Estatísticas

 array:24 [
  "pii" => "S2255553619300709"
  "issn" => "22555536"
  "doi" => "10.1016/j.jpedp.2018.10.007"
  "estado" => "S300"
  "fechaPublicacion" => "2020-03-01"
  "aid" => "737"
  "copyrightAnyo" => "2019"
  "documento" => "article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "fla"
  "cita" => "J Pediatr (Rio J). 2020;96:177-83"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 330
    "formatos" => array:3 [
      "EPUB" => 59
      "HTML" => 170
      "PDF" => 101
    ]
  ]
  "Traduccion" => array:1 [
    "en" => array:19 [
      "pii" => "S0021755718308192"
      "issn" => "00217557"
      "doi" => "10.1016/j.jped.2018.10.004"
      "estado" => "S300"
      "fechaPublicacion" => "2020-03-01"
      "aid" => "737"
      "documento" => "article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "fla"
      "cita" => "J Pediatr (Rio J). 2020;96:177-83"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 466
        "formatos" => array:3 [
          "EPUB" => 62
          "HTML" => 236
          "PDF" => 168
        ]
      ]
      "en" => array:12 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
        "titulo" => "Clinical outcomes after more conservative management of patent ductus arteriosus in preterm infants"
        "tienePdf" => "en"
        "tieneTextoCompleto" => "en"
        "tieneResumen" => array:2 [
          0 => "en"
          1 => "pt"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "177"
            "paginaFinal" => "183"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "pt" => array:1 [
            "titulo" => "Desfechos cl&#237;nicos ap&#243;s tratamento mais conservador da persist&#234;ncia do canal arterial em prematuros"
          ]
        ]
        "contieneResumen" => array:2 [
          "en" => true
          "pt" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "en" => true
        ]
        "contienePdf" => array:1 [
          "en" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Cristina Borr&#224;s-Novell, Ana Riverola, Victoria Aldecoa-Bilbao, Montserrat Izquierdo, Monica Domingo"
            "autores" => array:5 [
              0 => array:2 [
                "nombre" => "Cristina"
                "apellidos" => "Borr&#224;s-Novell"
              ]
              1 => array:2 [
                "nombre" => "Ana"
                "apellidos" => "Riverola"
              ]
              2 => array:2 [
                "nombre" => "Victoria"
                "apellidos" => "Aldecoa-Bilbao"
              ]
              3 => array:2 [
                "nombre" => "Montserrat"
                "apellidos" => "Izquierdo"
              ]
              4 => array:2 [
                "nombre" => "Monica"
                "apellidos" => "Domingo"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "en"
      "Traduccion" => array:1 [
        "pt" => array:9 [
          "pii" => "S2255553619300709"
          "doi" => "10.1016/j.jpedp.2018.10.007"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "pt"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2255553619300709?idApp=UINPBA000049"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0021755718308192?idApp=UINPBA000049"
      "url" => "/00217557/0000009600000002/v1_202003290632/S0021755718308192/v1_202003290632/en/main.assets"
    ]
  ]
  "itemSiguiente" => array:20 [
    "pii" => "S225555361830209X"
    "issn" => "22555536"
    "doi" => "10.1016/j.jpedp.2018.11.018"
    "estado" => "S300"
    "fechaPublicacion" => "2020-03-01"
    "aid" => "729"
    "copyright" => "Sociedade Brasileira de Pediatria"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "J Pediatr &#40;Rio J&#41;. 2020;96:184-92"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 505
      "formatos" => array:3 [
        "EPUB" => 58
        "HTML" => 295
        "PDF" => 152
      ]
    ]
    "pt" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Artigo Original</span>"
      "titulo" => "Coverage and educational actions related to the national vitamin A supplementation program&#58; a study in children from the state of Alagoas"
      "tienePdf" => "pt"
      "tieneTextoCompleto" => "pt"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "184"
          "paginaFinal" => "192"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Cobertura e a&#231;&#245;es educativas no &#226;mbito do programa nacional de suplementa&#231;&#227;o de vitamina A&#58; estudo em crian&#231;as do estado de Alagoas"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "pt" => true
      ]
      "contienePdf" => array:1 [
        "pt" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figura 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1266
              "Ancho" => 2207
              "Tamanyo" => 254642
            ]
          ]
          "descripcion" => array:1 [
            "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Cobertura do Programa Nacional de Suplementa&#231;&#227;o de Vitamina A no estado de Alagoas&#44; em 2014&#44; segundo dados do Minist&#233;rio da Sa&#250;de e de um inqu&#233;rito domiciliar envolvendo crian&#231;as de seis a 59 meses&#46;</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Fonte</span>&#58; Minist&#233;rio da Sa&#250;de &#40;Brasil&#44; 2014&#41;&#59; Inqu&#233;rito domiciliar&#46;</p> <p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Os resultados obtidos por meio do inqu&#233;rito domiciliar no estado de Alagoas referente &#224; faixa de 12 a 59 meses foram obtidos de forma diferente aos divulgados pelo Minist&#233;rio da Sa&#250;de&#46; Esse considerou a cobertura em rela&#231;&#227;o &#224; aplica&#231;&#227;o de uma 1<span class="elsevierStyleSup">a</span> e uma 2<span class="elsevierStyleSup">a</span> dose da suplementa&#231;&#227;o de vitamina A&#46; J&#225; no inqu&#233;rito domiciliar a cobertura foi definida segundo o registro de suplementa&#231;&#227;o na caderneta de sa&#250;de com data de at&#233; seis meses antes da entrevista&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Riquelane B&#46;M&#46; Lima, Haroldo S&#46; Ferreira, Andressa L&#46; Cavalcante, La&#237;se Gabrielly M&#46;L&#46; Santos, Regina Coeli S&#46; Vieira, Monica L&#46; Assun&#231;&#227;o"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "Riquelane B&#46;M&#46;"
              "apellidos" => "Lima"
            ]
            1 => array:2 [
              "nombre" => "Haroldo S&#46;"
              "apellidos" => "Ferreira"
            ]
            2 => array:2 [
              "nombre" => "Andressa L&#46;"
              "apellidos" => "Cavalcante"
            ]
            3 => array:2 [
              "nombre" => "La&#237;se Gabrielly M&#46;L&#46;"
              "apellidos" => "Santos"
            ]
            4 => array:2 [
              "nombre" => "Regina Coeli S&#46;"
              "apellidos" => "Vieira"
            ]
            5 => array:2 [
              "nombre" => "Monica L&#46;"
              "apellidos" => "Assun&#231;&#227;o"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "pt"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S0021755718305424"
        "doi" => "10.1016/j.jped.2018.08.006"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0021755718305424?idApp=UINPBA000049"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S225555361830209X?idApp=UINPBA000049"
    "url" => "/22555536/0000009600000002/v4_202005060625/S225555361830209X/v4_202005060625/pt/main.assets"
  ]
  "itemAnterior" => array:20 [
    "pii" => "S2255553619300151"
    "issn" => "22555536"
    "doi" => "10.1016/j.jpedp.2018.09.002"
    "estado" => "S300"
    "fechaPublicacion" => "2020-03-01"
    "aid" => "742"
    "copyright" => "Sociedade Brasileira de Pediatria"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "J Pediatr &#40;Rio J&#41;. 2020;96:168-76"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 506
      "formatos" => array:3 [
        "EPUB" => 75
        "HTML" => 287
        "PDF" => 144
      ]
    ]
    "pt" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Artigo Original</span>"
      "titulo" => "Blood pressure reference values for Brazilian adolescents&#58; data from the Study of Cardiovascular Risk in Adolescents &#40;ERICA Study&#41;"
      "tienePdf" => "pt"
      "tieneTextoCompleto" => "pt"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "168"
          "paginaFinal" => "176"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Valores de refer&#234;ncia para press&#227;o arterial em adolescentes brasileiros&#58; dados do Estudo dos Riscos Cardiovasculares em Adolescentes &#40;Estudo ERICA&#41;"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "pt" => true
      ]
      "contienePdf" => array:1 [
        "pt" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figura 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 3717
              "Ancho" => 1556
              "Tamanyo" => 406349
            ]
          ]
          "descripcion" => array:1 [
            "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Compara&#231;&#227;o dos percentis 95<span class="elsevierStyleHsp" style=""></span>da press&#227;o arterial sist&#243;lica e diast&#243;lica na mediana da estatura por idade em cinco estudos para adolescentes do sexo feminino &#40;A e B&#41; e do sexo masculino &#40;C e D&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Thiago Veiga Jardim, Bernard Rosner, Katia Vergetti Bloch, Maria Cristina Caetano Kuschnir, Moyses Szklo, Paulo C&#233;sar Veiga Jardim"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "Thiago"
              "apellidos" => "Veiga Jardim"
            ]
            1 => array:2 [
              "nombre" => "Bernard"
              "apellidos" => "Rosner"
            ]
            2 => array:2 [
              "nombre" => "Katia"
              "apellidos" => "Vergetti Bloch"
            ]
            3 => array:2 [
              "nombre" => "Maria Cristina Caetano"
              "apellidos" => "Kuschnir"
            ]
            4 => array:2 [
              "nombre" => "Moyses"
              "apellidos" => "Szklo"
            ]
            5 => array:2 [
              "nombre" => "Paulo C&#233;sar Veiga"
              "apellidos" => "Jardim"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "pt"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S0021755718305898"
        "doi" => "10.1016/j.jped.2018.09.003"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0021755718305898?idApp=UINPBA000049"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2255553619300151?idApp=UINPBA000049"
    "url" => "/22555536/0000009600000002/v4_202005060625/S2255553619300151/v4_202005060625/pt/main.assets"
  ]
  "pt" => array:19 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Artigo Original</span>"
    "titulo" => "Clinical outcomes after more conservative management of patent ductus arteriosus in preterm infants"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "177"
        "paginaFinal" => "183"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Cristina Borr&#224;s&#8208;Novell, Ana Riverola, Victoria Aldecoa&#8208;Bilbao, Montserrat Izquierdo, Monica Domingo, Mart&#237;n Iriondo"
        "autores" => array:6 [
          0 => array:4 [
            "nombre" => "Cristina"
            "apellidos" => "Borr&#224;s&#8208;Novell"
            "email" => array:1 [
              0 => "cborrasn@clinic.cat"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff1"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Ana"
