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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introdu&#231;&#227;o</span><p id="par0005" class="elsevierStylePara elsevierViewall">Recentemente&#44; os &#243;bitos de crian&#231;as<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>5 anos apresentaram queda dr&#225;stica&#44; com um n&#250;mero menor de 3&#44;6 milh&#245;es de &#243;bitos em 2013 em compara&#231;&#227;o com 2000&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a> Essa redu&#231;&#227;o &#233; principalmente atribu&#237;da a um progresso na preven&#231;&#227;o e no tratamento de doen&#231;as infecciosas em neonatos p&#243;s&#8208;neonatais e crian&#231;as entre 1&#8208;4 anos&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a> Com essa redu&#231;&#227;o nas infec&#231;&#245;es&#44; as doen&#231;as neonatais se tornaram mais importantes&#46; Em 1990&#44; os &#243;bitos neonatais representaram 37&#44;4&#37; dos &#243;bitos em crian&#231;as<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>5 anos em compara&#231;&#227;o com 41&#44;6&#37; em 2013&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a> As tr&#234;s principais causas do n&#250;mero de 2&#44;9 milh&#245;es de &#243;bitos neonatais anuais em todo o mundo s&#227;o complica&#231;&#245;es de parto prematuro &#40;1&#44;0 milh&#227;o&#41;&#44; condi&#231;&#245;es intraparto &#40;0&#44;7 milh&#227;o&#41; e infec&#231;&#245;es &#40;0&#44;6 milh&#227;o&#41;&#46; As condi&#231;&#245;es intraparto e nascimento prematuro dominam no per&#237;odo neonatal precoce&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Em 2013&#44; o Grupo de Estimativa sobre Epidemiologia Materno&#8208;Infantil relatou que os eventos intraparto representam 24&#37; dos &#243;bitos neonatais no mundo&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a> Dois ter&#231;os desses &#243;bitos ocorrem no sul da &#193;sia e na &#193;frica&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">5</span></a> Pa&#237;ses de alta renda t&#234;m baixa incid&#234;ncia de &#243;bitos associados a asfixia&#44; em aproximadamente 12&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a> Por outro lado&#44; ocorrem cerca de 740&#46;000&#8208;1&#46;480&#46;000 &#243;bitos neonatais globais anuais entre neonatos com peso ao nascer &#8805; 2&#46;500<span class="elsevierStyleHsp" style=""></span>g e em pa&#237;ses de baixa e m&#233;dia renda a maioria desses &#243;bitos est&#225; associada a asfixia intraparto&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">O Brasil&#44; o maior pa&#237;s da Am&#233;rica do Sul&#44; com uma popula&#231;&#227;o de aproximadamente 200 milh&#245;es e 3 milh&#245;es de nascimentos por ano&#44; passou por um progresso econ&#244;mico e social de 2003 a 2013&#44; no qual mais de 26 milh&#245;es de pessoas sa&#237;ram da pobreza e a desigualdade foi reduzida&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a> O 4&#176; Objetivo de Desenvolvimento do Mil&#234;nio foi atingido pelo pa&#237;s com uma redu&#231;&#227;o de 78&#37; da taxa de mortalidade abaixo de 5 anos de 1990 &#40;61&#44;5 por 1&#46;000 nascidos vivos&#41; a 2013 &#40;13&#44;7 por 1&#46;000 nascidos vivos&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a> As estimativas e os intervalos de incerteza para &#243;bitos neonatais precoces e tardios por 1&#46;000 nascidos vivos no Brasil em 2013 foram 7&#44;5 &#40;6&#44;6 a 8&#44;4&#41; e 2&#44;6 &#40;2&#44;4 a 2&#44;7&#41;&#44; respectivamente&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a> Os dados compilados pelas secretarias estaduais de Sa&#250;de e relatados para o Minist&#233;rio da Sa&#250;de indicaram que hip&#243;xia intrauterina e asfixia no parto representaram 7&#37; das causas b&#225;sicas de &#243;bitos entre 0 e 6 dias ap&#243;s o nascimento&#44; em 2014&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Os nascidos a termo t&#234;m o menor risco de mortalidade neonatal e infantil&#46; Em 11 pa&#237;ses da Europa Ocidental&#44; as taxas de mortalidade infantil dos nascidos &#8805; 37 semanas de gesta&#231;&#227;o ficaram abaixo de 2&#44;0 por 1&#46;000 nascidos vivos em 2010&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a> A taxa de mortalidade neonatal para neonatos com peso ao nascer &#8805; 2&#46;500<span class="elsevierStyleHsp" style=""></span>g em 2010 foi de 0&#44;73 por 1&#46;000 nascidos vivos nos Estados Unidos<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a> e 2&#44;63 no Brasil&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> A taxa das condi&#231;&#245;es intraparto associadas a essa alta taxa de mortalidade neonatal em beb&#234;s com peso normal ao nascer no Brasil n&#227;o &#233; bem avaliada&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">O estudo avalia a taxa anual e as caracter&#237;sticas epidemiol&#243;gicas principais dos &#243;bitos precoces associados &#224; asfixia perinatal em neonatos com peso ao nascer &#8805; 2&#46;500<span class="elsevierStyleHsp" style=""></span>g sem malforma&#231;&#245;es cong&#234;nitas no Brasil de 2005 a 2010&#44; considerando a presen&#231;a de hip&#243;xia intrauterina&#44; asfixia no parto ou s&#237;ndrome de aspira&#231;&#227;o de mec&#244;nio em qualquer linha dos atestados de &#243;bito&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todos</span><p id="par0030" class="elsevierStylePara elsevierViewall">Este &#233; um estudo de base populacional de todos os nascidos vivos com peso &#8805; 2&#46;500<span class="elsevierStyleHsp" style=""></span>g sem malforma&#231;&#245;es cong&#234;nitas&#44; que morreram por asfixia no parto at&#233; 168 horas ap&#243;s o nascimento&#44; de 1&#176; de janeiro de 2005 a 31 de dezembro de 2010 no Brasil&#46; O projeto foi aprovado pelo Comit&#234; de &#201;tica em Pesquisa da Universidade Federal de S&#227;o Paulo&#44; que foi o principal centro para esse projeto&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Em cada uma das 27 unidades federativas do Brasil&#44; dois investigadores fizeram uma pesquisa ativa sobre todos os neonatos que morreram na primeira semana ap&#243;s o nascimento&#46; Ambos os investigadores foram os coordenadores locais do Programa de Reanima&#231;&#227;o Neonatal da Sociedade Brasileira de Pediatria&#46; Os atestados de &#243;bito originais e&#47;ou prontu&#225;rios eletr&#244;nicos foram obtidos nas secretarias estaduais de Sa&#250;de dos 26 estados brasileiros e na Funda&#231;&#227;o Sistema Estadual de An&#225;lise de Dados do Estado de S&#227;o Paulo&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Os &#243;bitos associados &#224; presen&#231;a de asfixia perinatal inclu&#237;dos no estudo foram relatados em qualquer linha do atestado de &#243;bito como quaisquer dos seguintes casos&#44; de acordo com a Classifica&#231;&#227;o Internacional de Doen&#231;as&#44; 10&#170; Revis&#227;o &#40;CID 10&#41;&#58; P20&#46;0 &#8211; hip&#243;xia intrauterina diagnosticada antes do in&#237;cio do trabalho de parto&#59; P20&#46;1 &#8211; hip&#243;xia intrauterina diagnosticada durante o trabalho de parto e o parto&#59; P20&#46;9 &#8211; hip&#243;xia intrauterina n&#227;o especificada&#59; P21&#46;0 &#8211; asfixia grave as nascer&#59; P21&#46;1 &#8211; asfixia leve ou moderada ao nascer&#59; P21&#46;9 &#8211; asfixia ao nascer&#44; n&#227;o especificada&#59; ou P24&#46;0 &#8211; aspira&#231;&#227;o neonatal de mec&#244;nio&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a> Este estudo n&#227;o incluiu &#243;bitos causados por aspira&#231;&#227;o neonatal de secre&#231;&#245;es que n&#227;o mec&#244;nio&#44; &#243;bitos descritos como depress&#227;o cerebral neonatal ou &#243;bitos fetais&#46; Foram exclu&#237;dos todos os rec&#233;m&#8208;nascidos com malforma&#231;&#227;o cong&#234;nita relatados em qualquer linha dos atestados de &#243;bito&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Dois profissionais independentes informaram os dados de cada &#243;bito no prontu&#225;rio eletr&#244;nico especificamente criado para o estudo&#46; As vari&#225;veis registradas extra&#237;das dos atestados de &#243;bito foram&#58; data e hor&#225;rio de nascimento e &#243;bito&#59; cidade e estado onde as m&#227;es moram e onde o beb&#234; morreu&#59; local onde o neonato morreu &#40;hospital&#44; outra unidade de sa&#250;de&#44; casa&#44; rua&#41;&#59; idade da m&#227;e&#44; escolaridade &#40;nenhum&#44; 1&#8208;3&#44; 4&#8208;7&#44; 8&#8208;11&#44; &#8805; 12&#41; e local de trabalho de trabalho &#40;casa&#44; fora de casa&#41;&#59; n&#250;mero de partos anteriores&#59; semanas de gesta&#231;&#227;o &#40;&#60; 22&#44; 22&#8208;27&#44; 28&#8208;31&#44; 32&#8208;36&#44; 37&#8208;41&#44;<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>42&#41;&#59; gest&#227;o &#250;nica ou m&#250;ltipla&#59; cesariana ou parto vaginal&#59; peso ao nascer &#40;g&#41;&#59; sexo e etnia do neonato &#40;branco&#44; preto&#44; asi&#225;tico&#44; nativo brasileiro&#44; mulato&#41;&#59; c&#243;digo