array:24 [
  "pii" => "S217351151070035X"
  "issn" => "21735115"
  "doi" => "10.1016/S2173-5115(10)70035-X"
  "estado" => "S300"
  "fechaPublicacion" => "2010-03-01"
  "aid" => "70035"
  "copyright" => "Sociedade Portuguesa de Pneumologia"
  "copyrightAnyo" => "2010"
  "documento" => "article"
  "crossmark" => 0
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "subdocumento" => "fla"
  "cita" => "Rev Port Pneumol. 2010;16:273-86"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 3266
    "formatos" => array:3 [
      "EPUB" => 251
      "HTML" => 1933
      "PDF" => 1082
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2173511510700361"
    "issn" => "21735115"
    "doi" => "10.1016/S2173-5115(10)70036-1"
    "estado" => "S300"
    "fechaPublicacion" => "2010-03-01"
    "aid" => "70036"
    "copyright" => "Sociedade Portuguesa de Pneumologia"
    "documento" => "article"
    "crossmark" => 0
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Pneumol. 2010;16:287-305"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2939
      "formatos" => array:3 [
        "EPUB" => 218
        "HTML" => 1742
        "PDF" => 979
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "titulo" => "Are there any differences in the community acquired pneumonias admitted to hospital over the past decade?"
      "tienePdf" => "en"
      "tieneTextoCompleto" => 0
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "287"
          "paginaFinal" => "305"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Estarão diferentes as pneumonias agudas adquiridas na comunidade com internamento hospitalar em idade pediátrica na última década?"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Cláudia Calado, Pedro Nunes, Luísa Pereira, Teresa Nunes, Celeste Barreto, Teresa Bandeira"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "Cláudia"
              "apellidos" => "Calado"
            ]
            1 => array:2 [
              "nombre" => "Pedro"
              "apellidos" => "Nunes"
            ]
            2 => array:2 [
              "nombre" => "Luísa"
              "apellidos" => "Pereira"
            ]
            3 => array:2 [
              "nombre" => "Teresa"
              "apellidos" => "Nunes"
            ]
            4 => array:2 [
              "nombre" => "Celeste"
              "apellidos" => "Barreto"
            ]
            5 => array:2 [
              "nombre" => "Teresa"
              "apellidos" => "Bandeira"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511510700361?idApp=UINPBA00004E"
    "url" => "/21735115/0000001600000002/v1_201305151526/S2173511510700361/v1_201305151526/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2173511510700348"
    "issn" => "21735115"
    "doi" => "10.1016/S2173-5115(10)70034-8"
    "estado" => "S300"
    "fechaPublicacion" => "2010-03-01"
    "aid" => "70034"
    "copyright" => "Sociedade Portuguesa de Pneumologia"
    "documento" => "article"
    "crossmark" => 0
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Pneumol. 2010;16:253-72"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 3115
      "formatos" => array:3 [
        "EPUB" => 240
        "HTML" => 1862
        "PDF" => 1013
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "titulo" => "Which functional parameters can help differentiate severe asthma from COPD?"
      "tienePdf" => "en"
      "tieneTextoCompleto" => 0
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "253"
          "paginaFinal" => "272"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Quais os parâmetros funcionais que permitem diferenciar asma grave de DPOC?"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Ricardo Marques Dias, Fernando Hauaji Chacur, Sonia Regina da Silva Carvalho, Denise Duprat Neves"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Ricardo"
              "apellidos" => "Marques Dias"
            ]
            1 => array:2 [
              "nombre" => "Fernando"
              "apellidos" => "Hauaji Chacur"
            ]
            2 => array:2 [
              "nombre" => "Sonia Regina"
              "apellidos" => "da Silva Carvalho"
            ]
            3 => array:2 [
              "nombre" => "Denise"
              "apellidos" => "Duprat Neves"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511510700348?idApp=UINPBA00004E"
    "url" => "/21735115/0000001600000002/v1_201305151526/S2173511510700348/v1_201305151526/en/main.assets"
  ]
  "en" => array:14 [
    "idiomaDefecto" => true
    "titulo" => "Bronchopulmonary dysplasia: Clinical practices in five Portuguese neonatal intensive care units"
    "tieneTextoCompleto" => 0
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "273"
        "paginaFinal" => "286"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "H. Guimarães, G. Rocha, G. Vasconcellos, E. Proença, M.L. Carreira, M.R. Sossai, B. Morais, I. Martins, T. Rodrigues, M. Severo"
        "autores" => array:10 [
          0 => array:4 [
            "nombre" => "H."
            "apellidos" => "Guimarães"
            "email" => array:1 [
              0 => "herciliaguimaraes@gmail.com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">1</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">¿</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "G&#46;"
            "apellidos" => "Rocha"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">1</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "G&#46;"
            "apellidos" => "Vasconcellos"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">1</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "E&#46;"
            "apellidos" => "Proen&#231;a"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">2</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "M&#46;L&#46;"
            "apellidos" => "Carreira"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">3</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "M&#46;R&#46;"
            "apellidos" => "Sossai"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">4</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "B&#46;"
            "apellidos" => "Morais"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">4</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "I&#46;"
            "apellidos" => "Martins"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">5</span>"
                "identificador" => "aff0025"
              ]
            ]
          ]
          8 => array:3 [
            "nombre" => "T&#46;"
            "apellidos" => "Rodrigues"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">6</span>"
                "identificador" => "aff0030"
              ]
            ]
          ]
          9 => array:3 [
            "nombre" => "M&#46;"
            "apellidos" => "Severo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">6</span>"
                "identificador" => "aff0030"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:6 [
          0 => array:3 [
            "entidad" => "NICU&#44; Hospital de S&#46; Jo&#227;o&#44; Porto"
            "etiqueta" => "<span class="elsevierStyleSup">1</span>"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Maternidade J&#250;lio Dinis&#44; Porto"
            "etiqueta" => "<span class="elsevierStyleSup">2</span>"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Hospital de Santo Ant&#243;nio&#44; Porto"
            "etiqueta" => "<span class="elsevierStyleSup">3</span>"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Hospital Fernando da Fonseca&#44; Amadora&#47;<span class="elsevierStyleItalic">Sintra</span>"
            "etiqueta" => "<span class="elsevierStyleSup">4</span>"
            "identificador" => "aff0020"
          ]
          4 => array:3 [
            "entidad" => "Hospital Pedro Hispano&#44; Matosinhos"
            "etiqueta" => "<span class="elsevierStyleSup">5</span>"
            "identificador" => "aff0025"
          ]
          5 => array:3 [
            "entidad" => "Departamento de Epidemiologia&#44; Faculdade de Medicina da Universidade do Porto&#44; Portugal&#47;<span class="elsevierStyleItalic">Department of Epidemiology&#44; Faculty of Medicine of Porto University&#44; Portugal</span>"
            "etiqueta" => "<span class="elsevierStyleSup">6</span>"
            "identificador" => "aff0030"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Correspondence to&#47;Correspond&#234;ncia&#58; Servi&#231;o de Neonatologia&#47;Departamento de Pediatria &#8211; Hospital de S&#227;o Jo&#227;o&#44; Alameda Professor Hern&#226;ni Monteiro&#44; 4202-451 Porto&#46; Telephone&#58; 00351 225095816&#44; Fax&#58; &#43;225505919&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "pt" => array:1 [
        "titulo" => "Displasia broncopulmonar&#58; Pr&#225;ticas cl&#237;nicas em cinco unidades de cuidados intensivos neonatais"
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2009-06-29"
    "fechaAceptado" => "2009-09-08"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Key-words"
          "identificador" => "xpalclavsec160695"
          "palabras" => array:9 [
            0 => "Bronchopulmonary dysplasia"
            1 => "neonatal intensive care"
            2 => "preterm infants"
            3 => "better practices"
            4 => "mechanical ventilation"
            5 => "oxygen therapy"
            6 => "prenatal corticosteroids"
            7 => "sepsis"
            8 => "patent ductus arteriosus"
          ]
        ]
      ]
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec160694"
          "palabras" => array:9 [
            0 => "Displasia broncopulmonar"
            1 => "cuidados intensivos neonatais"
            2 => "rec&#233;m-nascidos de pr&#233;-termo"
            3 => "boas pr&#225;ticas"
            4 => "ventila&#231;&#227;o mec&#226;nica"
            5 => "oxig&#233;nio"
            6 => "corticoster&#243;ides pr&#233;-natais"
            7 => "s&#233;psis"