            "apellidos" => "Riverola"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff1"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Victoria"
            "apellidos" => "Aldecoa&#8208;Bilbao"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff1"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Montserrat"
            "apellidos" => "Izquierdo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff1"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Monica"
            "apellidos" => "Domingo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Mart&#237;n"
            "apellidos" => "Iriondo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff1"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Universitat de Barcelona&#44; Hospital Cl&#237;nic&#44; Hospital Sant Joan de D&#233;u&#44; BCNatal &#8208; Centre de Medicina Maternofetal i Neonatologia de Barcelona&#44; Departament de Neonatologia&#44; Barcelona&#44; Espanha"
            "etiqueta" => "a"
            "identificador" => "aff1"
          ]
          1 => array:3 [
            "entidad" => "Universitat Aut&#242;noma de Barcelona&#44; Institut d&#8217;Investigaci&#243; i Innovaci&#243; Parc Taul&#237;&#44; Hospital Universitari Parc Taul&#237;&#44; Departament de Neonatologia&#44; Sabadell&#44; Espanha"
            "etiqueta" => "b"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Autor para correspond&#234;ncia&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "pt" => array:1 [
        "titulo" => "Desfechos cl&#237;nicos ap&#243;s tratamento mais conservador da persist&#234;ncia do canal arterial em prematuros"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introdu&#231;&#227;o</span><p id="par0010" class="elsevierStylePara elsevierViewall">O fechamento do canal arterial &#233; frequentemente atrasado em prematuros&#44; com uma incid&#234;ncia estimada de pat&#234;ncia do canal arterial em idades gestacionais abaixo de 30 semanas de at&#233; 60&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">1</span></a> A probabilidade de pat&#234;ncia &#233; inversamente proporcional &#224; idade gestacional do neonato&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">2</span></a> Embora a persist&#234;ncia do canal arterial &#40;PCA&#41; tenha sido historicamente associada ao aumento da morbidade e mortalidade em rec&#233;m&#8208;nascidos prematuros&#44;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">3</span></a> a rela&#231;&#227;o de causa e efeito entre essas condi&#231;&#245;es desfavor&#225;veis ainda n&#227;o est&#225; bem estabelecida&#46; A PCA pode ser apenas um intermedi&#225;rio entre as altera&#231;&#245;es hemodin&#226;micas que ocorrem nas primeiras semanas de vida do beb&#234; prematuro&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Nas &#250;ltimas d&#233;cadas&#44; muitos prematuros foram tratados profil&#225;tica ou ativamente com inibidores da ciclo&#8208;oxigenase ou com fechamento cir&#250;rgico&#46; Portanto&#44; a real import&#226;ncia da PCA e sua evolu&#231;&#227;o natural s&#227;o dif&#237;ceis de determinar&#46; O tratamento conservador da PCA tem se tornado cada vez mais comum em prematuros&#44;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">5</span></a> mas ainda h&#225; controv&#233;rsias em rela&#231;&#227;o &#224; avalia&#231;&#227;o e ao manejo da PCA&#44; o que resulta em substancial heterogeneidade na pr&#225;tica cl&#237;nica&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">6&#44;7</span></a> As principais raz&#245;es para essa abordagem s&#227;o o fato de que os tratamentos da PCA est&#227;o relacionados a efeitos colaterais e quase 30&#37; dos prematuros com peso ao nascer<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>1&#46;000 gramas alcan&#231;am o fechamento espont&#226;neo do canal na primeira semana de vida&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">2</span></a> Al&#233;m disso&#44; a melhoria em longo prazo associada ao tratamento da PCA ainda precisa ser comprovada&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">6</span></a> Ainda &#233; incerto se uma abordagem mais conservadora pode afetar prematuros em longo prazo e especialmente aqueles nascidos com 23 a 26 semanas de gesta&#231;&#227;o&#46; Levamos em conta esses fatos e em 2011 adotamos uma abordagem mais conservadora para a PCA&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Este estudo foi desenvolvido para avaliar as diferen&#231;as no tratamento recebido e nos desfechos da prematuridade devido a uma mudan&#231;a na pr&#225;tica antes e depois da ado&#231;&#227;o de um novo protocolo de tratamento da PCA e analisar seu impacto na mortalidade e nos principais desfechos&#44; especialmente em prematuros nascidos com menos de 26 semanas de gesta&#231;&#227;o&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Os objetivos do nosso estudo foram&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0030" class="elsevierStylePara elsevierViewall">Avaliar as diferen&#231;as no tratamento recebido devido a uma mudan&#231;a na pr&#225;tica como desfecho principal&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#46;</span><p id="par0035" class="elsevierStylePara elsevierViewall">Avaliar as diferen&#231;as nos principais desfechos devido a uma mudan&#231;a na pr&#225;tica como desfechos secund&#225;rios&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3&#46;</span><p id="par0040" class="elsevierStylePara elsevierViewall">Analisar o impacto de uma abordagem mais conservadora no tratamento da PCA no subgrupo mais imaturo de rec&#233;m&#8208;nascidos extremamente prematuros &#40;nascidos com menos de 27 semanas de gesta&#231;&#227;o&#41;&#46;</p></li></ul></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todo</span><p id="par0045" class="elsevierStylePara elsevierViewall">Revisamos os prontu&#225;rios m&#233;dicos de rec&#233;m&#8208;nascidos prematuros com &#8804; 30 semanas de gesta&#231;&#227;o ao nascimento&#44; diagnosticados com PCA&#46; Revisamos os pacientes internados nas unidades de terapia intensiva neonatal terci&#225;ria do Hospital Sant Joan de D&#233;u e do Parc Taul&#237; Hospital de janeiro de 2009 a dezembro de 2016&#46; Os dados maternos&#44; perinatais e neonatais foram coletados dos prontu&#225;rios m&#233;dicos&#46; Pacientes que morreram antes de tr&#234;s dias de vida&#44; aqueles com doen&#231;a card&#237;aca cong&#234;nita e pacientes oriundos de outras institui&#231;&#245;es foram exclu&#237;dos&#46; Foi obtida aprova&#231;&#227;o &#233;tica para coleta de dados&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">De acordo com a defini&#231;&#227;o da <span class="elsevierStyleItalic">Vermont Oxford Network</span> &#40;VON&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">8</span></a> a PCA foi definida na presen&#231;a de pelo menos um dos seguintes achados&#58; <span class="elsevierStyleItalic">shunt</span> da esquerda para a direita ou <span class="elsevierStyleItalic">shunt</span> no canal bidirecional no eco Doppler e&#47;ou sopro sist&#243;lico ou cont&#237;nuo&#59; e pelo menos dois dos seguintes achados&#58; prec&#243;rdio hiperdin&#226;mico&#44; sopro card&#237;aco&#44; aumento da amplitude de pulso&#44; congest&#227;o vascular pulmonar&#44; cardiomegalia ou ambos&#46; Os cardiologistas de ambos os centros fizeram um estudo Doppler colorido do fluxo do canal em duas dimens&#245;es no eixo paraesternal e proje&#231;&#245;es supraesternais em todos os pacientes&#46; Determinamos o di&#226;metro transcanal&#44; fluxo diast&#243;lico anter&#243;grado pulmonar&#44; raz&#227;o &#225;trio esquerdo&#58; Aorta&#44; fluxo diast&#243;lico retr&#243;grado a&#243;rtico e fluxo transcanal&#46; N&#227;o fizemos altera&#231;&#245;es na triagem para PCA entre os per&#237;odos&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">O principal resultado da sobrevida sem morbidade foi um desfecho composto definido pela aus&#234;ncia de qualquer um dos desfechos secund&#225;rios na alta hospitalar&#58; doen&#231;a pulmonar cr&#244;nica &#40;DPC&#41;&#44; definida como uso suplementar de oxig&#234;nio na idade p&#243;s&#8208;menstrual de 36 semanas&#59; grau de retinopatia da prematuridade &#40;ROP&#41; grave &#62;<span class="elsevierStyleHsp" style=""></span>2 ou maior&#44; de acordo com a classifica&#231;&#227;o internacional&#59;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">8</span></a> grau de enterocolite necrosante &#40;ECN&#41;<span class="elsevierStyleHsp" style=""></span>&#62; 2 de acordo com a classifica&#231;&#227;o de Bell<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">9</span></a> e grau de hemorragia peri&#8208;intraventricular &#40;HPIV&#41; grave<span class="elsevierStyleHsp" style=""></span>&#62; 2 de acordo com a classifica&#231;&#227;o de Papile&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">10</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Uma classifica&#231;&#227;o de estadiamento da PCA foi usada para decidir se os pacientes deveriam receber tratamento ou n&#227;o&#46; Essa classifica&#231;&#227;o&#44; que varia de leve a grave&#44; baseia&#8208;se predominantemente na gravidade e na repercuss&#227;o do <span class="elsevierStyleItalic">shunt</span> no canal nos sistemas cardiovascular&#44; respirat&#243;rio e gastrointestinal&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">11</span></a> O tratamento cl&#237;nico foi feito com ibuprofeno intravenoso na dose padr&#227;o e o tratamento cir&#250;rgico envolveu o fechamento cl&#225;ssico ou o uso de um clipe&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Estrat&#233;gias adicionais tamb&#233;m foram aplicadas para modular o fluxo no canal&#46; Ajustamos a ventila&#231;&#227;o n&#227;o invasiva a uma press&#227;o positiva mais alta no fim da expira&#231;&#227;o &#40;6&#8208;8<span class="elsevierStyleHsp" style=""></span>cm H<span class="elsevierStyleInf">2</span>O&#41;&#46; Fizemos um balan&#231;o de fluidos preciso &#40;135&#8208;150<span class="elsevierStyleHsp" style=""></span>mL&#47;kg&#47;dia&#41; para garantir uma ingest&#227;o de energia ideal &#40;pelo menos 120<span class="elsevierStyleHsp" style=""></span>kcal&#47;kg&#47;dia&#41;&#46; Evitamos a administra&#231;&#227;o de volume r&#225;pido em b&#243;lus&#46; Corrigimos a anemia para um hemat&#243;crito&#8208;alvo<span class="elsevierStyleHsp" style=""></span>&#62; 35&#37;&#46; Na presen&#231;a de qualquer sinal de insufici&#234;ncia card&#237;aca ou edema pulmonar na radiografia de t&#243;rax&#44; foi considerado o uso de diur&#233;ticos&#46; Em julho de 2011&#44; mudamos nosso protocolo para uma abordagem mais conservadora da PCA&#44; conforme descrito abaixo&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">No primeiro per&#237;odo&#44; ou P1 &#40;2009&#8208;2011&#41;&#58; o tratamento cl&#237;nico com ibuprofeno era administrado se o paciente tivesse uma PCA de acordo com a defini&#231;&#227;o de VON&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">8</span></a> O fechamento cir&#250;rgico era feito ap&#243;s o insucesso de dois ciclos de tratamento farmacol&#243;gico&#44; se o paciente ainda precisasse de suporte respirat&#243;rio &#40;invasivo ou n&#227;o invasivo&#41; e se a PCA medisse mais de 2<span class="elsevierStyleHsp" style=""></span>mm no ultrassom&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">No segundo per&#237;odo&#44; ou P2 &#40;2012&#8208;2016&#41;&#58; tratamento cl&#237;nico com ibuprofeno era administrado se o paciente apresentasse qualquer um dos seguintes sinais cl&#237;nicos de