CID&#8208;10 nas linhas Ia&#44; Ib&#44; Ic&#44; Id e II&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Para calcular o &#237;ndice de mortalidade relacionado &#224; asfixia perinatal e o &#237;ndice de mortalidade relacionado a s&#237;ndrome de aspira&#231;&#227;o de mec&#244;nio&#44; foi obtido o n&#250;mero de nascidos vivos de 2005 a 2010 com peso &#8805; 2&#46;500<span class="elsevierStyleHsp" style=""></span>g sem malforma&#231;&#245;es relatadas nas certid&#245;es de nascimento na base de dados do sistema p&#250;blico de sa&#250;de de acesso aberto mantida pelo Minist&#233;rio da Sa&#250;de&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> Esses &#237;ndices foram analisados anualmente com rela&#231;&#227;o ao pa&#237;s como um todo e de cada uma das cinco regi&#245;es do Brasil&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">As caracter&#237;sticas maternas e neonatais foram comparadas durante os anos do estudo&#46; Todas as compara&#231;&#245;es usaram uma an&#225;lise estat&#237;stica descritiva&#44; o teste qui&#8208;quadrado e o <span class="elsevierStyleItalic">software</span> SPSS &#40;IBM SPSS Statistics for Windows&#44; vers&#227;o 21&#46;0&#44; EUA&#41; para determinar as tend&#234;ncias&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0060" class="elsevierStylePara elsevierViewall">Este estudo encontrou 27&#46;800 &#243;bitos neonatais precoces associados a asfixia perinatal entre 2005 e 2010 no Brasil&#46; Dentre eles&#44; 2&#46;767 &#40;10&#37;&#41; apresentaram diagn&#243;stico de malforma&#231;&#227;o cong&#234;nita no atestado de &#243;bito e 823 &#40;3&#37;&#41; eram neonatos n&#227;o vi&#225;veis com idade gestacional<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>22 semanas ou peso ao nascer<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>400<span class="elsevierStyleHsp" style=""></span>g&#46; Dentre os 24&#46;210 neonatos potencialmente vi&#225;veis sem malforma&#231;&#245;es cong&#234;nitas&#44; 2&#46;861 &#40;12&#37;&#41; n&#227;o tinham dados de peso ao nascer&#46; Os pacientes com e sem dados de peso ao nascer foram semelhante com rela&#231;&#227;o &#224; idade materna&#44; ocupa&#231;&#227;o e paridade&#44; gest&#227;o m&#250;ltipla&#44; idade gestacional e sexo neonatal&#46; Dentre os 21&#46;349 &#243;bitos com informa&#231;&#245;es de peso ao nascer o estudo encontrou 10&#46;675 &#40;50&#37;&#41; neonatos com peso ao nascer &#8805; 2&#46;500<span class="elsevierStyleHsp" style=""></span>g e sem malforma&#231;&#245;es que morreram por asfixia perinatal relacionada a doen&#231;as&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">O &#237;ndice de &#243;bitos neonatais precoces associados a asfixia perinatal por 1&#46;000 nascidos vivos de neonatos &#8805; 2&#46;500<span class="elsevierStyleHsp" style=""></span>g sem malforma&#231;&#245;es cong&#234;nitas reduziu de 0&#44;81 em 2005 para 0&#44;65 em 2010 no Brasil &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Essa redu&#231;&#227;o foi significativa em todas as regi&#245;es do pa&#237;s &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>A&#41;&#46; O &#237;ndice de &#243;bitos neonatais precoces associados &#224; s&#237;ndrome de aspira&#231;&#227;o de mec&#244;nio por 1&#46;000 nascidos vivos de neonatos &#8805; 2&#46;500<span class="elsevierStyleHsp" style=""></span>g sem malforma&#231;&#245;es permaneceu entre 0&#44;20 e 0&#44;29 durante o per&#237;odo do estudo no Brasil&#44; com redu&#231;&#227;o de apenas na Regi&#227;o Sudeste&#58; de 0&#44;24 por 1&#46;000 nascidos vivos em 2005 para 0&#44;18 em 2010 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>B&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">O n&#250;mero absoluto de &#243;bitos neonatais precoces no Brasil&#44; extra&#237;do da base de dados mantida pelo Minist&#233;rio da Sa&#250;de&#44;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> e o n&#250;mero de &#243;bitos associados a asfixia e &#224; s&#237;ndrome de aspira&#231;&#227;o de mec&#244;nio constatado no estudo s&#227;o mostrados na <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a>&#46; Os &#243;bitos neonatais precoces associados a asfixia perinatal representaram 40&#37; de todos os &#243;bitos neonatais precoces de neonatos &#8805; 2&#46;500<span class="elsevierStyleHsp" style=""></span>g sem malforma&#231;&#245;es durante o per&#237;odo do estudo no pa&#237;s&#46; Os &#243;bitos neonatais precoces associados &#224; s&#237;ndrome de aspira&#231;&#227;o de mec&#244;nio aumentaram de 14&#44;4&#37; de todos os &#243;bitos neonatais precoces de neonatos &#8805; 2&#46;500<span class="elsevierStyleHsp" style=""></span>g sem malforma&#231;&#245;es no Brasil em 2005 para 16&#44;6&#37; em 2010 &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Dentre os 4&#46;076 &#243;bitos com s&#237;ndrome de aspira&#231;&#227;o de mec&#244;nio&#44; 1&#46;976 &#40;48&#37;&#41; tamb&#233;m foram diagnosticados com hip&#243;xia intrauterina ou asfixia ao nascer em pelo menos uma das linhas do atestado de &#243;bito&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">As caracter&#237;sticas dos 10&#46;675 neonatos &#8805; 2&#46;500<span class="elsevierStyleHsp" style=""></span>g sem malforma&#231;&#245;es que apresentaram &#243;bito neonatal precoce associado a asfixia perinatal s&#227;o mostradas na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#46; A contribui&#231;&#227;o das regi&#245;es Norte e Nordeste do Brasil para os &#243;bitos neonatais precoces associados a asfixia perinatal aumentou de 58&#37; em 2005 para 60&#37; em 2010 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;040&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">As caracter&#237;sticas dos 4&#46;076 neonatos &#8805; 2&#46;500<span class="elsevierStyleHsp" style=""></span>g sem malforma&#231;&#245;es que apresentaram &#243;bito neonatal precoce associado a s&#237;ndrome de aspira&#231;&#227;o de mec&#244;nio de acordo com o ano do &#243;bito s&#227;o mostradas na <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#46; A contribui&#231;&#227;o das regi&#245;es Norte e Nordeste do Brasil para esses &#243;bitos aumentou de 48&#37; em 2005 para 55&#37; em 2010 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;010&#41;&#46; Foram feitas cesarianas com mais frequ&#234;ncia em neonatos que apresentaram &#243;bito neonatal precoce associado &#224; s&#237;ndrome de aspira&#231;&#227;o de mec&#244;nio em compara&#231;&#227;o com os nascidos vivos brasileiros<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> &#40;51&#37; em compara&#231;&#227;o com 48&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; principalmente na Regi&#227;o Norte &#40;49&#37; em compara&#231;&#227;o com 47&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; Nordeste &#40;43&#37; em compara&#231;&#227;o com 38&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; e Sudeste &#40;59&#37; em compara&#231;&#227;o com 55&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; do pa&#237;s&#46; Cuidados hospitalares neonatais estiveram igualmente dispon&#237;veis para os neonatos que apresentaram &#243;bito neonatal precoce associado &#224; s&#237;ndrome de aspira&#231;&#227;o de mec&#244;nio em compara&#231;&#227;o com todos os nascidos vivos brasileiros<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> &#40;98&#37; em compara&#231;&#227;o com 98&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;22&#41;&#44; por&#233;m a disponibilidade dos cuidados hospitalares neonatais foi maior para neonatos que morreram por s&#237;ndrome de aspira&#231;&#227;o de mec&#244;nio em compara&#231;&#227;ocom os nascidos vivos nas regi&#245;es Norte &#40;97&#37; em compara&#231;&#227;o com 92&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; e Nordeste &#40;98&#37; em compara&#231;&#227;o com 96&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;008&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discuss&#227;o</span><p id="par0085" class="elsevierStylePara elsevierViewall">Este estudo constatou que 10&#46;675 neonatos com peso &#8805; 2&#46;500<span class="elsevierStyleHsp" style=""></span>g sem malforma&#231;&#245;es morreram em 0 a 6 dias ap&#243;s o nascimento&#44; devido a asfixia perinatal&#59; a taxa desses &#243;bitos por dia reduziu de 5&#44;6 em 2005 para 4&#44;2 em 2010&#46; Apesar da redu&#231;&#227;o nos &#237;ndices de mortalidade em todas as regi&#245;es do pa&#237;s&#44; as regi&#245;es Norte e Nordeste do Brasil mostraram a maior taxa de &#243;bitos&#46; A maioria desses &#243;bitos ocorreu no primeiro dia de vida&#46; A asfixia perinatal contribuiu para 40&#37; de todos os &#243;bitos neonatais brasileiros de neonatos com baixo risco no per&#237;odo do estudo&#46; Notavelmente&#44; 40&#37; desses &#243;bitos associados a asfixia nesse grupo de neonatos ocorreram em um hospital localizado em munic&#237;pio diferente em compara&#231;&#227;o com a resid&#234;ncia materna&#46; Dentre os 10&#46;675 &#243;bitos precoces de neonatos com peso &#8805; 2&#46;500<span class="elsevierStyleHsp" style=""></span>g sem malforma&#231;&#245;es e com asfixia&#44; 4&#46;076 &#40;38&#37;&#41; foram diagnosticados com s&#237;ndrome de aspira&#231;&#227;o de mec&#244;nio em uma das linhas nos atestados de &#243;bito&#44; com aumento de 19&#37; na s&#237;ndrome de aspira&#231;&#227;o de mec&#244;nio atribu&#237;vel a &#243;bitos neonatais precoces em 2010&#44; em compara&#231;&#227;o com 2005&#46; Este estudo corrobora as informa&#231;&#245;es dispon&#237;veis&#44; de um lado&#44; sobre o fato de que a asfixia perinatal representa duas vezes &#40;1&#44;86&#8208;2&#44;06 vezes&#41; o n&#250;mero de &#243;bitos precoces de neonatos com peso normal ao nascer no pa&#237;s em compara&#231;&#227;o com o n&#250;mero relatado pelo Minist&#233;rio da Sa&#250;de&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> Por outro lado&#44; esse &#233; o primeiro relato da taxa de s&#237;ndrome de aspira&#231;&#227;o de mec&#244;nio com rela&#231;&#227;o a &#243;bitos neonatais precoces&#44; pois as estat&#237;sticas de sa&#250;de oficial n&#227;o isolam essa doen&#231;a de outras s&#237;ndromes de aspira&#231;&#227;o neonatal como uma causa do &#243;bito&#46; Deve&#8208;se destacar que 2&#46;100 neonatos que morreram por s&#237;ndrome de aspira&#231;&#227;o de mec&#244;nio&#44; cujos dados foram coletados por este estudo&#44; n&#227;o tinham c&#243;digo CID&#8208;10 relacionado a hip&#243;xia intrauterina ou asfixia ao nascer&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Houve uma redu&#231;&#227;o nos &#243;bitos neonatais precoces associados a asfixia perinatal de 0&#44;81 a 0&#44;61 por 1&#46;000 nascidos vivos com peso &#8805; 2&#46;500<span class="elsevierStyleHsp" style=""></span>g sem malforma&#231;&#245;es durante todo o per&#237;odo do estudo&#46; Essa redu&#231;&#227;o resultou de v&#225;rios fatores&#46; As principais for&#231;as que provavelmente levaram &#224; redu&#231;&#227;o no &#237;ndice incluem as mudan&#231;as socioecon&#244;micas e demogr&#225;ficas&#44; com crescimento econ&#244;mico&#44; redu&#231;&#227;o nas disparidades de renda&#44; urbaniza&#231;&#227;o&#44; melhoria na escolaridade materna e redu&#231;&#227;o nas taxas de fertilidade&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">14&#44;15</span></a> Durante 2003 e 2008&#44; houve uma redu&#231;&#227;o das desigualdades nas taxas de mortalidade de neonatos e crian&#231;as no n&#237;vel individual&#44; de acordo com a escolaridade materna e a renda familiar per capita no Brasil&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a> Os dados de todos os nascidos vivos brasileiros mostram que&#44; durante o per&#237;odo do estudo &#40;2005&#8208;2010&#41;&#44; a propor&#231;&#227;o de m&#227;es adolescentes reduziu de 21&#44;8&#37; para 19&#44;3&#37;&#44; a frequ&#234;ncia de m&#227;es com menos de 8 anos de escolaridade tamb&#233;m reduziu de 48&#44;5&#37; para 34&#44;1&#37; e os partos hospitalares aumentaram de 97&#44;1&#37; para 98&#44;1&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> Em nosso estudo&#44; apesar do fato de abranger apenas &#243;bitos neonatais precoces&#44; a frequ&#234;ncia de m&#227;es com<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>8 anos de escolaridade reduziu de 64&#37; para 53&#37; de 2005 a 2010 e a frequ&#234;ncia de m&#227;es que trabalham fora de casa aumentou de 31&#37; para 38&#37; no mesmo per&#237;odo&#46; Deve&#8208;se destacar que o Brasil apresenta diferen&#231;as regionais muito grandes&#44; principalmente em indicadores sociais&#44; como sa&#250;de&#44; mortalidade infantil e nutri&#231;&#227;o&#46; As regi&#245;es mais ricas&#44; como Sul e Sudeste&#44; t&#234;m indicadores melhores do que as regi&#245;es Norte e Nordeste&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a> Essa situa&#231;&#227;o &#233; mostrada na <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>A&#44; que indica que os &#243;bitos neonatais precoces relacionados a asfixia perinatal em neonatos com peso &#8805; 2&#46;500<span class="elsevierStyleHsp" style=""></span>g sem malforma&#231;&#245;es foram duas vezes maiores nas regi&#245;es Norte e Nordeste&#44; em compara&#231;&#227;o com as regi&#245;es Sul e Sudeste do Brasil&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">O progresso na sobrevida neonatal deve incluir planejamento pessoal para aumentar os n&#250;meros e melhorar as habilidades espec&#237;ficas voltadas para o cuidado no nascimento&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a> Na China&#44; as mudan&#231;as pol&#237;ticas permitiram que as parteiras iniciassem reanima&#231;&#227;o e tivessem treinamento em reanima&#231;&#227;o para obter a licen&#231;a&#46; De 2003 a 2008&#44; mais de 110&#46;659 profissionais receberam treinamento em reanima&#231;&#227;o em 322 hospitais representantes&#46; Os &#243;bitos relacionados a asfixia perinatal na sala de parto reduziram de 0&#44;75 para 0&#44;34 por 1&#46;000 nesse per&#237;odo&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">18</span></a> A redu&#231;&#227;o nos &#243;bitos neonatais precoces relacionados a asfixia perinatal de neonatos brasileiros com peso &#8805; 2&#46;500<span class="elsevierStyleHsp" style=""></span>g sem malforma&#231;&#245;es&#44; de 2005 a 2010&#44; pode ter ocorrido devido &#224; contribui&#231;&#227;o do amplo programa de treinamento destinado a melhorar as habilidades dos prestadores de servi&#231;os m&#233;dicos&#44; o Programa de Reanima&#231;&#227;o Neonatal&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a> Esse programa treinou mais de 75&#46;000 prestadores de servi&#231;os m&#233;dicos que trabalham nas salas de parto&#44; com uma rede de mais de 800 instrutores em todos os estados brasileiros desde 1994&#44; de acordo com as orienta&#231;&#245;es com base na melhor comprova&#231;&#227;o global dispon&#237;vel e atualizada a cada cinco anos&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">20&#8211;22</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Uma revis&#227;o dos estudos mostrou que h&#225; a ocorr&#234;ncia de l&#237;quido amni&#243;tico corado por mec&#244;nio em 13&#37; das gravidezes e que a s&#237;ndrome de aspira&#231;&#227;o ocorre em 4&#37; dos nascidos com l&#237;quido corado por mec&#244;nio&#44; com uma taxa de mortalidade de 10 por 100&#46;000 nascidos vivos&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a> Os &#237;ndices de mortalidade atribu&#237;dos &#224; s&#237;ndrome de aspira&#231;&#227;o de mec&#244;nio variaram de 1 a 5 por 100&#46;000 nascidos vivos em pa&#237;ses desenvolvidos na &#250;ltima d&#233;cada&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">24&#44;25</span></a> No Brasil&#44; de 2005 a 2010&#44; o &#237;ndice de mortalidade neonatal precoce associado &#224; s&#237;ndrome de aspira&#231;&#227;o de mec&#244;nio em neonatos com peso &#8805; 2&#46;500<span class="elsevierStyleHsp" style=""></span>g sem malforma&#231;&#245;es foi 23&#44;3 por 100&#46;000 nascidos vivos&#44; 4 a 23 vezes maiores do que os relatados anteriormente&#46; Apesar da redu&#231;&#227;o nos &#243;bitos neonatais precoces associados a asfixia perinatal no presente estudo&#44; os &#243;bitos associados &#224; s&#237;ndrome de aspira&#231;&#227;o de mec&#244;nio n&#227;o apenas reduziram&#44; mas sua contribui&#231;&#227;o para os &#243;bitos neonatais precoces associados a asfixia perinatal aumentou de 34&#37; em 2005 para 41&#37; em 2010&#46; Vale destacar que esse achado ocorreu apesar do aumento surpreendente nas taxas de cesariana no Brasil de 43&#44;3&#37; em 2005 para 52&#44;3&#37; em 2010&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> Deve&#8208;se especular se os partos cir&#250;rgicos e o cuidado hospitalar neonatal n&#227;o estiveram dispon&#237;veis para os neonatos que morreram por s&#237;ndrome de aspira&#231;&#227;o de mec&#244;nio&#44; por&#233;m&#44; com base em nossos resultados&#44; esse n&#227;o &#233; o caso&#46; Nas regi&#245;es Norte e Nordeste&#44; que t&#234;m a maior taxa de s&#237;ndrome de aspira&#231;&#227;o de mec&#244;nio na mortalidade neonatal precoce &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>B&#41;&#44; a disponibilidade de cesariana e o cuidado hospitalar neonatal foram ainda maiores para os neonatos estudados em compara&#231;&#227;o com todos os nascidos vivos das mesmas regi&#245;es&#46; Um dos motivos para essa alta taxa de mortalidade neonatal precoce espec&#237;fica deve&#8208;se provavelmente a problemas na organiza&#231;&#227;o do sistema brasileiro de cuidados perinatais&#44; que for&#231;a mulheres prestes a dar &#224; luz a visitar mais de um hospital antes de serem internadas em uma maternidade&#44; ocasionalmente em um munic&#237;pio distante de suas resid&#234;ncias&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">26</span></a> Al&#233;m disso&#44; como os hospitais secund&#225;rios de refer&#234;ncia&#44; principalmente