            8 => "canal arterial patente"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">With the advent of surfactant&#44; prenatal corticosteroids &#40;PNC&#41; and advances in technology&#44; the survival rate of extremely low birth weight &#40;ELBW&#41; infants has improved dramatically&#46; Rates of bronchopulmonary dysplasia &#40;BPD&#41; vary widely among neonatal intensive care units &#40;NICUs&#41; and many studies using multiple interventions have shown some improvement in BPD rates&#46; Implementing potentially better practices to reduce BPD has been an effort made over the last few decades&#46;</p> <span class="elsevierStyleSectionTitle">Aim</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">To compare five Portuguese NICUs in terms of clinical practices in very low birth weight &#40;VLBW&#41; infants&#44; in order to develop better practices to prevent BPD&#46;</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">256 preterm neonates&#44; gestational age &#40;GA&#41;<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30 weeks and&#47;or birthweight &#40;BW&#41;<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>1250g admitted to five Portuguese NICUs &#40;centers 1 to 5&#41; between 1st January 2004 and 31<span class="elsevierStyleSup">st</span> December 2006&#44; were studied&#46; VLBW infants with major malformations&#44; grade IV intraventricular haemorrhage in the first week of life and metabolic or neuromuscular disease were excluded&#46; BPD was defined as oxygen dependency at 36 weeks of postconceptional age&#46; We considered a practice to be improved as clinically significant whenever a decrease greater than 10&#37; in the prevalence of BPD adjusted for the practice&#44; GA and BW was achieved compared to BPD prevalence adjusted only for GA and BW&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The overall prevalence of BPD was 12&#46;9&#37;&#46; Our results revealed that PNC use should be improved in centers 4 and 5&#59; fluid policy in center 4&#59; oxygen therapy and sepsis prevention in centers 1 and 2&#46; Patent ductus arteriosus &#40;PDA&#41; treatment should be improved in center 2&#46;</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The implementation of potentially better practices to reduce lung injury in neonates in Portuguese NICUs&#44; according to each NICU&#44; must be addressed to increase the prescription of PNC&#44; to use a lower FiO<span class="elsevierStyleInf">2</span>&#44; to be careful with fluid administration in the first weeks of life and to prevent PDA and sepsis&#46; It is necessary to follow guidelines&#44; recommendations or protocols to improve quality in the prevention of BPD&#46;</p>"
      ]
      "pt" => array:2 [
        "titulo" => "Resumo"
        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Com o advento do surfactante&#44; dos corticoster&#243;ides pr&#233;-natais e dos avan&#231;os na tecnologia&#44; a sobrevida dos rec&#233;m-nascidos de extremo baixo peso tem melhorado dramaticamente&#46; As taxas de displasia broncopulmonar &#40;DBP&#41; variam amplamente entre unidades&#44; e v&#225;rios estudos&#44; avaliando resultados de m&#250;ltiplas interven&#231;&#245;es&#44; t&#234;m mostrado alguma melhoria na preval&#234;ncia da DBP&#46; A implementa&#231;&#227;o de potenciais boas pr&#225;ticas na DBP tem sido adoptada por muitos servi&#231;os nas &#250;ltimas d&#233;cadas&#46;</p> <span class="elsevierStyleSectionTitle">Objectivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Comparar cinco unidades portuguesas de cuidados intensivos neonatais no que se refere as pr&#225;ticas cl&#237;nicas no tratamento dos rec&#233;m-nascidos de muito baixo peso&#44; para desenvolver e melhorar as boas pr&#225;ticas na preven&#231;&#227;o da DBP&#46;</p> <span class="elsevierStyleSectionTitle">Popula&#231;&#227;o e m&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Foram estudados 256 rec&#233;m-nascidos com a idade gestacional inferior a 30 semanas e&#47;ou peso ao nascer inferior a 1250<span class="elsevierStyleHsp" style=""></span>g&#44; admitidos nas cinco unidades portuguesas &#40;centros 1 a 5&#41; entre 1 de Janeiro de 2004 e 31 de Dezembro de 2006&#46; Foram exclu&#237;dos os rec&#233;m-nascidos com malforma&#231;&#245;es <span class="elsevierStyleItalic">major</span>&#44; hemorragia intraventricular grau IV na primeira semana de vida e com doen&#231;a metab&#243;lica ou neuromuscular&#46; Definimos DBP como a depend&#234;ncia do oxig&#233;nio &#224;s 36 semanas de idade p&#243;sconcepcional&#46; A necessidade de melhorar determinada pr&#225;tica foi considerada significativa sempre que se verificava uma melhoria superior a 10&#37; na preval&#234;ncia da DBP ajustada para a pr&#225;tica&#44; idade gestacional e peso ao nascer&#44; comparada com a preval&#234;ncia ajustada s&#243; para a idade gestacional e peso ao nascer&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A preval&#234;ncia global da DBP foi de 12&#44;9&#37;&#46; Os resultados mostram que o uso de corticoster&#243;ides pr&#233;-natais deve ser melhorado nos centros 4 e 5&#59; a pol&#237;tica de fluidos deve ser melhorada no centro 4&#59; o uso de oxig&#233;nio e a preven&#231;&#227;o da s&#233;psis deve ser melhorada nos centros 1 e 2&#46; O tratamento do canal arterial patente deve ser melhorado no centro 2&#46;</p> <span class="elsevierStyleSectionTitle">Conclus&#227;o</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Neste estudo&#44; a implementa&#231;&#227;o de boas pr&#225;ticas para reduzir a les&#227;o pulmonar nos rec&#233;m-nascidos&#44; de acordo com cada unidade&#44; deve ser dirigida ao aumento da prescri&#231;&#227;o de corticoster&#243;ides pr&#233;-natais&#44; ao uso de menor FiO<span class="elsevierStyleInf">2</span>&#44; ao uso criterioso de l&#237;quidos na primeiras semanas de vida&#44; &#224; preven&#231;&#227;o do canal arterial patente e da s&#233;psis&#46; <span class="elsevierStyleItalic">Guidelines</span>&#44; recomenda&#231;&#245;es ou protocolos s&#227;o necess&#225;rios na melhoria da qualidade na preven&#231;&#227;o da DBP&#46;</p>"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliography"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:59 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pulmonary disease following respirator therapy of hyaline-membrane disease&#46; Bronchopulmonary dysplasia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "W&#46;H&#46; Northway Jr&#46;"
                            1 => "R&#46;C&#46; Rosan"
                            2 => "D&#46;Y&#46; Porter"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM196702162760701"
                      "Revista" => array:7 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1967"
                        "volumen" => "276"
                        "numero" => "7"
                        "paginaInicial" => "357"
                        "paginaFinal" => "368"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/5334613"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bronchopulmonary dysplasia&#58; clinical presentation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "E&#46; Bancalari"
                            1 => "G&#46;E&#46; Abdenour"
                            2 => "R&#46; Feller"
                            3 => "J&#46; Gannon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "J Pediatr"
                        "fecha" => "1979"
                        "volumen" => "95"
                        "numero" => "5 Pt 2"
                        "paginaInicial" => "819"
                        "paginaFinal" => "823"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/385815"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Abnormal pulmonary outcomes in premature infants&#58; prediction from oxygen requirement in the neonatal period"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46;T&#46; Shennan"
                            1 => "M&#46;S&#46; Dunn"
                            2 => "A&#46; Ohlsson"
                            3 => "K&#46; Lennox"
                            4 => "E&#46;M&#46; Hoskins"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "1988"
                        "volumen" => "82"
                        "numero" => "4"
                        "paginaInicial" => "527"
                        "paginaFinal" => "532"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3174313"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "National Institute of Child Health and Human Development Neonatal Research Network&#46; Impact of a physiologic definition on bronchopulmonary dysplasia rates"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:18 [
                            0 => "M&#46;C&#46; Walsh"
                            1 => "Q&#46; Yao"
                            2 => "P&#46; Gettner"
                            3 => "E&#46; Hale"
                            4 => "M&#46; Collins"
                            5 => "A&#46; Hensman"
                            6 => "R&#46; Everette"
                            7 => "N&#46; Peters"
                            8 => "N&#46; Miller"
                            9 => "G&#46; Muran"
                            10 => "K&#46; Auten"
                            11 => "N&#46; Newman"
                            12 => "G&#46; Rowan"
                            13 => "C&#46; Grisby"
                            14 => "K&#46; Arnell"
                            15 => "L&#46; Miller"
                            16 => "B&#46; Ball"
                            17 => "G&#46; McDavid"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1542/peds.2004-0204"
                      "Revista" => array:7 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2004"
                        "volumen" => "114"
                        "numero" => "5"
                        "paginaInicial" => "1305"
                        "paginaFinal" => "1311"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15520112"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "National Institutes of Child Health and Human Development Neonatal Research Network Validation of the National Institutes of Health consensus definition of bronchopulmonary dysplasia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:8 [
                            0 => "R&#46;A&#46; Ehrenkranz"
                            1 => "M&#46;C&#46; Walsh"
                            2 => "B&#46;R&#46; Vohr"
                            3 => "A&#46;H&#46; Jobe"
                            4 => "L&#46;L&#46; Wright"
                            5 => "A&#46;A&#46; Fanaroff"
                            6 => "L&#46;A&#46; Wrage"
                            7 => "K&#46; Poole"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1542/peds.2005-0249"
                      "Revista" => array:7 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2005"
                        "volumen" => "116"
                        "numero" => "6"
                        "paginaInicial" => "1353"
                        "paginaFinal" => "1360"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16322158"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "New developments in the presentation&#44; pathogenesis&#44; epidemiology and prevention of bronchopulmonary dysplasia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "I&#46;R&#46;S&#46; Sosenko"
                            1 => "E&#46; Bancalari"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:4 [
                        "titulo" => "The Newborn Lung Eduardo Bancalari"
                        "fecha" => "2008"
                        "editorial" => "Richard A Polin&#46; Saunders Elsevier"
                        "editorialLocalizacion" => "Consulting Ed"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A new health system for the 21st century"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "Crossing the Quality Chasm"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2001"