PCA&#58; dessatura&#231;&#227;o frequente &#40;&#62; 6 vezes&#47;dia&#41; n&#227;o relacionada a outra condi&#231;&#227;o&#44; necessidade de suporte respirat&#243;rio &#40;invasivo ou n&#227;o invasivo&#41;&#44; hipotens&#227;o sist&#234;mica &#40;press&#227;o arterial m&#233;dia inferior ao percentil 3 para a idade corrigida&#41;&#44; acidose metab&#243;lica &#40;pH &#60;<span class="elsevierStyleHsp" style=""></span>7&#44;10&#41; e hemorragia pulmonar &#40;evid&#234;ncia de secre&#231;&#227;o de l&#237;quido sanguinolento proveniente do trato respirat&#243;rio superior ou do tubo endotraqueal e novos infiltrados na radiografia de t&#243;rax&#41; e uma PCA de mais de 2<span class="elsevierStyleHsp" style=""></span>mm na ultrassonografia ap&#243;s a primeira semana de vida&#46; O fechamento cir&#250;rgico da PCA foi feito ap&#243;s o insucesso de dois ciclos de tratamento farmacol&#243;gico na presen&#231;a de PCA<span class="elsevierStyleHsp" style=""></span>&#62; 3<span class="elsevierStyleHsp" style=""></span>mm e comprometimento cardiopulmonar definido como duas tentativas malsucedidas de desmame do respirador ou necessidade continuada de suporte inotr&#243;pico atribu&#237;da &#224; presen&#231;a da PCA&#46; Al&#233;m disso&#44; o fechamento cir&#250;rgico foi adiado at&#233; a terceira ou quarta semana de vida&#44; sempre que poss&#237;vel&#46; N&#227;o usamos tratamento cl&#237;nico profil&#225;tico&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Em ambos os per&#237;odos&#44; registramos o tamanho da persist&#234;ncia do canal arterial no momento do diagn&#243;stico &#40;em mil&#237;metros&#44; com Doppler colorido&#41;&#44; idade p&#243;s&#8208;natal &#40;em dias&#41; no in&#237;cio do tratamento cl&#237;nico e tratamento cir&#250;rgico&#44; se feito&#46; Morte antes de 36 semanas de idade p&#243;s&#8208;menstrual e desfecho composto de sobrevida sem morbidade foram examinados&#46; A aus&#234;ncia de fluxo transcanal na ultrassonografia com Doppler foi considerada como marcador de fechamento&#46; A PCA na alta hospitalar foi considerada quando a presen&#231;a de um <span class="elsevierStyleItalic">shunt</span> da esquerda para a direita com di&#226;metro maior do que 1&#44;5<span class="elsevierStyleHsp" style=""></span>mm foi detectada na ultrassonografia com Doppler&#46; Esses pacientes foram acompanhados por cardiologistas pedi&#225;tricos e a data do fechamento definitivo foi registrada &#40;fechamento espont&#226;neo ou cir&#250;rgico&#41;&#46; Se o fechamento cir&#250;rgico fosse necess&#225;rio&#44; o tipo de dispositivo usado era registrado&#46; Finalmente&#44; uma an&#225;lise estratificada foi feita para analisar o impacto de uma abordagem mais conservadora nos neonatos mais prematuros &#40;23&#8208;26 semanas&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Os fatores de risco perinatais e neonatais para PCA e desfechos foram resumidos por meio de estat&#237;stica descritiva &#40;distribui&#231;&#227;o de frequ&#234;ncia para dados categ&#243;ricos e m&#233;dia e desvio&#8208;padr&#227;o ou mediana e intervalo interquartil para dados cont&#237;nuos&#41;&#46; A an&#225;lise univariada incluiu o teste do qui&#8208;quadrado e o teste exato de Fisher&#44; conforme apropriado&#44; para compara&#231;&#245;es categ&#243;ricas e o teste <span class="elsevierStyleItalic">t</span> de Student ou de Mann&#8208;Whitney para vari&#225;veis cont&#237;nuas&#46; Um modelo de regress&#227;o log&#237;stica ajustado foi usado para avaliar a mudan&#231;a no manejo da PCA na sobrevida sem morbidade&#46; Todos os testes de hip&#243;teses foram bilaterais e valores de p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 foram considerados estatisticamente significativos&#46; Todos os dados foram analisados com o software SPSS &#40;IBM Corporation&#44; Statistical Package for the Social Sciences&#44; vers&#227;o 20&#46;0&#44; EUA&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0090" class="elsevierStylePara elsevierViewall">A amostra do estudo incluiu 188 lactentes &#40;61&#37; do sexo masculino&#41; com m&#233;dia de idade gestacional &#40;&#177; DP&#41; de 27 &#40;&#177; 1&#44;8&#41; semanas e peso m&#233;dio ao nascer de 973 &#40;&#177; 272&#41; gramas&#59; desses&#44; 82 &#40;43&#44;6&#37;&#41; nasceram com &#8804; 26 semanas de gesta&#231;&#227;o&#46; Considerando toda a coorte&#44; 80&#37; receberam pelo menos uma dose de esteroides pr&#233;&#8208;natais&#44; 54&#37; necessitaram de intuba&#231;&#227;o na sala de parto&#44; 77&#37; receberam surfactante e 15&#37; foram diagnosticados com sepse precoce&#46; N&#227;o encontramos diferen&#231;as significativas na compara&#231;&#227;o dos dois per&#237;odos em rela&#231;&#227;o aos principais fatores de risco perinatais e cl&#237;nicos&#44; exceto pela necessidade de intuba&#231;&#227;o na sala de parto &#40;65&#44;1&#37; no P1 <span class="elsevierStyleItalic">versus</span> 48&#37; no P2&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;027&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">N&#227;o houve diferen&#231;as no tamanho do canal ao diagn&#243;stico quando os dois per&#237;odos foram comparados&#46; No P2&#44; menos pacientes receberam ibuprofeno &#40;n&#250;mero necess&#225;rio para causar dano<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3 &#91;IC95&#37;&#58; 2&#44;5&#8208;6&#44;2&#93;&#41; e foram tratados tardiamente &#40;6&#176; dia&#41; e menos pacientes tiveram fechamento cir&#250;rgico &#40;n&#250;mero necess&#225;rio para causar dano<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5 &#91;IC95&#37;&#58; 3&#44;1&#8208;20&#44;3&#93;&#41;&#46; Os pacientes tratados no P2 eram mais imaturos &#40;26&#44;6<span class="elsevierStyleHsp" style=""></span>&#177; 1&#44;5 semanas <span class="elsevierStyleItalic">vs</span>&#46; 27&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;9 semanas&#44; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; e apresentavam taxas mais altas de DPC &#40;23&#44;3&#37; <span class="elsevierStyleItalic">vs</span>&#46; 6&#44;4&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;017&#41; e ROP grave &#40;19&#37; <span class="elsevierStyleItalic">vs</span>&#46; 2&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;007&#41;&#44; mas esses resultados n&#227;o foram significativos ao serem ajustados para a idade gestacional&#46; Uma diminui&#231;&#227;o no tratamento cl&#237;nico &#40;77&#37; em 2011 <span class="elsevierStyleItalic">versus</span> 40&#37; em 2015&#41; e cir&#250;rgico &#40;18&#37; em 2011 <span class="elsevierStyleItalic">versus</span> 10&#37; em 2015&#41; foi observada ao longo do tempo&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">No P2&#44; os pacientes tiveram mais dias de PCA e 26 pacientes &#40;24&#44;5&#37;&#41; receberam alta hospitalar com canal patente &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46; Desses&#44; apenas dois pacientes nascidos antes de 26 semanas de gesta&#231;&#227;o necessitaram de fechamento transcateter do canal durante o acompanhamento &#40;um aos 4 anos e outro aos 10 meses&#41;&#46; O fechamento da PCA ocorreu antes dos 12 meses de vida em 90&#37; dos pacientes que tiveram alta hospitalar com um canal patente&#44; com uma pat&#234;ncia mediana de 157 dias &#40;122&#8208;241&#41;&#46; Nenhum dos pacientes que receberam alta hospitalar com PCA desenvolveu hipertens&#227;o pulmonar durante o seguimento&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">N&#227;o foram encontradas diferen&#231;as significativas entre os per&#237;odos nos principais desfechos&#44; seja na necessidade e dura&#231;&#227;o do suporte respirat&#243;rio&#44; taxa de infec&#231;&#227;o nosocomial ou tempo de interna&#231;&#227;o &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46; N&#227;o foram encontradas diferen&#231;as nas taxas de mortalidade &#40;17&#44;5&#37; <span class="elsevierStyleItalic">versus</span> 15&#44;2&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;690&#41;&#46; Sobreviv&#234;ncia sem morbidade foi semelhante nos dois per&#237;odos quando ajustada para idade gestacional e necessidade de intuba&#231;&#227;o na sala de parto&#44; OR ajustado<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;10 &#40;IC95&#37;&#58; 0&#44;55&#8208;2&#44;22&#41;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;783&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Em uma an&#225;lise de subgrupo feita para avaliar o impacto de uma abordagem mais conservadora nos neonatos mais prematuros &#40;23&#8208;26 semanas <span class="elsevierStyleItalic">versus</span> 27&#8208;30 semanas&#41;&#44; observamos que os pacientes nascidos com 23 a 26 semanas de idade gestacional tamb&#233;m receberam menos tratamento cl&#237;nico &#40;88&#37; <span class="elsevierStyleItalic">versus</span> 66&#44;7&#37;&#44; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;045&#41; e tratamento cir&#250;rgico &#40;35&#37; <span class="elsevierStyleItalic">versus</span> 24&#44;5&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;375&#41;&#44; embora nenhum tenha sido estatisticamente significativo&#46; Foram encontradas diferen&#231;as na incid&#234;ncia de DPC &#40;50&#37; <span class="elsevierStyleItalic">vs</span>&#46; 19&#44;6&#37;&#41; e sobrevida sem morbidade &#40;20&#37; <span class="elsevierStyleItalic">vs</span>&#46; 45&#44;6&#37;&#41; embora n&#227;o tenham alcan&#231;ado signific&#226;ncia estat&#237;stica quando ajustadas pela ventila&#231;&#227;o mec&#226;nica<span class="elsevierStyleHsp" style=""></span>&#62; 24 horas&#44; com OR ajustado<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;24 &#40;IC95&#37;&#58; 0&#44;68&#8208;7&#44;35&#41;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;186 &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discuss&#227;o</span><p id="par0115" class="elsevierStylePara elsevierViewall">O manejo mais conservador da PCA em nossa popula&#231;&#227;o mostrou uma redu&#231;&#227;o de 30&#37; no tratamento cl&#237;nico e de 20&#37; no tratamento cir&#250;rgico&#44; sem altera&#231;&#245;es na mortalidade ou na sobrevida sem morbidade&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">A evid&#234;ncia cient&#237;fica sobre o tratamento da PCA &#233; ampla e &#224;s vezes contradit&#243;ria&#59; ainda hoje essa condi&#231;&#227;o v&#234; diversas abordagens&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">12</span></a> Em prematuros com &#60;<span class="elsevierStyleHsp" style=""></span>32 semanas de idade gestacional&#44; taxas mais baixas de tratamento cl&#237;nico &#40;cerca de 20&#37;&#41; e fechamento cir&#250;rgico &#40;&#60; 10&#37;&#41; foram relatadas anteriormente&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">11&#44;13&#8211;15</span></a> Chock et al&#46; descreveram taxas semelhantes &#224;s nossas&#59; no per&#237;odo 1&#44; 18&#37; dos lactentes tinham tratamento conservador <span class="elsevierStyleItalic">versus</span> 39&#37; no per&#237;odo 2 &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">16</span></a> Em contrapartida&#44; Bixler et al&#46; encontraram taxas mais baixas de tratamento cl&#237;nico&#58; entre 20 e 38&#37; de uso de indometacina ou ibuprofeno para tratamento de PCA em lactentes com &#60;<span class="elsevierStyleHsp" style=""></span>28 semanas de gesta&#231;&#227;o em 2015 e 3 a 10&#37; de fechamento da PCA em lactentes com &#60;<span class="elsevierStyleHsp" style=""></span>28 semanas de gesta&#231;&#227;o em 