>&#41;&#44; provided funding for manuscript translation&#46;</p></span></span>"
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    "fechaRecibido" => "2023-04-16"
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            1 => "Colostrum"
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        "resumen" => "<span id="abss0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0002">Objective</span><p id="spara006" class="elsevierStyleSimplePara elsevierViewall">To evaluate the effect of oropharyngeal colostrum immunotherapy &#40;OCI&#41; on the mortality of preterm newborns &#40;PTNB&#41; with very low birth weight &#40;VLBW&#41;&#46;</p></span> <span id="abss0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0003">Method</span><p id="spara007" class="elsevierStyleSimplePara elsevierViewall">Non-randomized clinical trial&#44; carried out with 138 mother-child pairs attended at a public maternity hospital&#46; The treatment group used raw colostrum&#44; dripping 4 drops &#40;0&#46;2&#160;ml&#41; into the oropharyngeal mucosa&#44; totaling 8 administrations in 24&#160;h&#44; up to the 7th complete day of life &#40;OCI&#41;&#46; The control group was composed of newborns admitted to the same maternity hospital before the implementation of the OCI&#46; Analyzes were performed&#58; descriptive&#44; bivariate&#44; multiple logistic regression&#44; and survival analysis&#44; with a significance level of 5&#37; and 95&#37; CI&#46;</p></span> <span id="abss0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0004">Results</span><p id="spara008" class="elsevierStyleSimplePara elsevierViewall">The treatment group had an RR of death of 0&#46;26 &#40;95&#37; CI&#160;&#61;&#160;0&#46;07&#8211;0&#46;67&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;00&#41;&#44; adjusted for maternal age&#44; marital status&#44; gestational hypertension&#44; type of delivery&#44; number of prenatal visits&#44; and birth weight&#46; Number Needed to Treat &#40;NNT&#41; demonstrated that for every 5 individuals treated with OCI&#44; one death was prevented NNT&#160;&#61;&#160;4&#46;9 &#40;95&#37; CI&#160;&#61;&#160;1&#46;84&#8211;5&#46;20&#41;&#59; however&#44; for PTNB with VLBW who remained hospitalized for 50&#44; 100 and 150 days&#44; the NNT reduces to 4&#44; 4 and 3&#44; respectively&#46;</p></span> <span id="abss0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0005">Conclusion</span><p id="spara009" class="elsevierStyleSimplePara elsevierViewall">The OCI proved to be a beneficial intervention&#44; since it reduced the risk of mortality in PTNB with VLBW when compared to the control group&#46;</p></span>"
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                  \t\t\t\t</td><a name="en0019"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">56 &#40;77&#46;8&#41;&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">&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"><span class="elsevierStyleBold">Race&#47;self-declared color</span>&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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0023"></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><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"><span class="elsevierStyleHsp" style=""></span>Black&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="char" valign="top">59 &#40;89&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0027"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">67 &#40;97&#46;1&#41;&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">0&#46;07&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"><span class="elsevierStyleHsp" style=""></span>Non-black&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="char" valign="top">7 &#40;10&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0031"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">2 &#40;2&#46;9&#41;&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">&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"><span class="elsevierStyleBold">Marital status</span>&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><a name="en0035"></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><a name="en0036"></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="en0037"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Without a companion&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="char" valign="top">34 &#40;53&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0039"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">64 &#40;91&#46;4&#41;&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">0&#46;00&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"><span class="elsevierStyleHsp" style=""></span>With a companion&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="char" valign="top">30 &#40;46&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0043"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">6 &#40;8&#46;6&#41;&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">&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"><span class="elsevierStyleBold">Work</span>&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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0047"></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><a name="en0048"></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="en0049"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Not paid&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="char" valign="top">40 &#40;63&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0051"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">43 &#40;65&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0052"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><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"><span class="elsevierStyleHsp" style=""></span>Paid&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="char" valign="top">23 &#40;36&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0055"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">23 &#40;34&#46;8&#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"><span class="elsevierStyleBold">Place of residence</span>&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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0059"></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><a name="en0060"></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="en0061"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Rural&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="char" valign="top">15 &#40;22&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0063"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">19 &#40;26&#46;4&#41;&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">0&#46;62&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"><span class="elsevierStyleHsp" style=""></span>Urban&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="char" valign="top">51 &#40;77&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0067"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">53 &#40;73&#46;6&#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">&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"><span class="elsevierStyleBold">Gestational age</span>&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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0071"></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><a name="en0072"></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="en0073"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60; 28 weeks&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="char" valign="top">39 &#40;60&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0075"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">53 &#40;73&#46;6&#41;&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">0&#46;09&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"><span class="elsevierStyleHsp" style=""></span>&#8805; 28 weeks&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="char" valign="top">26 &#40;40&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0079"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">19 &#40;26&#46;4&#41;&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">&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"><span class="elsevierStyleBold">Number of pregnancies</span>&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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0083"></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><a name="en0084"></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="en0085"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Primiparous&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="char" valign="top">31 &#40;47&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0087"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">30 &#40;42&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0088"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0089"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Other situation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0090"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">35 &#40;53&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0091"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">41 &#40;57&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0092"></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="en0093"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">Number of prenatal care consultations</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0094"></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><a name="en0095"></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><a name="en0096"></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="en0097"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60; 6 consultations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0098"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">17 &#40;26&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0099"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">15 &#40;21&#46;1&#41;&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="" valign="top">0&#46;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0101"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8805; 