                        "editorial" => "National Academy"
                        "editorialLocalizacion" => "Washington DC"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Vermont Oxford Network Neonatal Intensive Care Quality Improvement Collaborative&#46; Reduction of bronchopulmonary dysplasia after participation in the Breathsavers Group of the Vermont Oxford Network Neonatal Intensive Care Quality Improvement Collaborative"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Breathsavers Group"
                          "etal" => false
                          "autores" => array:7 [
                            0 => "N&#46;R&#46; Payne"
                            1 => "M&#46; LaCorte"
                            2 => "P&#46; Karna"
                            3 => "S&#46; Chen"
                            4 => "M&#46; Finkelstein"
                            5 => "J&#46;P&#46; Goldsmith"
                            6 => "J&#46;H&#46; Carpenter"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1542/peds.2006-0913C"
                      "Revista" => array:7 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2006"
                        "volumen" => "118"
                        "numero" => "Suppl 2"
                        "paginaInicial" => "S73"
                        "paginaFinal" => "S77"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17079626"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluation and development of potentially better practices to reduce bronchopulmonary dysplasia in very low birth weight infants"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Breathsavers Group"
                          "etal" => false
                          "autores" => array:6 [
                            0 => "N&#46;R&#46; Payne"
                            1 => "M&#46; LaCorte"
                            2 => "S&#46; Sun"
                            3 => "P&#46; Karna"
                            4 => "M&#46; Lewis-Hunstiger"
                            5 => "J&#46;P&#46; Goldsmith"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1542/peds.2006-0913B"
                      "Revista" => array:7 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2006"
                        "volumen" => "118"
                        "numero" => "Suppl 2"
                        "paginaInicial" => "S65"
                        "paginaFinal" => "S72"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17079625"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Implementing potentially better practices to reduce lung injury in neonates"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:9 [
                            0 => "K&#46; Burch"
                            1 => "W&#46; Rhine"
                            2 => "R&#46; Baker"
                            3 => "F&#46; Litman"
                            4 => "J&#46;W&#46; Kaempf"
                            5 => "E&#46; Schwarz"
                            6 => "S&#46; Sun"
                            7 => "N&#46;R&#46; Payne"
                            8 => "P&#46;J&#46; Sharek"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2003"
                        "volumen" => "111"
                        "numero" => "4 Pt 2"
                        "paginaInicial" => "e432"
                        "paginaFinal" => "e436"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12671163"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluation and development of potentially better practices to prevent chronic lung disease and reduce lung injury in neonates"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:8 [
                            0 => "P&#46;J&#46; Sharek"
                            1 => "R&#46; Baker"
                            2 => "F&#46; Litman"
                            3 => "J&#46; Kaempf"
                            4 => "K&#46; Burch"
                            5 => "E&#46; Schwarz"
                            6 => "S&#46; Sun"
                            7 => "N&#46;R&#46; Payne"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2003"
                        "volumen" => "111"
                        "numero" => "4 Pt 2"
                        "paginaInicial" => "e426"
                        "paginaFinal" => "e431"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12671162"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bronchopulmonarydysplasia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46;H&#46; Jobe"
                            1 => "E&#46; Bancalari"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Am J Respi Crit Care Med"
                        "fecha" => "2001"
                        "volumen" => "163"
                        "paginaInicial" => "1723"
                        "paginaFinal" => "1729"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "American Academy of Pediatrics&#46; Committee on Fetus and Newborn&#46; Perinatal Care at the Threshold of Viability"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "H&#46; MacDonald"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2002"
                        "volumen" => "110"
                        "paginaInicial" => "1024"
                        "paginaFinal" => "1027"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12415047"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "New ballard score&#44; expanded to include extremely premature infants"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46;L&#46; Ballard"
                            1 => "J&#46;C&#46; Khoury"
                            2 => "K&#46; Wedig"
                            3 => "L&#46; Wang"
                            4 => "B&#46;L&#46; Eilers-Walsman"
                            5 => "R&#46; Lipp"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr"
                        "fecha" => "1991"
                        "volumen" => "119"
                        "paginaInicial" => "417"
                        "paginaFinal" => "423"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1880657"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Idiopathic respiratory distress syndrome of the newborn"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46;J&#46; Rudolph"
                            1 => "C&#46;A&#46; Smith"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Pediatr"
                        "fecha" => "1960"
                        "volumen" => "57"
                        "paginaInicial" => "905"
                        "paginaFinal" => "921"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Necrotizing enterocolitis&#58; treatment based on staging criteria"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;C&#46; Walsh"
                            1 => "R&#46;M&#46; Kliegman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ped Clin N Am"
                        "fecha" => "1986"
                        "volumen" => "33"
                        "paginaInicial" => "179"
                        "paginaFinal" => "201"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "titulo" => "An International classification of retinopathy of prematurity"
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "1984"
                        "volumen" => "74"
                        "paginaInicial" => "127"
                        "paginaFinal" => "133"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6547526"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "titulo" => "The international classification of retinopathy of prematurity revisited&#46;&#44; International Committee for the Classification of Retinopathy of Prematurity"
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/archopht.123.7.991"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Ophthalmol"
                        "fecha" => "2005"
                        "volumen" => "123"
                        "paginaInicial" => "991"
                        "paginaFinal" => "999"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16009843"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidence and evolution of subependymal and intraventricular hemorrhage&#58; a study of infants with birthweights less than 1500g"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46;A&#46; Papile"
                            1 => "J&#46; Burstein"
                            2 => "R&#46; Burstein"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "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"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Preterm brain injury"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "L&#46; de Vries"
                            1 => "J&#46;M&#46; Rennie"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:5 [
                        "titulo" => "Textbook of neonatology"
                        "paginaInicial" => "1252"
                        "paginaFinal" => "1270"
                        "edicion" => "3rd edition&#46;"
                        "serieFecha" => "1999"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bronchopulmonary dysplasia&#58; changes in pathogenesis&#44; epidemiology and definition"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "E&#46; Bancalari"
                            1 => "N&#46; Claure"
                            2 => "I&#46;R&#46; Sosenko"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Semin Neonatol"
                        "fecha" => "2003"
                        "volumen" => "8"
                        "numero" => "1"
                        "paginaInicial" => "63"
                        "paginaFinal" => "71"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12667831"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "National Institute of Child Health and Human Development Neonatal Research Network&#46; Oxygen delivery through nasal cannulae to preterm infants&#58; can practice be improved&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "M&#46; Walsh"
                            1 => "W&#46; Engle"
                            2 => "A&#46; Laptook"
                            3 => "S&#46;N&#46; Kazzi"
                            4 => "S&#46; Buchter"
                            5 => "M&#46; Rasmussen"
                            6 => "Q&#46; Yao"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1542/peds.2004-2411"
                      "Revista" => array:7 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2005"
                        "volumen" => "116"
                        "numero" => "4"
                        "paginaInicial" => "857"
                        "paginaFinal" => "861"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16199694"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prophylactic corticosteroids for preterm birth"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "P&#46; Crowley"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Cochrane Database Syst Rev"