nas regi&#245;es Norte e Nordeste do Brasil&#44; n&#227;o t&#234;m unidades de terapia intensiva neonatal&#44; as gr&#225;vidas normalmente s&#227;o transferidas quando h&#225; comprova&#231;&#227;o de sofrimento fetal&#44; o que leva a atrasos na chegada &#224; unidade de sa&#250;de de refer&#234;ncia e&#44; consequentemente&#44; atrasos no recebimento oportuno de cuidado adequado&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a> De acordo com nossos dados&#44; entre os neonatos que morreram de s&#237;ndrome de aspira&#231;&#227;o de mec&#244;nio&#44; 38&#37; de suas m&#227;es moravam em uma cidade diferente da unidade onde o neonato morreu em 2005 e essa incid&#234;ncia aumentou para 44&#37; em 2010&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">O uso de atestados de &#243;bito para obter dados &#233; a principal limita&#231;&#227;o do estudo&#46; Usar essa fonte de informa&#231;&#245;es traz preocupa&#231;&#245;es relacionadas &#224; falta de relatos de &#243;bitos e suas causas&#44; pois os dados s&#227;o fornecidos por m&#233;dicos sem uma avalia&#231;&#227;o objetiva de como a asfixia perinatal de fato contribuiu para o &#243;bito&#46; Apesar dessas preocupa&#231;&#245;es&#44; a abrang&#234;ncia do Sistema de Informa&#231;&#227;o sobre Mortalidade &#233; adequada&#44; com um aumento nos relatos de mortalidade infantil de 70&#37; em 2005&#8208;2007 para 85&#37; em 2008&#8208;2010&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a> Al&#233;m disso&#44; como os dados foram coletados de uma fonte secund&#225;ria&#44; n&#227;o &#233; poss&#237;vel avaliar quantos natimortos foram de fatos neonatos que nasceram vivos&#44; mas morreram nos primeiros minutos ap&#243;s o nascimento&#46; Essas limita&#231;&#245;es d&#227;o a entender que a taxa de asfixia perinatal em &#243;bitos neonatais precoces de neonatos com peso &#8805; 2&#46;500<span class="elsevierStyleHsp" style=""></span>g sem malforma&#231;&#245;es ainda &#233; mais alta do que a documentada neste estudo&#46; Por fim&#44; a falta de cruzamento entre as certid&#245;es de nascimento e os atestados de &#243;bito em n&#237;vel nacional afeta a obten&#231;&#227;o de dados precisos sobre algumas caracter&#237;sticas maternas e neonatais&#46; &#201; importante enfatizar que a coleta de dados para o estudo foi feita por pediatras coordenadores estaduais do Programa de Reanima&#231;&#227;o Neonatal&#44; o que aumenta sua conscientiza&#231;&#227;o dos dados sobre o local&#44; os ajuda a construir pontes com a coordena&#231;&#227;o de sa&#250;de dos estados e capacita&#8208;os para discutir solu&#231;&#245;es locais para as altas taxas de &#243;bitos neonatais associados a asfixia perinatal&#46; Deve&#8208;se enfatizar tamb&#233;m que os dados referem&#8208;se a &#243;bitos entre 2005&#8208;2010 e n&#227;o consideraram importantes esfor&#231;os feitos pelo governo federal para melhorar a sa&#250;de materna e neonatal da&#237; por diante&#46; Em 2011&#44; o Minist&#233;rio da Sa&#250;de estabeleceu a Rede Cegonha&#44; para aumentar o acesso e melhorar a qualidade do acompanhamento pr&#233;&#8208;natal e assist&#234;ncia durante o parto&#44; cuidado ap&#243;s o parto e cuidado infantil&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">29</span></a> O impacto dessas a&#231;&#245;es pode ter reduzido a mortalidade neonatal associada a asfixia perinatal nos anos a seguir&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Parto seguro e in&#237;cio de vida saud&#225;vel s&#227;o o cora&#231;&#227;o do capital humano e do progresso econ&#244;mico&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">4&#44;30</span></a> Este estudo demonstrou que as taxas de mortalidade neonatal precoce associadas a asfixia perinatal de neonatos no melhor espectro de peso ao nascer e sem malforma&#231;&#245;es cong&#234;nitas ainda s&#227;o altas e a s&#237;ndrome de aspira&#231;&#227;o de mec&#244;nio desempenha um importante papel&#46; Os resultados deste estudo podem ajudar a melhorar o planejamento de sa&#250;de nacional&#44; identificar e superar os gargalos no cuidado materno e neonatal para melhorar a sobrevida dos rec&#233;m&#8208;nascidos&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Financiamento</span><p id="par0115" class="elsevierStylePara elsevierViewall">A Funda&#231;&#227;o Sociedade Brasileira de Pediatria financiou o <span class="elsevierStyleItalic">software</span> para entrada de dados&#44; os profissionais que inseriram os dados na base de dados e a tradu&#231;&#227;o para o ingl&#234;s do manuscrito pela <span class="elsevierStyleItalic">American Journal Experts</span>&#46; A Funda&#231;&#227;o Sociedade Brasileira de Pediatria n&#227;o teve papel no projeto do estudo&#44; na coleta&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#44; na elabora&#231;&#227;o do relat&#243;rio e na decis&#227;o de enviar o manuscrito para publica&#231;&#227;o&#46; Nenhum dos autores foi pago para escrever esse manuscrito&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflitos de interesse</span><p id="par0120" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflitos de interesse&#46;</p></span></span>"
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            1 => "Early neonatal mortality"
            2 => "Meconium aspiration syndrome"
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            4 => "Newborn"
            5 => "Brazil"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To assess the annual burden of early neonatal deaths associated with perinatal asphyxia in infants weighing &#8805;2&#44;500<span class="elsevierStyleHsp" style=""></span>g in Brazil from 2005 to 2010&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The population study enrolled all live births of infants with birth weight &#8805;2&#44;500<span class="elsevierStyleHsp" style=""></span>g and without malformations who died up to six days after birth with perinatal asphyxia&#44; defined as intrauterine hypoxia&#44; asphyxia at birth&#44; or meconium aspiration syndrome&#46; The cause of death was written in any field of the death certificate&#44; according to <span class="elsevierStyleItalic">International Classification of Diseases</span>&#44;&#160;<span class="elsevierStyleItalic">10th Revision</span> &#40;P20&#46;0&#44; P21&#46;0&#44; and P24&#46;0&#41;&#46; An active search was performed in 27 Brazilian federative units&#46; The chi&#8208;squared test for trend was applied to analyze early neonatal mortality ratios associated with perinatal asphyxia by study year&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 10&#44;675 infants weighing &#8805;2&#44;500<span class="elsevierStyleHsp" style=""></span>g without malformations died within six days after birth with perinatal asphyxia&#46; Deaths occurred in the first 24<span class="elsevierStyleHsp" style=""></span>h after birth in 71&#37; of the infants&#46; Meconium aspiration syndrome was reported in 4076 &#40;38&#37;&#41; of these deaths&#46; The asphyxia&#8208;specific early neonatal mortality ratio decreased from 0&#46;81 in 2005 to 0&#46;65 <span class="elsevierStyleItalic">per 1&#44;000 live births</span> in 2010 in Brazil &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#59; the meconium aspiration syndrome&#8208;specific early neonatal mortality ratio remained between 0&#46;20 and 0&#46;29 per 1&#44;000 live births during the study period&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Despite the decreasing rates in Brazil from 2005 to 2010&#44; early neonatal mortality rates associated with perinatal asphyxia in infants in the better spectrum of birth weight and without congenital malformations are still high&#44; and meconium aspiration syndrome plays a major role&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Avaliar a taxa anual de &#243;bitos neonatais precoces associados &#224; asfixia perinatal em neonatos de peso &#8805; 2&#46;500<span class="elsevierStyleHsp" style=""></span>g no Brasil de 2005 a 2010&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A popula&#231;&#227;o do estudo envolveu todos os nascidos vivos de neonatos com peso ao nascer &#8805; 2&#46;500<span class="elsevierStyleHsp" style=""></span>g e sem malforma&#231;&#245;es que morreram at&#233; seis dias ap&#243;s o nascimento por asfixia perinatal&#44; definida como hip&#243;xia intrauterina&#44; asfixia no nascimento ou s&#237;ndrome de aspira&#231;&#227;o de mec&#244;nio&#46; A causa do &#243;bito foi escrita em qualquer linha do atestado de &#243;bito&#44; de acordo com a Classifica&#231;&#227;o Internacional de Doen&#231;as&#44; 10<span class="elsevierStyleSup">a</span> Revis&#227;o &#40;P20&#46;0&#44; P21&#46;0 e P24&#46;0&#41;&#46; Foi feita uma pesquisa ativa em 27 unidades federativas brasileiras&#46; O teste qui&#8208;quadrado de tend&#234;ncia foi aplicado para analisar os &#237;ndices de mortalidade neonatal associados a asfixia perinatal at&#233; o ano do estudo&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Morreram 