2015&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">13</span></a> Assim&#44; a taxa de tratamento cl&#237;nico de 56&#37; e a taxa de ligadura cir&#250;rgica de 16&#37; ainda podem ser consideradas altas&#59; nossa popula&#231;&#227;o tem uma ampla faixa de idade gestacional&#44; com 43&#44;6&#37; dos beb&#234;s com &#60;<span class="elsevierStyleHsp" style=""></span>27 semanas de idade gestacional&#46; Talvez diferentes abordagens pessoais entre os neonatologistas de nossos centros tenham influenciado esses resultados&#59; algumas retic&#234;ncias&#44; especialmente durante os primeiros meses ap&#243;s a mudan&#231;a no protocolo&#44; podem ter ocorrido&#46; Infelizmente&#44; n&#227;o supervisionamos a ades&#227;o ao protocolo nem planejamos um per&#237;odo de <span class="elsevierStyleItalic">washout</span>&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Um achado relevante neste estudo que vale a pena ressaltar &#233; que a cirurgia foi evitada em um de cada cinco pacientes&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Um dos nossos objetivos foi tamb&#233;m explorar o tratamento nos pacientes mais imaturos &#40;23&#8208;27 semanas&#41;&#46; Apesar da mudan&#231;a em nosso protocolo para uma abordagem mais conservadora&#44; ainda tratamos dois ter&#231;os dos pacientes com inibidores da ciclo&#8208;oxigenase e 24&#44;5&#37; deles&#44; cirurgicamente&#46; Lee et al&#46; relataram uma taxa de fechamento cir&#250;rgico de 43&#37; em pacientes com peso ao nascer &#60;<span class="elsevierStyleHsp" style=""></span>750<span class="elsevierStyleHsp" style=""></span>g e de 24&#37; em pacientes com peso entre 715 e 1&#46;000<span class="elsevierStyleHsp" style=""></span>g&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">17</span></a> Weisz et al&#46; tamb&#233;m relataram uma taxa de 24&#37; de fechamento cir&#250;rgico de PCA em beb&#234;s extremamente prematuros&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">18</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Um atraso significativo na administra&#231;&#227;o da primeira dose de ibuprofeno foi observado&#44; de tr&#234;s dias de vida em P1 a seis dias em P2&#46; Em um estudo de coorte populacional de beb&#234;s nascidos antes de 27 semanas de gesta&#231;&#227;o do estudo Express &#40;<span class="elsevierStyleItalic">Extremely Preterm Infants in Sweden Study&#41;&#44;</span> os autores descobriram que um in&#237;cio tardio do tratamento cl&#237;nico estava associado a um menor risco de doen&#231;a pulmonar cr&#244;nica&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">19</span></a> N&#227;o detectamos um atraso significativo na cirurgia como outros autores&#44;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">12&#44;16</span></a> provavelmente porque o fechamento cir&#250;rgico j&#225; foi feito em torno da terceira ou quarta semana de vida no P1&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">A quest&#227;o do papel da PCA nos desfechos respirat&#243;rios&#44; neurol&#243;gicos e gastrointestinais tem sido amplamente discutida&#58;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">6&#44;18&#44;20&#44;21</span></a> um <span class="elsevierStyleItalic">shunt</span> hemodinamicamente significativo da esquerda para a direita pode resultar em maior fluxo sangu&#237;neo pulmonar e comprometimento da perfus&#227;o de &#243;rg&#227;os vitais&#46; Alguns autores levantam a hip&#243;tese de que os resultados adversos historicamente associados &#224; PCA podem tamb&#233;m estar ligados &#224; prematuridade em si ou a alguma outra condi&#231;&#227;o coexistente&#44; como infec&#231;&#227;o intrauterina ou inflama&#231;&#227;o&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">22</span></a> Benitz concluiu que n&#227;o h&#225; evid&#234;ncias claras de que o tratamento ativo seja ben&#233;fico para beb&#234;s prematuros&#44; porque ele n&#227;o melhora claramente a mortalidade ou morbidades&#44; como doen&#231;a pulmonar cr&#244;nica&#44; enterocolite necrosante&#44; hemorragia peri&#8208;intraventricular e retinopatia&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">23</span></a> Chock et al&#46; compararam rec&#233;m&#8208;nascidos de muito baixo peso ao nascer diagnosticados com PCA em dois per&#237;odos diferentes e n&#227;o encontraram aumento nos desfechos cl&#237;nicos adversos&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">16</span></a> Diferen&#231;as estatisticamente significantes entre P1 e P2 nos principais desfechos classicamente relacionados &#224; prematuridade n&#227;o foram demonstradas&#44; como podemos observar na <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Uma redu&#231;&#227;o n&#227;o significativa na incid&#234;ncia global de enterocolite necrosante grave de 15&#44;5&#37; para 6&#44;9&#37; foi encontrada&#46; Uma redu&#231;&#227;o significativa na incid&#234;ncia de enterocolite necrosante grave de 10&#44;8&#37; para 1&#44;6&#37; foi encontrada em pacientes entre 27 e 30 semanas de gesta&#231;&#227;o entre os per&#237;odos&#46; Em 2011&#44; leite de doadoras foi introduzido em nossos hospitais&#44; de modo que a redu&#231;&#227;o na NEC poderia se relacionar mais com esse fato do que diretamente com o tratamento da PCA&#46; Ainda assim&#44; um menor uso de inibidores da ciclooxigenase no P2 pode ter exercido um papel nesse caso&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">5&#44;20</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Classicamente&#44; acredita&#8208;se que o <span class="elsevierStyleItalic">shunt</span> do canal tenha uma influ&#234;ncia negativa no desenvolvimento pulmonar&#46; Mohamed et al&#46; n&#227;o encontraram diferen&#231;as na doen&#231;a pulmonar cr&#244;nica entre dois per&#237;odos de tratamento de PCA<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">24</span></a> e Slaughter et al&#46; n&#227;o identificaram altera&#231;&#245;es na mortalidade ou displasia broncopulmonar moderada a grave em prematuros com &#60;<span class="elsevierStyleHsp" style=""></span>29 semanas de gesta&#231;&#227;o ap&#243;s tratamento cl&#237;nico para PCA&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">25</span></a> Por outro lado&#44; Bixler et al&#46; observaram redu&#231;&#227;o progressiva em todas as principais morbidades&#44; com exce&#231;&#227;o da displasia broncopulmonar&#44; em uma grande popula&#231;&#227;o de lactentes com &#60;<span class="elsevierStyleHsp" style=""></span>30 semanas de gesta&#231;&#227;o de 2006 a 2015&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">11</span></a> No P2&#44; observou&#8208;se redu&#231;&#227;o na incid&#234;ncia de doen&#231;a pulmonar cr&#244;nica e sobrevida sem morbidade&#44; principalmente nos pacientes mais prematuros&#46; A melhoria pr&#233;&#8208;natal e p&#243;s&#8208;natal dos cuidados em rec&#233;m&#8208;nascidos prematuros nos &#250;ltimos anos&#44; inclusive menos intuba&#231;&#227;o na sala de parto e estrat&#233;gias ventilat&#243;rias protetoras&#44; provavelmente teve impacto sobre esses resultados&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Detectamos um aumento n&#227;o significativo&#44; mas preocupante&#44; de 5&#44;3&#37; para 11&#44;8&#37; na mortalidade no per&#237;odo conservador em pacientes entre 27 a 30 semanas de gesta&#231;&#227;o&#46; Revisando os prontu&#225;rios desses lactentes&#44; dois deles nascidos com 27 semanas de gesta&#231;&#227;o morreram na primeira semana de vida devido &#224; instabilidade respirat&#243;ria e hemodin&#226;mica no contexto de hemorragia peri&#8208;intraventricular bilateral grave&#46; Outros quatro pacientes morreram de causas relacionadas a infec&#231;&#245;es cong&#234;nitas ou nosocomiais&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Com o tratamento conservador da PCA&#44; os neonatologistas precisam enfrentar novos desafios&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">26</span></a> A PCA pode ser entendida como um tipo de condi&#231;&#227;o cr&#244;nica durante a interna&#231;&#227;o hospitalar&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">27</span></a> Foi demonstrado em nosso estudo que houve um aumento not&#225;vel na dura&#231;&#227;o da pat&#234;ncia do canal arterial&#46; Isso pode estar levando&#44; na pr&#225;tica cl&#237;nica&#44; a um tratamento respirat&#243;rio&#44; pol&#237;tica de fluidos&#44; alimenta&#231;&#227;o enteral&#44; crit&#233;rios de transfus&#227;o de sangue e subsequente monitoramento cl&#237;nico e ecocardiogr&#225;fico precisos&#46; Neste estudo&#44; um n&#250;mero not&#225;vel de pacientes recebeu alta hospitalar com PCA&#46; Uma quest&#227;o a considerar &#233; como a manuten&#231;&#227;o de um <span class="elsevierStyleItalic">shunt</span> prolongado da esquerda para a direita pode afetar a perfus&#227;o cerebral e o status de crescimento&#46; Mais estudos de acompanhamento s&#227;o necess&#225;rios para se verificar quais ser&#227;o os desfechos em longo prazo do desenvolvimento neurol&#243;gico desses beb&#234;s&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">28</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">Reconhecemos algumas limita&#231;&#245;es no presente estudo&#46; Como &#233; um estudo cl&#237;nico retrospectivo&#44; n&#227;o podemos testar a causalidade das rela&#231;&#245;es ou determinar se as mudan&#231;as na pr&#225;tica entre os per&#237;odos afetaram os resultados&#46; N&#227;o houve per&#237;odo de <span class="elsevierStyleItalic">washout</span> entre os per&#237;odos&#59; &#233; prov&#225;vel que nem todos os neonatologistas tenham feito a mudan&#231;a imediata e completa para uma abordagem conservadora&#46; At&#233; mesmo comparamos o tamanho da PCA entre os grupos&#59; n&#227;o pareamos as coortes em termos da signific&#226;ncia hemodin&#226;mica da PCA&#44; o que poderia ter sido muito interessante&#46; O tamanho da amostra dos subgrupos mais imaturos pode ter limitado o poder de detectar diferen&#231;as estatisticamente significativas&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Em conclus&#227;o&#44; neste estudo mostramos que uma abordagem conservadora e mais tolerante em rec&#233;m&#8208;nascidos de muito baixo peso com PCA pode&#44; em alguns casos&#44; evitar tratamentos cl&#237;nicos e cir&#250;rgicos e seus potenciais efeitos colaterais&#44; sem altera&#231;&#245;es relevantes na mortalidade e na sobrevida sem morbidade&#46; Nos pacientes mais jovens&#44; as taxas de tratamentos cl&#237;nicos e cir&#250;rgicos para PCA ainda s&#227;o altas&#44; mas um maior n&#250;mero desses pacientes sobrevive e com menos morbidades associadas&#46; Um grupo significativo de pacientes recebeu alta hospitalar com um canal perme&#225;vel&#44; sem aparentes resultados indesej&#225;veis&#44; mas o acompanhamento em longo prazo ainda &#233; necess&#225;rio&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Esta pesquisa n&#227;o recebeu recurso financeiro espec&#237;fico de ag&#234;ncias de financiamento dos setores p&#250;blico&#44; comercial ou sem fins lucrativos&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflitos de interesse</span><p id="par0180" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflitos de interesse&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:10 [
        0 => array:3 [
          "identificador" => "xres1332985"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Objective"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Method"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusion"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1228092"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres1332984"