                        "fecha" => "2007"
                        "volumen" => "18"
                        "numero" => "3"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46; Roberts"
                            1 => "S&#46; Dalziel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Cochrane Database Syst Rev"
                        "fecha" => "2006"
                        "volumen" => "19"
                        "numero" => "3"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Antenatal corticosteroids revisited&#58; repeat courses &#8211; National Institutes of Health Consensus Development Conference Statement&#46; August 17&#8211;18&#44; 2000"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "National Institutes of Health Consensus Development Panel"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Obstet Gynecol"
                        "fecha" => "2001"
                        "volumen" => "98"
                        "numero" => "1"
                        "paginaInicial" => "144"
                        "paginaFinal" => "150"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11430973"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "26&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Repeat doses of prenatal corticosteroids for women at risk of preterm birth for preventing neonatal respiratory disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46;A&#46; Crowther"
                            1 => "J&#46;E&#46; Harding"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Cochrane Database Syst Rev"
                        "fecha" => "2007"
                        "volumen" => "18"
                        "numero" => "3"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surfactant replacement therapy for severe neonatal respiratory distress syndrome&#58; an international randomized clinical trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "Collaborative European Multicenter Study Group"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "1988"
                        "volumen" => "82"
                        "numero" => "5"
                        "paginaInicial" => "683"
                        "paginaFinal" => "691"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2903480"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib28"
              "etiqueta" => "28&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison outcomes of surfactant therapy in respiratory distress syndrome in two periods"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "U&#46; Chotigeat"
                            1 => "N&#46; Promwong"
                            2 => "W&#46; Kanjanapattanakul"
                            3 => "M&#46; Khorana"
                            4 => "V&#46; Sangtawesin"
                            5 => "S&#46; Horpaopan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:8 [
                        "tituloSerie" => "J Med Assoc Thai"
                        "fecha" => "2008"
                        "volumen" => "91"
                        "numero" => "Suppl 3"
                        "paginaInicial" => "S109"
                        "paginaFinal" => "S114"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19253505"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0140673605676258"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib29"
              "etiqueta" => "29&#46;"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Halliday HL&#44; O&#39;Neil CP&#46; What is the evidence for drug therapy in the prevention and management of bronchopulmonary dysplasia&#63; In&#58; The newborn lung&#46; Neonatal questions and controversies&#46; Eduardo Bancalari&#46; Ed Richard A Polin&#46; Saunders Elsevier 2008&#59; 208-232&#46;"
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib30"
              "etiqueta" => "30&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Early surfactant administration with brief ventilation vs&#46; selective surfactant and continued mechanical ventilation for preterm infants with or at risk for respiratory distress syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "T&#46;P&#46; Stevens"
                            1 => "E&#46;W&#46; Harrington"
                            2 => "M&#46; Blennow"
                            3 => "R&#46;F&#46; Soll"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Cochrane Database Syst Rev"
                        "fecha" => "2007"
                        "volumen" => "17"
                        "numero" => "4"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib31"
              "etiqueta" => "31&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Multiple versus single doses of exogenous surfactant for the prevention or treatment of neonatal respiratory distress syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46; Soll"
                            1 => "E&#46; Ozek"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Cochrane Database Syst Rev"
                        "fecha" => "2009"
                        "volumen" => "21"
                        "numero" => "1"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib32"
              "etiqueta" => "32&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surfactant therapy in preterm infants with respiratory distress syndrome and in nearterm or term newborns with acute RDS"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46;J&#46; Ramanathan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Perinatol"
                        "fecha" => "2006"
                        "volumen" => "26"
                        "numero" => "Suppl 1"
                        "paginaInicial" => "S63"
                        "paginaFinal" => "S64"
                        "itemHostRev" => array:3 [
                          "pii" => "S1470204511702327"
                          "estado" => "S300"
                          "issn" => "14702045"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib33"
              "etiqueta" => "33&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Portuguese Neonatal Network"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "VLBW infants in Portugal&#46; National Multicenter Study&#44; 1996&#8211;2000"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "Bial Award of Clinical Medicine"
                        "fecha" => "2002"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib34"
              "etiqueta" => "34&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Choosing a right surfactant for respiratory distress syndrome treatment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46; Ramanathan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000151749"
                      "Revista" => array:7 [
                        "tituloSerie" => "Neonatology"
                        "fecha" => "2009"
                        "volumen" => "95"
                        "numero" => "1"
                        "paginaInicial" => "1"
                        "paginaFinal" => "5"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18832858"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib35"
              "etiqueta" => "35&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Association between fluid intake and weight loss during the first ten days of life and risk of bronchopulmonary dysplasia in extremely low birth weight infants"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Neonatal Research Network"
                          "etal" => false
                          "autores" => array:9 [
                            0 => "W&#46; Oh"
                            1 => "B&#46;B&#46; Poindexter"
                            2 => "R&#46; Perritt"
                            3 => "J&#46;A&#46; Lemons"
                            4 => "C&#46;R&#46; Bauer"
                            5 => "R&#46;A&#46; Ehrenkranz"
                            6 => "B&#46;J&#46; Stoll"
                            7 => "K&#46; Poole"
                            8 => "L&#46;L&#46; Wright"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jpeds.2005.06.039"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Pediatr"
                        "fecha" => "2005"
                        "volumen" => "147"
                        "numero" => "6"
                        "paginaInicial" => "786"
                        "paginaFinal" => "790"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16356432"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib36"
              "etiqueta" => "36&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fluid regimens in the first week of life may increase risk of patent ductus arteriosus in extremely low birth weight infants"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:8 [
                            0 => "B&#46;E Stephens"
                            1 => "M&#46;J&#46; Gargus"
                            2 => "R&#46;V&#46; Walden"
                            3 => "N&#46; Mance"
                            4 => "J&#46; Nye"
                            5 => "L&#46; McKinley"
                            6 => "R&#46; Tucker"
                            7 => "B&#46;R&#46; Vohr"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/sj.jp.7211895"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Perinatol"
                        "fecha" => "2008"
                        "volumen" => "28"
                        "numero" => "2"
                        "paginaInicial" => "123"
                        "paginaFinal" => "128"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18046337"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib37"
              "etiqueta" => "37&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Restricted versus liberal water intake for preventing morbidity and mortality in preterm infants"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "E&#46;F&#46; Bell"
                            1 => "M&#46;J&#46; Acarregui"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "Cochrane Database Syst Rev"
                        "fecha" => "2008"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib38"
              "etiqueta" => "38&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Optimal ventilatory strategies and surfactant to protect the preterm lungs"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46; Ramanathan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000121456"
                      "Revista" => array:7 [
                        "tituloSerie" => "Neonatology"
                        "fecha" => "2008"
                        "volumen" => "93"
                        "numero" => "4"
                        "paginaInicial" => "302"
                        "paginaFinal" => "308"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18525214"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib39"
              "etiqueta" => "39&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Continuous positive airway pressure and surfactant"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "K&#46; Bohlin"