10&#46;675 neonatos com peso &#8805; 2&#46;500<span class="elsevierStyleHsp" style=""></span>g sem malforma&#231;&#245;es at&#233; 0&#8208;6 dias ap&#243;s o nascimento por asfixia perinatal&#46; Os &#243;bitos ocorreram nas primeiras 24 horas ap&#243;s o nascimento em 71&#37; dos neonatos&#46; A s&#237;ndrome de aspira&#231;&#227;o de mec&#244;nio foi relatada em 4&#46;076 &#40;38&#37;&#41; dos &#243;bitos&#46; O &#237;ndice de mortalidade neonatal precoce relacionada &#224; asfixia caiu de 0&#44;81 em 2005 para 0&#44;65 por 1&#46;000 nascidos vivos em 2010 no Brasil &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#59; o &#237;ndice de mortalidade neonatal precoce relacionada a s&#237;ndrome de aspira&#231;&#227;o de mec&#244;nio permaneceu entre 0&#44;20&#8208;0&#44;29 por 1&#46;000 nascidos vivos durante o per&#237;odo do estudo&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#245;es</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Apesar da redu&#231;&#227;o nas taxas no Brasil de 2005 a 2010&#44; as taxas de mortalidade neonatal precoce associadas &#224; asfixia perinatal em neonatos no melhor espectro de peso ao nascer e sem malforma&#231;&#245;es cong&#234;nitas ainda s&#227;o altas e a s&#237;ndrome de aspira&#231;&#227;o de mec&#244;nio desempenha um importante papel&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclus&#245;es"
          ]
        ]
      ]
    ]
    "NotaPie" => array:2 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Como citar este artigo&#58; Almeida MF&#44; Kawakami MD&#44; Moreira LM&#44; Santos RM&#44; Anchieta LM&#44; Guinsburg R&#46; Early neonatal deaths associated with perinatal asphyxia in infants &#8805;2500<span class="elsevierStyleHsp" style=""></span>g in Brazil&#46; J Pediatr &#40;Rio J&#41;&#46; 2017&#59;93&#58;576&#8211;84&#46;</p>"
      ]
      1 => array:2 [
        "etiqueta" => "&#9734;&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Estudo feito na Sociedade Brasileira de Pediatria&#44; Programa de Reanima&#231;&#227;o Neonatal&#44; S&#227;o Paulo&#44; SP&#44; Brasil&#46;</p>"
      ]
    ]
    "multimedia" => array:4 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figura 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
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            "Alto" => 1364
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">&#205;ndice de mortalidade neonatal precoce associada a asfixia no parto &#40;A&#41; e s&#237;ndrome de aspira&#231;&#227;o de mec&#244;nio &#40;B&#41; por 1&#46;000 nascidos vivos com peso ao nascer &#8805; 2&#46;500<span class="elsevierStyleHsp" style=""></span>g sem anomalias cong&#234;nitas&#44; de acordo com o ano de &#243;bito e regi&#227;o do Brasil&#46;</p>"
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      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figura 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1170
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            "Tamanyo" => 127598
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        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">N&#250;mero de &#243;bitos neonatais precoces com peso ao nascer &#8805; 2&#46;500<span class="elsevierStyleHsp" style=""></span>g sem anomalias cong&#234;nitas associados a asfixia no parto e s&#237;ndrome de aspira&#231;&#227;o de mec&#244;nio no Brasil&#44; de acordo com o ano de &#243;bito&#46;</p>"
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      ]
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        "identificador" => "tbl0005"
        "etiqueta" => "Tabela 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Tabela "
            "rol" => "short"
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        ]
        "tabla" => array:2 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Dados ausentes<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2005 n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;051&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2006<br>n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;822&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2007<br>n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;811&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2008<br>n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;790&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2009<br>n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;659&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2010<br>n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;542&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">X</span><span class="elsevierStyleSup">2</span> de tend&#234;ncia<br>&#40;p&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">M&#227;e branca&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">M&#227;e<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>20 anos de idade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;352&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">M&#227;e<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>8 anos de escolaridade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dona de casa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Primeira gesta&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;413&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gest&#227;o m&#250;ltipla&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;115&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cesariana&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Idade gestacional 37&#8208;41 semanas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">82&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;251&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Peso ao nascer &#8805; 4&#46;000<span class="elsevierStyleHsp" style=""></span>g&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;522&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;300&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#211;bito em hospital&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">97&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">98&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">97&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">97&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">97&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">98&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;933&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#211;bito na 1&#170; hora ap&#243;s o nascimento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;208&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#211;bito nas primeiras 24 horas ap&#243;s o nascimento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">72&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">72&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">71&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">71&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;568&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#211;bito em hospital p&#250;blico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">72&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">74&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#211;bito em uma capital de estado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;066&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">M&#227;e que mora no interior&#44; por&#233;m o &#243;bito ocorreu na capital&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;235&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#211;bito na cidade de resid&#234;ncia materna&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S&#237;ndrome de aspira&#231;&#227;o de mec&#244;nio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "pt" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas dos 10&#46;675 &#243;bitos neonatais precoces associados a asfixia perinatal em neonatos com peso ao nascer &#8805; 2&#46;500<span class="elsevierStyleHsp" style=""></span>g sem malforma&#231;&#245;es&#44; de acordo com o ano de &#243;bito</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Dados ausentes<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2005<br>n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>698&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2006<br>n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>650&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2007<br>n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>689&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2008<br>n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>741&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2009<br>n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>661&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2010<br>n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>637&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">X</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span> de