          "titulo" => "Resumo"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Objetivo"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "M&#233;todo"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclus&#227;o"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1228091"
          "titulo" => "Palavras&#8208;chave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introdu&#231;&#227;o"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "M&#233;todo"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Resultados"
        ]
        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Discuss&#227;o"
        ]
        8 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Conflitos de interesse"
        ]
        9 => array:1 [
          "titulo" => "Refer&#234;ncias"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2018-07-27"
    "fechaAceptado" => "2018-10-01"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1228092"
          "palabras" => array:6 [
            0 => "Patent ductus arteriosus"
            1 => "Ductal patency"
            2 => "Preterm infant"
            3 => "Ibuprofen"
            4 => "Surgical ligation"
            5 => "Surgical closure"
          ]
        ]
      ]
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras&#8208;chave"
          "identificador" => "xpalclavsec1228091"
          "palabras" => array:6 [
            0 => "Persist&#234;ncia do canal arterial"
            1 => "Pat&#234;ncia do canal"
            2 => "Prematuro"
            3 => "Ibuprofeno"
            4 => "Ligadura cir&#250;rgica"
            5 => "Fechamento cir&#250;rgico"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Management of patent ductus arteriosus is still controversial&#46; This study aimed to describe the impact of a more conservative approach on treatment rates and on main outcomes of prematurity&#44; especially in preterm infants with &#60;26 weeks of gestation&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Clinical charts review of infants &#8804;30 weeks with patent ductus arteriosus between 2009 and 2016 at two centers&#46; In 2011&#44; the authors changed patent ductus arteriosus management&#58; in first period &#40;2009&#8211;2011&#41;&#44; patients who failed medical treatment underwent surgical closure&#59; in second period &#40;2012&#8211;2016&#41;&#44; only those with cardiopulmonary compromise underwent surgical ligation&#46; Medical treatment&#44; surgical closure&#44; mortality&#44; and survival&#8208;without&#8208;morbidity were compared&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">This study included 188 patients &#40;27<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2 weeks&#44; 973<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>272 grams&#41;&#59; 63 in P1 and 125 in P2&#46; In P2&#44; significantly lower rates of medical treatment &#40;85&#46;7&#37; P1 <span class="elsevierStyleItalic">versus</span> 56&#37; P2&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and surgical closure &#40;34&#46;5&#37; P1 <span class="elsevierStyleItalic">versus</span> 16&#46;1&#37; P2&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; were observed&#46; No differences were found in chronic lung disease &#40;28&#46;8&#37; <span class="elsevierStyleItalic">versus</span> 13&#46;9&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;056&#41;&#44; severe retinopathy of prematurity &#40;7&#46;5&#37; <span class="elsevierStyleItalic">versus</span> 11&#46;8&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;403&#41;&#44; necrotizing enterocolitis &#40;15&#46;5&#37; <span class="elsevierStyleItalic">versus</span> 6&#46;9&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;071&#41;&#44; severe intraventricular hemorrhage &#40;25&#46;4&#37; <span class="elsevierStyleItalic">versus</span> 18&#46;4&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;264&#41;&#44; mortality &#40;17&#46;5&#37; <span class="elsevierStyleItalic">versus</span> 15&#46;2&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;690&#41; or survival&#8208;without&#8208;morbidity adjusted OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;10 &#40;95&#37; CI&#58; 0&#46;55&#8211;2&#46;22&#41;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;783&#46; In P2&#44; 24&#46;5&#37; patients were discharged with patent ductus arteriosus&#46; The subgroup born between 23 and 26 weeks &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>82&#41; showed significant differences&#58; lower incidence of chronic lung disease &#40;50&#37; <span class="elsevierStyleItalic">versus</span> 19&#46;6&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;019&#41; and more survival&#8208;without&#8208;morbidity &#40;20&#37; <span class="elsevierStyleItalic">versus</span> 45&#46;6&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;028&#41; were found&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A conservative approach in preterm infants with patent ductus arteriosus can avoid medical and surgical treatments&#44; without a significant impact in survival&#8208;without&#8208;morbidity&#46; However&#44; two&#8208;thirds of preterm infants under 26 weeks are still treated&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Method"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusion"
          ]
        ]
      ]
      "pt" => array:3 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">O tratamento da persist&#234;ncia do canal arterial ainda &#233; controverso&#46; Nosso objetivo foi descrever o impacto de uma abordagem mais conservadora em nossas taxas de tratamento e nos principais desfechos da prematuridade&#44; especialmente em prematuros com<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>26 semanas de gesta&#231;&#227;o&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Revis&#227;o de prontu&#225;rios de lactentes com<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>30 semanas e persist&#234;ncia do canal arterial entre 2009&#8208;2016 em dois centros&#46; Em 2011&#44; mudamos o manejo da persist&#234;ncia do canal arterial&#58; no primeiro per&#237;odo &#40;2009&#8208;2011&#41;&#44; os pacientes que n&#227;o apresentaram sucesso com o tratamento cl&#237;nico foram submetidos a fechamento cir&#250;rgico&#59; no segundo per&#237;odo &#40;2012&#8208;2016&#41;&#44; apenas aqueles com comprometimento cardiopulmonar foram submetidos ao fechamento cir&#250;rgico&#46; Comparamos o tratamento cl&#237;nico&#44; fechamento cir&#250;rgico&#44; mortalidade e sobrevida sem morbidade&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Foram inclu&#237;dos 188 pacientes &#40;27<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2 semanas&#44; 973<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>272 gramas&#41;&#59; 63 em P1 e 125 em P2&#46; Em P2&#44; foram observadas taxas significativamente mais baixas de tratamento cl&#237;nico &#40;85&#44;7&#37; no P1 <span class="elsevierStyleItalic">versus</span> 56&#37; no P2&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; e fechamento cir&#250;rgico &#40;34&#44;5&#37; no P1 <span class="elsevierStyleItalic">versus</span> 16&#44;1&#37; no P2&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; N&#227;o foram encontradas diferen&#231;as em rela&#231;&#227;o &#224; doen&#231;a pulmonar cr&#244;nica &#40;28&#44;8&#37; <span class="elsevierStyleItalic">versus</span> 13&#44;9&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;056&#41;&#44; retinopatia grave da prematuridade &#40;7&#44;5&#37; <span class="elsevierStyleItalic">versus</span> 11&#44;8&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;403&#41;&#44; enterocolite necrosante &#40;15&#44;5&#37; <span class="elsevierStyleItalic">versus</span> 6&#44;9&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;071&#41;&#44; hemorragia intraventricular grave &#40;25&#44;4&#37; <span class="elsevierStyleItalic">versus</span> 18&#44;4&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;264&#41;&#44; mortalidade &#40;17&#44;5&#37; <span class="elsevierStyleItalic">versus</span> 15&#44;2&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;690&#41; ou OR ajustado pela sobrevida sem morbidade<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;10 &#40;IC95&#37;&#58; 0&#44;55&#8208;2&#44;22&#41;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;783&#46; Em P2&#44; 24&#44;5&#37; dos pacientes receberam alta com persist&#234;ncia do canal arterial&#46; O subgrupo nascido entre 23 a 26 semanas &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>82&#41; apresentou diferen&#231;as significativas&#44; foram encontradas menor incid&#234;ncia de doen&#231;a pulmonar cr&#244;nica &#40;50&#37; <span class="elsevierStyleItalic">versus</span> 19&#44;6&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;019&#41; e maior sobrevida sem morbidade &#40;20&#37; <span class="elsevierStyleItalic">versus</span> 45&#44;6&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;028&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#227;o</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Uma abordagem conservadora em prematuros com persist&#234;ncia do canal arterial pode evitar tratamentos cl&#237;nicos e cir&#250;rgicos&#44; sem um impacto significativo na sobrevida sem morbidade&#46; No entanto&#44; dois ter&#231;os dos prematuros com menos de 26 semanas ainda s&#227;o tratados&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todo"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclus&#227;o"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0045">Como citar este artigo&#58; Borr&#224;s&#8208;Novell C&#44; Riverola A&#44; Aldecoa&#8208;Bilbao V&#44; Izquierdo M&#44; Domingo M&#44; Iriondo M&#46; Clinical outcomes after more conservative management of patent ductus arteriosus in preterm infants&#46; J Pediatr &#40;Rio J&#41;&#46; 2020&#59;96&#58;177&#8211;83&#46;</p>"
      ]
    ]
    "multimedia" => array:4 [