                            1 => "B&#46; Jonsson"
                            2 => "A&#46;S&#46; Gustafsson"
                            3 => "M&#46; Blennow"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000121457"
                      "Revista" => array:7 [
                        "tituloSerie" => "Neonatology"
                        "fecha" => "2008"
                        "volumen" => "93"
                        "numero" => "4"
                        "paginaInicial" => "309"
                        "paginaFinal" => "315"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18525215"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib40"
              "etiqueta" => "40&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lung protective ventilatory strategies in very low birth weight infants"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46; Ramanathan"
                            1 => "S&#46; Sardesai"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/jp.2008.49"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Perinatol"
                        "fecha" => "2008"
                        "volumen" => "28"
                        "numero" => "Suppl 1"
                        "paginaInicial" => "S41"
                        "paginaFinal" => "S46"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18446177"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib41"
              "etiqueta" => "41&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Does nasal CPAP reduce bronchopulmonary dysplasia &#40;BPD&#41;&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46; Patel"
                            1 => "A&#46; Greenough"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1651-2227.2008.00931.x"
                      "Revista" => array:7 [
                        "tituloSerie" => "Acta Paediatr"
                        "fecha" => "2008"
                        "volumen" => "97"
                        "numero" => "10"
                        "paginaInicial" => "1314"
                        "paginaFinal" => "1317"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18647275"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            41 => array:3 [
              "identificador" => "bib42"
              "etiqueta" => "42&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Take a breath &#8211; but do not add oxygen &#40;if not needed&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "O&#46;D&#46; Saugstad"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1651-2227.2006.00348.x"
                      "Revista" => array:7 [
                        "tituloSerie" => "Acta Paediatr"
                        "fecha" => "2007"
                        "volumen" => "96"
                        "numero" => "6"
                        "paginaInicial" => "798"
                        "paginaFinal" => "800"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17537006"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            42 => array:3 [
              "identificador" => "bib43"
              "etiqueta" => "43&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Resuscitation of newborn infants with 21&#37; or 100&#37; oxygen&#58; an updated systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "O&#46;D&#46; Saugstad"
                            1 => "S&#46; Ramji"
                            2 => "R&#46;F&#46; Soll"
                            3 => "M&#46; Vento"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000143397"
                      "Revista" => array:8 [
                        "tituloSerie" => "Neonatology"
                        "fecha" => "2008"
                        "volumen" => "94"
                        "numero" => "3"
                        "paginaInicial" => "176"
                        "paginaFinal" => "182"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18612215"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1556086415314945"
                          "estado" => "S300"
                          "issn" => "15560864"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            43 => array:3 [
              "identificador" => "bib44"
              "etiqueta" => "44&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Optimum oxygen therapy in preterm babies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "W&#46; Tin"
                            1 => "S&#46; Gupta"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Dis Child Fetal Neonatal&#46;"
                        "fecha" => "2007"
                        "volumen" => "92"
                        "numero" => "2"
                        "paginaInicial" => "F143"
                        "paginaFinal" => "F147"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            44 => array:3 [
              "identificador" => "bib45"
              "etiqueta" => "45&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Oxygen in neonatal anesthesia&#58; friend or foe&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46; Sola"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/ACO.0b013e3282f8ad8d"
                      "Revista" => array:7 [
                        "tituloSerie" => "Curr Opin Anaesthesiol"
                        "fecha" => "2008"
                        "volumen" => "21"
                        "numero" => "3"
                        "paginaInicial" => "332"
                        "paginaFinal" => "339"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18458550"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            45 => array:3 [
              "identificador" => "bib46"
              "etiqueta" => "46&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Supplemental therapeutic oxygen for pretreshold retinopathy of prematurity &#40;STOP-ROP&#41;&#44; a randomized controlled trial&#46; I&#58; Primary outcomes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "STOP-ROP Multicenter Study Group"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2000"
                        "volumen" => "105"
                        "paginaInicial" => "295"
                        "paginaFinal" => "310"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10654946"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            46 => array:3 [
              "identificador" => "bib47"
              "etiqueta" => "47&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Adjunctive therapies in chronic lung disease&#58; examining the evidence"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "W&#46; Tin"
                            1 => "T&#46;E&#46; Wiswell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.siny.2007.09.008"
                      "Revista" => array:8 [
                        "tituloSerie" => "Semin Fetal Neonatal Med"
                        "fecha" => "2008"
                        "volumen" => "13"
                        "numero" => "1"
                        "paginaInicial" => "44"
                        "paginaFinal" => "52"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17983879"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0300289609000908"
                          "estado" => "S300"
                          "issn" => "03002896"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            47 => array:3 [
              "identificador" => "bib48"
              "etiqueta" => "48&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Inflammation and bronchopulmonary dysplasia&#58; a continuing story"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "C&#46;P&#46; Speer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.siny.2006.03.004"
                      "Revista" => array:8 [
                        "tituloSerie" => "Semin Fetal Neonatal Med"
                        "fecha" => "2006"
                        "volumen" => "11"
                        "numero" => "5"
                        "paginaInicial" => "354"
                        "paginaFinal" => "362"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16702036"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S147020451170184X"
                          "estado" => "S300"
                          "issn" => "14702045"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            48 => array:3 [
              "identificador" => "bib49"
              "etiqueta" => "49&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bronchopulmonary dysplasia and inflammatory biomarkers in the premature neonate"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46;L&#46; Bose"
                            1 => "C&#46;E&#46; Dammann"
                            2 => "M&#46;M&#46; Laughon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Dis Child Fetal Neonatal"
                        "fecha" => "2008"
                        "volumen" => "93"
                        "numero" => "6"
                        "paginaInicial" => "F455"
                        "paginaFinal" => "F461"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            49 => array:3 [
              "identificador" => "bib50"
              "etiqueta" => "50&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bronchoalveolar inflammation following airway infection in preterm infants with chronic lung disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "P&#46; Groneck"
                            1 => "J&#46; Schmale"
                            2 => "V&#46; Soditt"
                            3 => "H&#46; St&#252;tzer"
                            4 => "B&#46; G&#246;tze-Speer"
                            5 => "C&#46;P&#46; Speer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:8 [
                        "tituloSerie" => "Pediatr Pulmonol"
                        "fecha" => "2001"
                        "volumen" => "31"
                        "numero" => "5"
                        "paginaInicial" => "331"
                        "paginaFinal" => "338"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11340678"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0169500211002236"
                          "estado" => "S300"
                          "issn" => "01695002"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            50 => array:3 [
              "identificador" => "bib51"
              "etiqueta" => "51&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chorioamnionitis and lung damage in the extremely low birth weight infant"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "G&#46; Rocha"
                            1 => "E&#46; Proen&#231;a"
                            2 => "C&#46; Quintas"
                            3 => "T&#46; Rodrigues"
                            4 => "H&#46; Guimar&#227;es"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Port Pneumol"
                        "fecha" => "2007"