tend&#234;ncia<br>&#40;p&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">M&#227;e branca&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">M&#227;e<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>20 anos de idade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;867&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">M&#227;e<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>8 anos de escolaridade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dona de casa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Primeira gesta&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;465&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gesta&#231;&#227;o m&#250;ltipla&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;634&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cesariana&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;555&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Idade gestacional 37&#8208;41 semanas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">87&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">87&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">87&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">87&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">87&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;206&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Idade gestacional &#8805; 42 semanas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;033&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Peso ao nascer &#8805; 4000<span class="elsevierStyleHsp" style=""></span>g&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;443&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;474&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#211;bito em hospital&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">98&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">98&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">99&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">97&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">97&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">99&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;493&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#211;bito na 1&#170; hora ap&#243;s o nascimento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;506&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#211;bito nas primeiras 24 horas ap&#243;s o nascimento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">71&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">74&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">71&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">72&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;404&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#211;bito em hospital p&#250;blico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">79&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">71&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">72&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#211;bito em uma capital de estado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;075&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">M&#227;e que mora no interior&#44; por&#233;m o &#243;bito ocorreu na capital&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;786&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#211;bito na cidade de resid&#234;ncia materna&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1580218.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Dados ausentes&#58; &#37; dos 4&#46;076 &#243;bitos sem informa&#231;&#245;es&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas dos 4&#46;076 &#243;bitos neonatais precoces associados a s&#237;ndrome de aspira&#231;&#227;o de mec&#244;nio em neonatos com peso ao nascer &#8805; 2&#46;500 g sem malforma&#231;&#245;es&#44; de acordo com o ano de &#243;bito</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Refer&#234;ncias"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:30 [
            0 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Global&#44; regional&#44; and national causes of child mortality in 2000&#8211;13&#44; with projections to inform post&#8208;2015 priorities&#58; an updated systematic analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Liu"
                            1 => "S&#46; Oza"
                            2 => "D&#46; Hogan"
                            3 => "J&#46; Perin"
                            4 => "I&#46; Rudan"
                            5 => "J&#46;E&#46; Lawn"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(14)61698-6"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25280870"
                            "web" => "Medline"
                          ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Setting research priorities to reduce almost one million deaths from birth asphyxia by 2015"
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;E&#46; Lawn"
                            1 => "R&#46; Bahl"
                            2 => "S&#46; Bergstrom"
                            3 => "Z&#46;A&#46; Bhutta"
                            4 => "G&#46;L&#46; Darmstadt"
                            5 => "M&#46; Ellis"
                          ]
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                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "PLoS Med"
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                        "paginaInicial" => "e1&#46;000389"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "3"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Global&#44; regional&#44; and national levels of neonatal&#44; infant&#44; and under&#8208;5 mortality during 1990&#8211;2013&#58; a systematic analysis for the Global Burden of Disease Study 2013"
                      "autores" => array:1 [
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                          "autores" => array:6 [
                            0 => "H&#46; Wang"
                            1 => "C&#46;A&#46; Liddell"
                            2 => "M&#46;M&#46; Coates"
                            3 => "M&#46;D&#46; Mooney"
                            4 => "C&#46;E&#46; Levitz"
                            5 => "A&#46;E&#46; Schumacher"
                          ]
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(14)60497-9"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2014"
                        "volumen" => "384"
                        "paginaInicial" => "957"
                        "paginaFinal" => "979"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24797572"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "4"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Every newborn&#58; progress&#44; priorities&#44; and potential beyond survival"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;E&#46; Lawn"
                            1 => "H&#46; Blencowe"
                            2 => "S&#46; Oza"
                            3 => "D&#46; You"
                            4 => "A&#46;C&#46; Lee"
                            5 => "P&#46; Waiswa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(14)60496-7"
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                        "paginaInicial" => "189"
                        "paginaFinal" => "205"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24853593"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Two million intrapartum&#8208;related stillbirths and neonatal deaths&#58; where&#44; why&#44; and what can be done&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;E&#46; Lawn"
                            1 => "A&#46;C&#46; Lee"
                            2 => "M&#46; Kinney"
                            3 => "L&#46; Sibley"
                            4 => "W&#46;A&#46; Carlo"
                            5 => "V&#46;K&#46; Paul"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijgo.2009.07.016"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Gynaecol Obstet"
                        "fecha" => "2009"
                        "volumen" => "107"
                        "paginaInicial" => "S5"
                        "paginaFinal" => "S19"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19815202"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Global burden&#44; epidemiologic trends&#44; and prevention of intrapartum&#8208;related deaths in low&#8208;resource settings"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46; Ariff"
                            1 => "A&#46;C&#46; Lee"
                            2 => "J&#46; Lawn"
                            3 => "Z&#46;A&#46; Bhutta"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.clp.2016.05.001"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Perinatol"
                        "fecha" => "2016"
                        "volumen" => "43"
                        "paginaInicial" => "593"