      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Tabela 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Tabela "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Valores s&#227;o n &#40;&#37;&#41; ou m&#233;dia &#40;desvio&#8208;padr&#227;o&#41;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Per&#237;odo 1 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Per&#237;odo 2 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>125&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&#8208;valor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Idade gestacional &#40;semanas&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#44;9 &#40;2&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#44;0 &#40;1&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;488&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Peso ao nascer &#40;gramas&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">962 &#40;272&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">979 &#40;273&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;684&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sexo masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40 &#40;63&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75 &#40;60&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;643&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides antenatais&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49 &#40;77&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">101 &#40;80&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;626&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intuba&#231;&#227;o na sala de parto&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41 &#40;65&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60 &#40;48&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;027&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Administra&#231;&#227;o de surfactante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50 &#40;79&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">94 &#40;75&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;524&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sepse precoce&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;19&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;12&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;256&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2284805.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas cl&#237;nicas dos pacientes e preval&#234;ncia dos principais fatores de risco perinatais e neonatais para PCA</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Tabela 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Tabela "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Valores s&#227;o n &#40;&#37;&#41;&#44; m&#233;dia &#40;desvio&#8208;padr&#227;o&#41; ou mediana &#91;p25&#8208;p75&#93;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Per&#237;odo 1 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Per&#237;odo 2 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>125&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&#8208;valor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tamanho do canal &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;6 &#40;0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;6 &#40;0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;629&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Administra&#231;&#227;o de Ibuprofeno&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54 &#40;85&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70 &#40;56&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tempo de tratamento cl&#237;nico<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#91;2&#8208;4&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#91;4&#8208;7&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fechamento cir&#250;rgico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;34&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;16&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tempo do fechamento cir&#250;rgico<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#44;5 &#91;17&#8208;30&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27 &#91;18&#8208;35&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;766&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dias de PCA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#91;6&#8208;23&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#91;12&#8208;61&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PCA na alta hospitalar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;24&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2284808.png"
              ]
            ]
          ]
          "notaPie" => array:2 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Dias de vida no momento em que o tratamento cl&#237;nico foi iniciado&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Dias de vida no momento em que o fechamento cir&#250;rgico foi feito&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Tratamento da PCA e dura&#231;&#227;o de sua administra&#231;&#227;o&#46; Dias de PCA e PCA na alta hospitalar</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Tabela 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Tabela "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Valores s&#227;o n &#40;&#37;&#41; ou m&#233;dia &#40;desvio&#8208;padr&#227;o&#41;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Per&#237;odo 1 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Per&#237;odo 2 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>125&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&#8208;valor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Doen&#231;a pulmonar cr&#244;nica<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;28&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;15&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;056&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Retinopatia grave da prematuridade<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;7&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;11&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;403&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Enterocolite necrosante<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;15&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;6&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;071&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hemorragia intraventricular grave<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;25&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;18&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;264&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Infec&#231;&#227;o nosocomial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;44&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51 &#40;41&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;739&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ventila&#231;&#227;o mec&#226;nica &#40;dias&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;238&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ventila&#231;&#227;o n&#227;o invasiva &#40;dias&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32 &#40;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38 &#40;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;248&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oxig&#234;nio &#40;dias&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54 &#40;54&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38 &#40;39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;051&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tempo de hospitaliza&#231;&#227;o &#40;dias&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89 &#40;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85 &#40;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;595&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mortalidade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;17&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;15&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;690&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sobreviv&#234;ncia sem morbidade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31 &#40;49&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71 &#40;56&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;324&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2284806.png"
              ]
            ]
          ]
          "notaPie" => array:4 [
            0 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Doen&#231;a pulmonar cr&#244;nica como uso suplementar de oxig&#234;nio com 36 semanas de idade p&#243;s&#8208;menstrual&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0020"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Retinopatia grave de grau 2<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&#44; 3 e 4 de acordo com a classifica&#231;&#227;o internacional&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0025"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Enterocolite necrosante grau 2 e 3 de acordo com a classifica&#231;&#227;o de Bell&#46;</p>"
            ]
            3 => array:3 [
              "identificador" => "tblfn0030"
              "etiqueta" => "d"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Hemorragia intraventricular grave grau 3 e 4 de acordo com a classifica&#231;&#227;o de Papile&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Principais desfechos em ambos os per&#237;odos</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Tabela 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at4"
            "detalle" => "Tabela "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Valores s&#227;o n &#40;&#37;&#41; ou m&#233;dia &#40;desvio&#8208;padr&#227;o&#41;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">23&#8208;26 semanas &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>82&#41;</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">27&#8208;30 semanas &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>106&#41;</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P1 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P2&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">p&#8208;valor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P1&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P2 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>68&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">p&#8208;valor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Administra&#231;&#227;o de Ibuprofeno&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;88&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38 &#40;66&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;045&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32 &#40;84&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32 &#40;47&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tempo de tratamento cl&#237;nico<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fechamento cir&#250;rgico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;24&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;375&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;34&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;9&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tempo do fechamento cir&#250;rgico<a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;871&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 &#40;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;445&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dias de PCA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84 &#40;221&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;199&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61 &#40;117&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;023&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PCA na alta hospitalar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;19&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;056&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;28&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Doen&#231;a pulmonar cr&#244;nica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;19&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;19&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;13&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;405&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Retinopatia grave da prematuridade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;18&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;20&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;858&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;2&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;4&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;602&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Enterocolite necrosante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;23&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;13&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;280&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;10&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;1&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;039&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hemorragia intraventricular grave&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;44&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;24&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;078&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;13&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;13&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;991&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mortalidade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;19&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;105&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;5&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;11&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;272&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sobreviv&#234;ncia sem morbidade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;45&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;028&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;68&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45 &#40;66&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;814&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2284807.png"