                        "volumen" => "3"
                        "numero" => "5"
                        "paginaInicial" => "745"
                        "paginaFinal" => "754"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            51 => array:3 [
              "identificador" => "bib52"
              "etiqueta" => "52&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Influence of infection on patent ductus arteriosus and chronic lung disease in premature infants weighing 1000 grams or less"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; Gonzalez"
                            1 => "I&#46;R&#46; Sosenko"
                            2 => "J&#46; Chandar"
                            3 => "H&#46; Hummler"
                            4 => "N&#46; Claure"
                            5 => "E&#46; Bancalari"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "J Pediatr"
                        "fecha" => "1996"
                        "volumen" => "128"
                        "numero" => "4"
                        "paginaInicial" => "470"
                        "paginaFinal" => "478"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8618179"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            52 => array:3 [
              "identificador" => "bib53"
              "etiqueta" => "53&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Coagulase-negative staphylococcal sepsis as a predictor of bronchopulmonary dysplasia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Liljedahl"
                            1 => "L&#46; Bodin"
                            2 => "J&#46; Schollin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Acta Paediatr"
                        "fecha" => "2004"
                        "volumen" => "93"
                        "numero" => "2"
                        "paginaInicial" => "211"
                        "paginaFinal" => "215"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15046276"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            53 => array:3 [
              "identificador" => "bib54"
              "etiqueta" => "54&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predischarge morbidities in extremely and very low-birth-weight infants in spanish neonatal units"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:9 [
                            0 => "M&#46; Moro"
                            1 => "J&#46; P&#233;rez-Rodriguez"
                            2 => "J&#46; Figueras-Aloy"
                            3 => "C&#46; Fern&#225;ndez"
                            4 => "E&#46; Dom&#233;nech"
                            5 => "R&#46; Jim&#233;nez"
                            6 => "V&#46; P&#233;rez-Sheriff"
                            7 => "J&#46; Quero"
                            8 => "V&#46; Roques"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Am J Perinatol"
                        "fecha" => "2008"
                        "paginaInicial" => "17"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            54 => array:3 [
              "identificador" => "bib55"
              "etiqueta" => "55&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "First SIBEN clinical consensus&#58; diagnostic and therapeutic approach to patent ductus arteriosus in premature newborns"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:45 [
                            0 => "S&#46;G&#46; Golombek"
                            1 => "A&#46; Sola"
                            2 => "H&#46; Baquero"
                            3 => "D&#46; Borbonet"
                            4 => "F&#46; Caba&#241;as"
                            5 => "C&#46; Fajardo"
                            6 => "G&#46; Goldsmit"
                            7 => "L&#46; Lemus"
                            8 => "E&#46; Miura"
                            9 => "A&#46; Pellicer"
                            10 => "J&#46;M&#46; P&#233;rez"
                            11 => "M&#46; Rogido"
                            12 => "G&#46; Zambosco"
                            13 => "B&#46; van Overmeire"
                            14 => "S&#46;G&#46; Golombek"
                            15 => "A&#46; Sola"
                            16 => "R&#46; Clyman"
                            17 => "B&#46; van Overmeire"
                            18 => "G&#46; Goldsmit"
                            19 => "D&#46; Natta"
                            20 => "G&#46; Zambosco"
                            21 => "E&#46; Miura"
                            22 => "J&#46;M&#46; P&#233;erez"
                            23 => "C&#46; Weissheimer"
                            24 => "H&#46; Baquero"
                            25 => "J&#46; Garc&#237;a Harker"
                            26 => "A&#46;N&#46; Oviedo Barrantes"
                            27 => "M&#46; Morgues"
                            28 => "J&#46;L&#46; Tapia"
                            29 => "F&#46; Dom&#237;nguez"
                            30 => "M&#46; Majano"
                            31 => "F&#46; Caba&#241;as"
                            32 => "Pellicer A&#46;"
                            33 => "H&#46; Cruz"
                            34 => "C&#46; Fajardo"
                            35 => "M&#46; Rogido"
                            36 => "L&#46; Lemus"
                            37 => "A&#46;V&#46; Origel"
                            38 => "Lacarruba J&#46;M&#46;"
                            39 => "M&#46; Lee"
                            40 => "J&#46; Tresierra"
                            41 => "H&#46; Guimar&#227;es"
                            42 => "R&#46; Bustos"
                            43 => "D&#46; Borbonet"
                            44 => "J&#46;L&#46; Perales"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "An Pediatr"
                        "fecha" => "2008"
                        "volumen" => "69"
                        "numero" => "5"
                        "paginaInicial" => "454"
                        "paginaFinal" => "481"
                        "itemHostRev" => array:3 [
                          "pii" => "S147020450970364X"
                          "estado" => "S300"
                          "issn" => "14702045"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            55 => array:3 [
              "identificador" => "bib56"
              "etiqueta" => "56&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ibuprofen for the treatment of patent ductus arteriosus in preterm and&#47;or low birth weight infants"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Ohlsson"
                            1 => "R&#46; Walia"
                            2 => "S&#46; Shah"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Cochrane Database Syst Rev"
                        "fecha" => "2008"
                        "volumen" => "23"
                        "numero" => "1"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            56 => array:3 [
              "identificador" => "bib57"
              "etiqueta" => "57&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prophylactic surgical ligation of patent ductus arteriosus for prevention of mortality and morbidity in extremely low birth weight infants"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46; Mosalli"
                            1 => "K&#46; Alfaleh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Cochrane Database Syst Rev"
                        "fecha" => "2008"
                        "volumen" => "23"
                        "numero" => "1"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            57 => array:3 [
              "identificador" => "bib58"
              "etiqueta" => "58&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ibuprofen-induced patent ductus arteriosus closure&#58; physiologic&#44; histologic&#44; and biochemical effects on the premature lung"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:12 [
                            0 => "D&#46; McCurnin"
                            1 => "S&#46; Seidner"
                            2 => "L&#46;Y&#46; Chang"
                            3 => "N&#46; Waleh"
                            4 => "M&#46; Ikegami"
                            5 => "J&#46; Petershack"
                            6 => "B&#46; Yoder"
                            7 => "L&#46; Giavedoni"
                            8 => "K&#46;H&#46; Albertine"
                            9 => "M&#46;J&#46; Dahl"
                            10 => "Z&#46;M&#46; Wang"
                            11 => "R&#46;I&#46; Clyman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1542/peds.2007-2051"
                      "Revista" => array:7 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2008"
                        "volumen" => "121"
                        "numero" => "5"
                        "paginaInicial" => "945"
                        "paginaFinal" => "956"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18450898"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            58 => array:3 [
              "identificador" => "bib59"
              "etiqueta" => "59&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Trends in outcomes for very preterm infants in the southern region of Sweden over a 10-year period"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "P&#46; Lundqvist"
                            1 => "K&#46; K&#228;ll&#233;n"
                            2 => "I&#46; Hallstr&#246;m"
                            3 => "L&#46;H&#46; Westas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1651-2227.2008.01155.x"
                      "Revista" => array:7 [
                        "tituloSerie" => "Acta Paediatr"
                        "fecha" => "2009"
                        "volumen" => "98"
                        "numero" => "4"
                        "paginaInicial" => "648"
                        "paginaFinal" => "653"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19133870"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735115/0000001600000002/v1_201305151526/S217351151070035X/v1_201305151526/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "9552"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original Article&#47;Artigo Original"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21735115/0000001600000002/v1_201305151526/S217351151070035X/v1_201305151526/en/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217351151070035X?idApp=UINPBA00004E"
]
Share
Journal Information
Vol. 16. Issue 2.
Pages 273-286 (March - April 2010)
Share
Share
Download PDF
More article options
Vol. 16. Issue 2.
Pages 273-286 (March - April 2010)
Full text access
Bronchopulmonary dysplasia: Clinical practices in five Portuguese neonatal intensive care units
Displasia broncopulmonar: Práticas clínicas em cinco unidades de cuidados intensivos neonatais
Visits
913
H. Guimarães1,
Corresponding author
herciliaguimaraes@gmail.com