6 consultations&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="top">47 &#40;73&#46;4&#41;&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="top">56 &#40;78&#46;9&#41;&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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0105"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">Childbirth type</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0106"></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><a name="en0107"></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><a name="en0108"></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="en0109"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Artifitial&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="top">14 &#40;21&#46;2&#41;&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="char" valign="top">21 &#40;29&#46;2&#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;28&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" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Normal&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="top">52 &#40;78&#46;8&#41;&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="char" valign="top">51 &#40;70&#46;8&#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="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0117"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">Infection during pregnancy</span>&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">&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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0120"></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="en0121"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&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="char" valign="top">23 &#40;36&#46;5&#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="top">14 &#40;26&#46;4&#41;&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="" valign="top">0&#46;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0125"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>No&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="char" valign="top">40 &#40;63&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0127"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">39 &#40;73&#46;6&#41;&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="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0129"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">Membrane rupture</span>&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="" valign="top">&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="" valign="top">&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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0133"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8804; 24 hours&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0134"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">19 &#40;86&#46;4&#41;&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="top">9 &#40;90&#46;0&#41;&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">1&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0137"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62; 24 hours&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="top">3 &#40;13&#46;6&#41;&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="char" valign="top">1 &#40;10&#46;0&#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">&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" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">Gestational hypertension</span>&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="" valign="top">&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">&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="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0145"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&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="char" valign="top">15 &#40;22&#46;7&#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="char" valign="top">14 &#40;25&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0148"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0149"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\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="char" valign="top">51 &#40;77&#46;3&#41;&nbsp;\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="top">41 &#40;74&#46;6&#41;&nbsp;\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="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0153"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">Corticosteroid use during pregnancy</span>&nbsp;\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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0155"></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><a name="en0156"></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="en0157"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\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="top">15 &#40;23&#46;4&#41;&nbsp;\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="top">12 &#40;25&#46;5&#41;&nbsp;\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&#46;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0161"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0162"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">49 &#40;76&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0163"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">35 &#40;74&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0164"></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="en0165"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">Newborn&#39;s sex</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0166"></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><a name="en0167"></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><a name="en0168"></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="en0169"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0170"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">34 &#40;51&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0171"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">28 &#40;40&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0172"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0173"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0174"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">32 &#40;48&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0175"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">42 &#40;60&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0176"></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="en0177"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">Weight at birth</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0178"></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><a name="en0179"></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><a name="en0180"></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="en0181"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8804; 1&#44;000 grams&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0182"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">28 &#40;42&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0183"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">26 &#40;36&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0184"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0185"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62; 1&#44;000 grams&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0186"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">38 &#40;57&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0187"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">46 &#40;63&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0188"></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="en0189"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">5-minute Apgar score</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0190"></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><a name="en0191"></a><td class="td" title="\n
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                    0 => array:2 [
                      "titulo" => "Intervention effect of oropharyngeal administration of colostrum in preterm infants&#58; a meta-analysis"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M Huo"
                            1 => "C Liu"
                            2 => "H Mei"
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                      "titulo" => "Oropharyngeal administration of colostrum to extremely low birth weight infants&#58; theoretical perspectives"
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                            0 => "NA Rodriguez"
                            1 => "PP Meier"
                            2 => "MW Groer"
                            3 => "JM&#46; Zeller"
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                      "titulo" => "Evaluation of the secretory immunoglobulin A levels in the colostrum and milk of mothers of term and pre-trerm newborns"
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        "titulo" => "Acknowledgments"
        "texto" => "<p id="para0049" class="elsevierStylePara elsevierViewall">The authors would like to thank the mothers of premature newborns for their consent to carry out this study&#59; <span class="elsevierStyleGrantSponsor" id="gs0001">FAPESB</span> for funding the research&#44; through Public Notice <span class="elsevierStyleGrantNumber" refid="gs0001">003&#47;2017</span> - <span class="elsevierStyleGrantSponsor" id="gs0002">Research Program for the SUS&#58; Shared Health Management - PPSUS&#47;BA - FAPESB&#47;SESAB&#47;CNPQ&#47;MS</span>&#59; and <span class="elsevierStyleGrantSponsor" id="gs0003">Hospital In&#225;cia Pinto dos Santos &#40;Hospital da Mulher&#41;</span> for their support and collaboration in the development of this research&#46;</p>"
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Article information
ISSN: 00217557
Original language: English
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Jornal de Pediatria (English Edition)
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