              ]
            ]
          ]
          "notaPie" => array:2 [
            0 => array:3 [
              "identificador" => "tblfn0035"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0035">Dias de vida no momento em que o tratamento cl&#237;nico foi iniciado&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0040"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0040">Dias de vida no momento em que o fechamento cir&#250;rgico foi feito&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Tratamento da PCA e principais desfechos em cada per&#237;odo de acordo com a idade gestacional</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Refer&#234;ncias"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:28 [
            0 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patent ductus arteriosus&#58; are current neonatal treatment options better or worse than no treatment at all&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46;I&#46; Clyman"
                            1 => "J&#46; Couto"
                            2 => "G&#46;M&#46; Murphy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1053/j.semperi.2011.09.022"
                      "Revista" => array:6 [
                        "tituloSerie" => "Semin Perinatol"
                        "fecha" => "2012"
                        "volumen" => "36"
                        "paginaInicial" => "123"
                        "paginaFinal" => "129"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22414883"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Spontaneous closure of patent ductus arteriosus in infants &#8804;1500<span class="elsevierStyleHsp" style=""></span>g"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Semberova"
                            1 => "J&#46; Sirc"
                            2 => "J&#46; Miletin"
                            3 => "J&#46; Kucera"
                            4 => "I&#46; Berka"
                            5 => "S&#46; Sebkova"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1542/peds.2017-0685"
                      "Revista" => array:4 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2017"
                        "volumen" => "140"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28924060"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "What is new for patent ductus arteriosus management in premature infants in 2015&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "K&#46;M&#46; Perez"
                            1 => "M&#46;M&#46; Laughon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MOP.0000000000000200"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Pediatr"
                        "fecha" => "2015"
                        "volumen" => "27"
                        "paginaInicial" => "158"
                        "paginaFinal" => "164"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25689456"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Reflections of the changes in patent ductus arteriosus management during the last 10 years"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; EL-Khuffash"
                            1 => "D&#46;E&#46; Weisz"
                            2 => "P&#46;J&#46; McNamara"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/archdischild-2014-306214"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Dis Child Fetal Neonatal Ed"
                        "fecha" => "2016"
                        "volumen" => "101"
                        "paginaInicial" => "F474"
                        "paginaFinal" => "F478"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27118761"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Association of placebo&#44; indomethacin&#44; ibuprofen&#44; and acetaminophen with closure of hemodynamically significant patent ductus arteriosus in preterm infants&#58; a systematic review and meta&#8208;analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Mitra"
                            1 => "I&#46;D&#46; Florez"
                            2 => "M&#46;E&#46; Tamayo"
                            3 => "L&#46; Mbuagbaw"
                            4 => "T&#46; Vanniyasingam"
                            5 => "A&#46;A&#46; Veroniki"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jama.2018.1896"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2018"
                        "volumen" => "319"
                        "paginaInicial" => "1221"
                        "paginaFinal" => "1238"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29584842"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Committee on Fetus and Newborn&#44; American Academy of Pediatrics&#46; Patent ductus arteriosus in preterm infants"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "W&#46;E&#46; Benitz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1542/peds.2015-3412"
                      "Revista" => array:4 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2016"
                        "volumen" => "137"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26940987"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Trends and variation in management and outcomes of very low&#8208;birth&#8208;weight infants with patent ductus arteriosus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;I&#46; Hagadorn"
                            1 => "E&#46;A&#46; Brownell"
                            2 => "J&#46;M&#46; Trzaski"
                            3 => "K&#46;R&#46; Johnson"
                            4 => "S&#46; Lainwala"
                            5 => "B&#46;T&#46; Campbell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/pr.2016.166"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Res"
                        "fecha" => "2016"
                        "volumen" => "80"
                        "paginaInicial" => "785"
                        "paginaFinal" => "792"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27509008"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Manual of operations&#58; Part 2&#46; Data definitions &#38; infant data forms&#46; Release 19&#46;0"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Vermont Oxford Network"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2014"
                        "editorial" => "Vermont Oxford Network"
                        "editorialLocalizacion" => "Burlington&#44; VA"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Neonatal necrotizing enterocolitis&#58; therapeutic decisions based upon clinical staging"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;J&#46; Bell"
                            1 => "J&#46;L&#46; Ternberg"
                            2 => "R&#46;D&#46; Feigin"
                            3 => "J&#46;P&#46; Keating"
                            4 => "R&#46; Marshall"
                            5 => "L&#46; Barton"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/00000658-197801000-00001"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Surg"
                        "fecha" => "1978"
                        "volumen" => "187"
                        "paginaInicial" => "1"
                        "paginaFinal" => "7"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/413500"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidence and evolution of the subependymal intraventricular hemorrhage&#58; a study of infants with weights &#60;1500 grams"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "L&#46;S&#46; Papile"
                            1 => "J&#46; Burstein"
                            2 => "R&#46; Burstein"
                            3 => "H&#46; Koffler"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s0022-3476(78)80282-0"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr"
                        "fecha" => "1978"
                        "volumen" => "92"
                        "paginaInicial" => "529"
                        "paginaFinal" => "534"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/305471"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Towards a rational management of patent ductus arteriosus&#58; the need for disease staging"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "P&#46;J&#46; McNamara"
                            1 => "A&#46; Sehgal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/adc.2007.118117"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Dis Child Fetal Neonatal Ed"
                        "fecha" => "2007"
                        "volumen" => "92"
                        "paginaInicial" => "F424"
                        "paginaFinal" => "F427"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17951547"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patent ductus arteriosus treatment in very preterm infants&#58; a European population&#8208;based cohort study &#40;EPICE&#41; on variation and outcomes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;K&#46; Edstedt Bonamy"
                            1 => "A&#46; Gudmundsdottir"
                            2 => "R&#46;F&#46; Maier"
                            3 => "L&#46; Toome"
                            4 => "J&#46; Zeitlin"
                            5 => "M&#46; Bonet"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000454798"
                      "Revista" => array:6 [
                        "tituloSerie" => "Neonatology"
                        "fecha" => "2017"
                        "volumen" => "111"
                        "paginaInicial" => "367"
                        "paginaFinal" => "375"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28125815"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Changes in the diagnosis and management of patent ductus arteriosus from 2006 to 2015 in United States neonatal intensive care units"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "G&#46;M&#46; Bixler"
                            1 => "G&#46;C&#46; Powers"