Correspondence to/Correspondência: Serviço de Neonatologia/Departamento de Pediatria – Hospital de São João, Alameda Professor Hernâni Monteiro, 4202-451 Porto. Telephone: 00351 225095816, Fax: +225505919.
, G. Rocha1, G. Vasconcellos1, E. Proença2, M.L. Carreira3, M.R. Sossai4, B. Morais4, I. Martins5, T. Rodrigues6, M. Severo6
1 NICU, Hospital de S. João, Porto
2 Maternidade Júlio Dinis, Porto
3 Hospital de Santo António, Porto
4 Hospital Fernando da Fonseca, Amadora/Sintra
5 Hospital Pedro Hispano, Matosinhos
6 Departamento de Epidemiologia, Faculdade de Medicina da Universidade do Porto, Portugal/Department of Epidemiology, Faculty of Medicine of Porto University, Portugal
This item has received
Article information
Abstract

With the advent of surfactant, prenatal corticosteroids (PNC) and advances in technology, the survival rate of extremely low birth weight (ELBW) infants has improved dramatically. Rates of bronchopulmonary dysplasia (BPD) vary widely among neonatal intensive care units (NICUs) and many studies using multiple interventions have shown some improvement in BPD rates. Implementing potentially better practices to reduce BPD has been an effort made over the last few decades.