                        "paginaFinal" => "608"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27524456"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "4 million neonatal deaths&#58; when&#63; where&#63; why&#63;"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Lancet Neonatal Survival Steering Team"
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;E&#46; Lawn"
                            1 => "S&#46; Cousens"
                            2 => "J&#46; Zupan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(05)71048-5"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2005"
                        "volumen" => "365"
                        "paginaInicial" => "891"
                        "paginaFinal" => "900"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15752534"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "8"
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                0 => array:3 [
                  "comentario" => "&#91;cited 1 Jul 2016&#93;&#46; Available from&#58; <span class="elsevierStyleInterRef" id="intr0010" href="http://www.worldbank.org/en/country/brazil">http&#58;&#47;&#47;www&#46;worldbank&#46;org&#47;en&#47;country&#47;brazil</span>"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Brazil&#58; overview"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "The World Bank"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:1 [
                        "fecha" => "2015"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "&#91;cited 1 Jul 2016&#93;&#46; Available from&#58; <span class="elsevierStyleInterRef" id="intr0015" href="http://mdgs.un.org/unsd/mdg/Resources/Static/Products/Progress2015/Snapshots/BRA.pdf">http&#58;&#47;&#47;mdgs&#46;un&#46;org&#47;unsd&#47;mdg&#47;Resources&#47;Static&#47;Products&#47;Progress2015&#47;Snapshots&#47;BRA&#46;pdf</span>"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "MDG country progress snapshot&#58; Brazil"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Millennium Development Goals Indicators"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:1 [
                        "fecha" => "2015"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0200"
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                  "referenciaCompleta" => "Brasil&#46; Minist&#233;rio da Sa&#250;de&#46; Portal da Sa&#250;de Datasus&#58; estat&#237;sticas vitais&#46; &#91;cited 1 Jul 2016&#93;&#46; Available from&#58; <a href="http://www2.datasus.gov.br/DATASUS/index.php?area=0205">http&#58;&#47;&#47;www2&#46;datasus&#46;gov&#46;br&#47;DATASUS&#47;index&#46;php&#63;area&#61;0205</a>"
                ]
              ]
            ]
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              "identificador" => "bib0205"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "International comparisons of infant mortality and related factors&#58; United States and Europe&#44; 2010"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46;F&#46; MacDorman"
                            1 => "T&#46;J&#46; Matthews"
                            2 => "A&#46;D&#46; Mohangoo"
                            3 => "J&#46; Zeitlin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Natl Vital Stat Rep"
                        "fecha" => "2014"
                        "volumen" => "63"
                        "paginaInicial" => "1"
                        "paginaFinal" => "6"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26759855"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "12"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Infant mortality statistics from the 2010 period linked birth&#47;infant death data set"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "T&#46;J&#46; Matthews"
                            1 => "M&#46;F&#46; MacDorman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Natl Vital Stat Rep"
                        "fecha" => "2013"
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                        "paginaInicial" => "1"
                        "paginaFinal" => "26"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24979975"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0215"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "International statistical classification of diseases and related health problems"
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                        0 => array:2 [
                          "etal" => false
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                            0 => "World Health Organization &#40;WHO&#41;"
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                      "Libro" => array:4 [
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                        "editorialLocalizacion" => "Geneve"
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                    ]
                  ]
                ]
              ]
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            13 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Maternal and child health in Brazil&#58; progress and challenges"
                      "autores" => array:1 [
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                          "etal" => false
                          "autores" => array:6 [
                            0 => "C&#46;G&#46; Victora"
                            1 => "E&#46;M&#46; Aquino"
                            2 => "M&#46; do Carmo Leal"
                            3 => "C&#46;A&#46; Monteiro"
                            4 => "F&#46;C&#46; Barros"
                            5 => "C&#46;L&#46; Szwarcwald"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(11)60138-4"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2011"
                        "volumen" => "377"
                        "paginaInicial" => "1863"
                        "paginaFinal" => "1876"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21561656"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Health conditions and health&#8208;policy innovations in Brazil&#58; the way forward"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46;G&#46; Victora"
                            1 => "M&#46;L&#46; Barreto"
                            2 => "M&#46; do Carmo Leal"
                            3 => "C&#46;A&#46; Monteiro"
                            4 => "M&#46;I&#46; Schmidt"
                            5 => "J&#46; Paim"
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                      ]
                    ]
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                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(11)60055-X"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2011"
                        "volumen" => "377"
                        "paginaInicial" => "2042"
                        "paginaFinal" => "2053"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21561659"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0230"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evolution of socioeconomic inequalities in infant and child mortality in Brazil&#44; 1993&#8211;20"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "L&#46;P&#46; Garcia"
                            1 => "L&#46;R&#46; Santana"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Cien Saude Colet"
                        "fecha" => "2011"
                        "volumen" => "16"
                        "paginaInicial" => "3717"
                        "paginaFinal" => "3728"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21987316"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Every Newborn&#58; health&#8208;systems bottlenecks and strategies to accelerate scale&#8208;up in countries"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46;E&#46; Dickson"
                            1 => "A&#46; Simen-Kapeu"
                            2 => "M&#46;V&#46; Kinney"
                            3 => "L&#46; Huicho"
                            4 => "L&#46; Vesel"
                            5 => "E&#46; Lackritz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
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                        "tituloSerie" => "Lancet"
                        "fecha" => "2014"
                        "volumen" => "384"
                        "paginaInicial" => "438"
                        "paginaFinal" => "454"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24853600"
                            "web" => "Medline"
                          ]
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                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0240"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of a nationwide training program for neonatal resuscitation in China"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            2 => "H&#46;M&#46; Ye"
                            3 => "R&#46;J&#46; Yu"
                            4 => "X&#46;H&#46; Huang"