                            2 => "R&#46;H&#46; Clark"
                            3 => "M&#46;W&#46; Walker"
                            4 => "V&#46;N&#46; Tolia"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jpeds.2017.05.024"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr"
                        "fecha" => "2017"
                        "volumen" => "189"
                        "paginaInicial" => "105"
                        "paginaFinal" => "112"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28600155"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Trends in patent ductus arteriosus diagnosis and management for very low birth weight infants"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46; Ngo"
                            1 => "J&#46; Profit"
                            2 => "J&#46;B&#46; Gould"
                            3 => "H&#46;C&#46; Lee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2017"
                        "volumen" => "139"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Canadian Neonatal Network&#46; Trends and outcomes of patent ductus arteriosus treatment in very preterm infants in Canada"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46; Lokku"
                            1 => "L&#46; Mirea"
                            2 => "S&#46;K&#46; Lee"
                            3 => "P&#46;S&#46; Shah"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1055/s-0036-1593351"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Perinatol"
                        "fecha" => "2017"
                        "volumen" => "34"
                        "paginaInicial" => "441"
                        "paginaFinal" => "450"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27649293"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Changing management of the patent ductus arteriosus&#58; effect on neonatal outcomes and resource utilization"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "V&#46;Y&#46; Chock"
                            1 => "V&#46;V&#46; Goel"
                            2 => "J&#46;P&#46; Palma"
                            3 => "T&#46;M&#46; Luh"
                            4 => "N&#46;A&#46; Wang"
                            5 => "S&#46; Gaskari"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Perinatol"
                        "fecha" => "2017"
                        "volumen" => "34"
                        "paginaInicial" => "990"
                        "paginaFinal" => "995"
                        "itemHostRev" => array:3 [
                          "pii" => "S2530016418301319"
                          "estado" => "S300"
                          "issn" => "25300164"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hospital variation in medical and surgical treatment of patent ductus arteriosus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "H&#46; Lee"
                            1 => "D&#46; Durand"
                            2 => "B&#46; Danielsen"
                            3 => "G&#46; Villarin"
                            4 => "R&#46; Powers"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1055/s-0034-1387931"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Perinatol"
                        "fecha" => "2015"
                        "volumen" => "32"
                        "paginaInicial" => "379"
                        "paginaFinal" => "386"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25241108"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Association of patent ductus arteriosus ligation with death or neurodevelopmental impairment among extremely preterm infants"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46;E&#46; Weisz"
                            1 => "L&#46; Mirea"
                            2 => "E&#46; Rosenberg"
                            3 => "M&#46; Jang"
                            4 => "L&#46; Ly"
                            5 => "P&#46;T&#46; Church"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jamapediatrics.2016.5143"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA Pediatr"
                        "fecha" => "2017"
                        "volumen" => "171"
                        "paginaInicial" => "443"
                        "paginaFinal" => "449"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28264088"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Timing of pharmacological treatment for patent ductus arteriosus and risk of secondary surgery&#44; death or chronic lung disease&#58; a population&#8208;based cohort study of extremely preterm infants"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; Gudmundsdottir"
                            1 => "S&#46; Johansson"
                            2 => "S&#46; H&#229;kansson"
                            3 => "M&#46; Norman"
                            4 => "K&#46; K&#228;llen"
                            5 => "A&#46; Bonamy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000367887"
                      "Revista" => array:6 [
                        "tituloSerie" => "Neonatology"
                        "fecha" => "2015"
                        "volumen" => "107"
                        "paginaInicial" => "87"
                        "paginaFinal" => "92"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25412681"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The use of non&#8208;steroidal anti&#8208;inflammatory drugs for patent ductus arteriosus closure in preterm infants"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "W&#46;E&#46; Benitz"
                            1 => "S&#46; Bhomal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.siny.2017.07.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Semin Fetal Neonatal Med"
                        "fecha" => "2017"
                        "volumen" => "22"
                        "paginaInicial" => "302"
                        "paginaFinal" => "307"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28724506"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Non&#8208;pharmacological management of a hemodynamically significant patent ductus arteriosus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Smith"
                            1 => "P&#46;J&#46; McNamara"
                            2 => "A&#46;F&#46; El-Khuffash"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.siny.2018.03.008"
                      "Revista" => array:6 [
                        "tituloSerie" => "Semin Fetal Neonatal Med"
                        "fecha" => "2018"
                        "volumen" => "23"
                        "paginaInicial" => "245"
                        "paginaFinal" => "249"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29580939"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patent ductus arteriosus of the preterm infant"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46;E&#46; Hamrick"
                            1 => "G&#46; Hansmann"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1542/peds.2009-3506"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2010"
                        "volumen" => "125"
                        "paginaInicial" => "1020"
                        "paginaFinal" => "1030"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20421261"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treatment of persistent patent ductus arteriosus in preterm infants&#58; time to accept the null hypothesis&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "W&#46;E&#46; Benitz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/jp.2010.3"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Perinatol"
                        "fecha" => "2010"
                        "volumen" => "30"
                        "paginaInicial" => "241"
                        "paginaFinal" => "252"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20182439"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patent ductus arteriosus in premature infants&#58; to treat or not to treat&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46;A&#46; Mohamed"
                            1 => "M&#46; El-Dib"
                            2 => "S&#46; Alqahtani"
                            3 => "K&#46; Alyami"
                            4 => "A&#46;N&#46; Ibrahim"
                            5 => "H&#46; Aly"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Perinatol"
                        "fecha" => "2017"
                        "volumen" => "37"
                        "paginaInicial" => "652"
                        "paginaFinal" => "657"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparative effectiveness of nonsteroidal anti&#8208;inflammatory drug treatment versus no treatment for patent ductus arteriosus in preterm infants"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;L&#46; Slaughter"
                            1 => "P&#46;B&#46; Reagan"
                            2 => "T&#46;B&#46; Newman"
                            3 => "M&#46;A&#46; Klebanoff"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jamapediatrics.2016.4354"
                      "Revista" => array:5 [
                        "tituloSerie" => "JAMA Pediatr"
                        "fecha" => "2017"
                        "volumen" => "171"
                        "paginaInicial" => "e164354"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28046188"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Preterm patent ductus arteriosus&#58; should we treat it&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "N&#46; Evans"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Paediatr Child Health"
                        "fecha" => "2012"
                        "volumen" => "48"
                        "paginaInicial" => "753"
                        "paginaFinal" => "758"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patent ductus arteriosus&#58; to treat or not to treat&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "W&#46;E&#46; Benitz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/archdischild-2011-300381"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Dis Child Fetal Neonatal Ed"
                        "fecha" => "2012"
                        "volumen" => "97"
                        "paginaInicial" => "F80"
                        "paginaFinal" => "F82"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22174019"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Managing the patent ductus arteriosus&#58; current treatment options"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46;M&#46; Heuchan"
                            1 => "R&#46;I&#46; Clyman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Arch Dis Child Fetal Neonatal Ed"
                        "fecha" => "2014"
                        "volumen" => "99"
                        "paginaInicial" => "F431"
                        "paginaFinal" => "F436"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "pt"
  "url" => "/22555536/0000009600000002/v4_202005060625/S2255553619300709/v4_202005060625/pt/main.assets"
  "Apartado" => array:4 [
    "identificador" => "16682"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Artigos originais"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/22555536/0000009600000002/v4_202005060625/S2255553619300709/v4_202005060625/pt/main.pdf?idApp=UINPBA000049&text.app=https://jped.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2255553619300709?idApp=UINPBA000049"
]