                            5 => "D&#46;H&#46; Wang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Chin Med J &#40;Engl&#41;"
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                        "volumen" => "125"
                        "paginaInicial" => "1448"
                        "paginaFinal" => "1456"
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0245"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "From the Neonatal Resuscitation Program to Helping Babies Breathe&#58; global impact of educational programs in neonatal resuscitation"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
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                    0 => array:2 [
                      "doi" => "10.1016/j.siny.2015.06.005"
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                        "tituloSerie" => "Semin Fetal Neonatal Med"
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                        "paginaInicial" => "300"
                        "paginaFinal" => "308"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26265602"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0250"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Part 11&#58; Neonatal resuscitation&#58; 2010 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;M&#46; Perlman"
                            1 => "J&#46; Wyllie"
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                            3 => "D&#46;L&#46; Atkins"
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                        "tituloSerie" => "Circulation"
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                        "paginaInicial" => "S516"
                        "paginaFinal" => "S538"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20956259"
                            "web" => "Medline"
                          ]
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                    0 => array:2 [
                      "titulo" => "Neonatal resuscitation&#58; in pursuit of evidence gaps in knowledge"
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                        0 => array:3 [
                          "colaboracion" => "Nalini Singhal for the Neonatal ILCOR Task Force Group"
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                          "autores" => array:5 [
                            0 => "J&#46; Perlman"
                            1 => "J&#46; Kattwinkel"
                            2 => "J&#46; Wyllie"
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                            4 => "S&#46; Velaphi"
                          ]
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                        "paginaInicial" => "545"
                        "paginaFinal" => "550"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22245921"
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              "etiqueta" => "22"
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                0 => array:1 [
                  "referenciaCompleta" => "Sociedade Brasileira de Pediatria&#46; Programa de Reanima&#231;&#227;o Neonatal&#46; &#91;cited 1 Jul 2016&#93;&#46; Available from&#58; <a href="http://www.sbp.com.br/reanimacao">http&#58;&#47;&#47;www&#46;sbp&#46;com&#46;br&#47;reanimacao</a>"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Delivery room risk factors for meconium aspiration syndrome"
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                          "etal" => false
                          "autores" => array:2 [
                            0 => "W&#46;F&#46; Liu"
                            1 => "T&#46; Harrington"
                          ]
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                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1055/s-2002-35611"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Perinatol"
                        "fecha" => "2002"
                        "volumen" => "19"
                        "paginaInicial" => "367"
                        "paginaFinal" => "378"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12442226"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0270"
              "etiqueta" => "24"
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                    0 => array:2 [
                      "titulo" => "The epidemiology of meconium aspiration syndrome&#58; incidence&#44; risk factors&#44; therapies&#44; and outcome"
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                        0 => array:3 [
                          "colaboracion" => "Australian and New Zealand Neonatal Network"
                          "etal" => false
                          "autores" => array:2 [
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                            1 => "B&#46; Copnell"
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                        ]
                      ]
                    ]
                  ]
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                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2006"
                        "volumen" => "117"
                        "paginaInicial" => "1712"
                        "paginaFinal" => "1721"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16651329"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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                      "titulo" => "A population&#8208;based study of meconium aspiration syndrome in neonates born between 37 and 43 weeks of gestation"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
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                            1 => "C&#46; Rybakowski"
                            2 => "C&#46; Ferdynus"
                            3 => "P&#46; Sagot"
                            4 => "J&#46;B&#46; Gouyon"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1155/2012/321545"
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Pediatr"
                        "fecha" => "2012"
                        "volumen" => "2012"
                        "paginaInicial" => "321545"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22187569"
                            "web" => "Medline"
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                  ]
                ]
              ]
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              "etiqueta" => "26"
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                      "titulo" => "Birth in Brazil survey&#58; neonatal mortality&#44; pregnancy and childbirth quality of care"
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                          "autores" => array:6 [
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                            1 => "A&#46;A&#46; Lima Friche"
                            2 => "A&#46;A&#46; Silva"
                            3 => "D&#46; Campos"
                            4 => "S&#46;D&#46; Azevedo Bittencourt"
                            5 => "M&#46;L&#46; Carvalho"
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                      ]
                    ]
                  ]
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                        "tituloSerie" => "Cad Saude Publ"
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                        "volumen" => "30"
                        "paginaInicial" => "S1"
                        "paginaFinal" => "S15"
                      ]
                    ]
                  ]
                ]
              ]
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                0 => array:2 [
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                            3 => "R&#46; Goldenberg"
                            4 => "S&#46; Niermeyer"
                            5 => "G&#46;L&#46; Darmstadt"
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                    0 => array:2 [
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                        "tituloSerie" => "Semin Perinatol"
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                        "paginaInicial" => "395"
                        "paginaFinal" => "407"
                        "link" => array:1 [
                          0 => array:2 [
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                            "web" => "Medline"
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              ]
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                      "titulo" => "Impact of health research on advances in knowledge&#44; research capacity&#8208;building and evidence&#8208;informed policies&#58; a case study on maternal mortality and morbidity in Brazil"
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                      "titulo" => "Advancing the newborn and stillbirth global agenda&#58; priorities for the next decade"
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