Aim

To compare five Portuguese NICUs in terms of clinical practices in very low birth weight (VLBW) infants, in order to develop better practices to prevent BPD.

Patients and methods

256 preterm neonates, gestational age (GA)<30 weeks and/or birthweight (BW)<1250g admitted to five Portuguese NICUs (centers 1 to 5) between 1st January 2004 and 31st December 2006, were studied. VLBW infants with major malformations, grade IV intraventricular haemorrhage in the first week of life and metabolic or neuromuscular disease were excluded. BPD was defined as oxygen dependency at 36 weeks of postconceptional age. We considered a practice to be improved as clinically significant whenever a decrease greater than 10% in the prevalence of BPD adjusted for the practice, GA and BW was achieved compared to BPD prevalence adjusted only for GA and BW.

Results

The overall prevalence of BPD was 12.9%. Our results revealed that PNC use should be improved in centers 4 and 5; fluid policy in center 4; oxygen therapy and sepsis prevention in centers 1 and 2. Patent ductus arteriosus (PDA) treatment should be improved in center 2.

Conclusion

The implementation of potentially better practices to reduce lung injury in neonates in Portuguese NICUs, according to each NICU, must be addressed to increase the prescription of PNC, to use a lower FiO2, to be careful with fluid administration in the first weeks of life and to prevent PDA and sepsis. It is necessary to follow guidelines, recommendations or protocols to improve quality in the prevention of BPD.

Key-words:
Bronchopulmonary dysplasia
neonatal intensive care
preterm infants
better practices
mechanical ventilation
oxygen therapy
prenatal corticosteroids
sepsis
patent ductus arteriosus
Resumo

Com o advento do surfactante, dos corticosteróides pré-natais e dos avanços na tecnologia, a sobrevida dos recém-nascidos de extremo baixo peso tem melhorado dramaticamente. As taxas de displasia broncopulmonar (DBP) variam amplamente entre unidades, e vários estudos, avaliando resultados de múltiplas intervenções, têm mostrado alguma melhoria na prevalência da DBP. A implementação de potenciais boas práticas na DBP tem sido adoptada por muitos serviços nas últimas décadas.

Objectivo

Comparar cinco unidades portuguesas de cuidados intensivos neonatais no que se refere as práticas clínicas no tratamento dos recém-nascidos de muito baixo peso, para desenvolver e melhorar as boas práticas na prevenção da DBP.

População e métodos

Foram estudados 256 recém-nascidos com a idade gestacional inferior a 30 semanas e/ou peso ao nascer inferior a 1250g, admitidos nas cinco unidades portuguesas (centros 1 a 5) entre 1 de Janeiro de 2004 e 31 de Dezembro de 2006. Foram excluídos os recém-nascidos com malformações major, hemorragia intraventricular grau IV na primeira semana de vida e com doença metabólica ou neuromuscular. Definimos DBP como a dependência do oxigénio às 36 semanas de idade pósconcepcional. A necessidade de melhorar determinada prática foi considerada significativa sempre que se verificava uma melhoria superior a 10% na prevalência da DBP ajustada para a prática, idade gestacional e peso ao nascer, comparada com a prevalência ajustada só para a idade gestacional e peso ao nascer.

Resultados

A prevalência global da DBP foi de 12,9%. Os resultados mostram que o uso de corticosteróides pré-natais deve ser melhorado nos centros 4 e 5; a política de fluidos deve ser melhorada no centro 4; o uso de oxigénio e a prevenção da sépsis deve ser melhorada nos centros 1 e 2. O tratamento do canal arterial patente deve ser melhorado no centro 2.

Conclusão

Neste estudo, a implementação de boas práticas para reduzir a lesão pulmonar nos recém-nascidos, de acordo com cada unidade, deve ser dirigida ao aumento da prescrição de corticosteróides pré-natais, ao uso de menor FiO2, ao uso criterioso de líquidos na primeiras semanas de vida, à prevenção do canal arterial patente e da sépsis. Guidelines, recomendações ou protocolos são necessários na melhoria da qualidade na prevenção da DBP.

Palavras-chave:
Displasia broncopulmonar
cuidados intensivos neonatais
recém-nascidos de pré-termo
boas práticas
ventilação mecânica
oxigénio
corticosteróides pré-natais
sépsis
canal arterial patente
Full text is only aviable in PDF
Bibliography
[1.]
W.H. Northway Jr., R.C. Rosan, D.Y. Porter.
Pulmonary disease following respirator therapy of hyaline-membrane disease. Bronchopulmonary dysplasia.
N Engl J Med, 276 (1967), pp. 357-368
[2.]
E. Bancalari, G.E. Abdenour, R. Feller, J. Gannon.
Bronchopulmonary dysplasia: clinical presentation.
J Pediatr, 95 (1979), pp. 819-823
[3.]
A.T. Shennan, M.S. Dunn, A. Ohlsson, K. Lennox, E.M. Hoskins.
Abnormal pulmonary outcomes in premature infants: prediction from oxygen requirement in the neonatal period.
Pediatrics, 82 (1988), pp. 527-532
[4.]
M.C. Walsh, Q. Yao, P. Gettner, E. Hale, M. Collins, A. Hensman, R. Everette, N. Peters, N. Miller, G. Muran, K. Auten, N. Newman, G. Rowan, C. Grisby, K. Arnell, L. Miller, B. Ball, G. McDavid.
National Institute of Child Health and Human Development Neonatal Research Network. Impact of a physiologic definition on bronchopulmonary dysplasia rates.
Pediatrics, 114 (2004), pp. 1305-1311
[5.]
R.A. Ehrenkranz, M.C. Walsh, B.R. Vohr, A.H. Jobe, L.L. Wright, A.A. Fanaroff, L.A. Wrage, K. Poole.
National Institutes of Child Health and Human Development Neonatal Research Network Validation of the National Institutes of Health consensus definition of bronchopulmonary dysplasia.
Pediatrics, 116 (2005), pp. 1353-1360
[6.]
I.R.S. Sosenko, E. Bancalari.
New developments in the presentation, pathogenesis, epidemiology and prevention of bronchopulmonary dysplasia.
The Newborn Lung Eduardo Bancalari, Richard A Polin. Saunders Elsevier, (2008),
[7.]
Crossing the Quality Chasm.
A new health system for the 21st century.
National Academy, (2001),
[8.]
N.R. Payne, M. LaCorte, P. Karna, S. Chen, M. Finkelstein, J.P. Goldsmith, J.H. Carpenter, Breathsavers Group.
Vermont Oxford Network Neonatal Intensive Care Quality Improvement Collaborative. Reduction of bronchopulmonary dysplasia after participation in the Breathsavers Group of the Vermont Oxford Network Neonatal Intensive Care Quality Improvement Collaborative.
Pediatrics, 118 (2006), pp. S73-S77
[9.]
N.R. Payne, M. LaCorte, S. Sun, P. Karna, M. Lewis-Hunstiger, J.P. Goldsmith, Breathsavers Group.
Evaluation and development of potentially better practices to reduce bronchopulmonary dysplasia in very low birth weight infants.
Pediatrics, 118 (2006), pp. S65-S72
[10.]
K. Burch, W. Rhine, R. Baker, F. Litman, J.W. Kaempf, E. Schwarz, S. Sun, N.R. Payne, P.J. Sharek.
Implementing potentially better practices to reduce lung injury in neonates.
Pediatrics, 111 (2003), pp. e432-e436
[11.]
P.J. Sharek, R. Baker, F. Litman, J. Kaempf, K. Burch, E. Schwarz, S. Sun, N.R. Payne.
Evaluation and development of potentially better practices to prevent chronic lung disease and reduce lung injury in neonates.
Pediatrics, 111 (2003), pp. e426-e431
[12.]
A.H. Jobe, E. Bancalari.
Bronchopulmonarydysplasia.
Am J Respi Crit Care Med, 163 (2001), pp. 1723-1729
[13.]
H. MacDonald.
American Academy of Pediatrics. Committee on Fetus and Newborn. Perinatal Care at the Threshold of Viability.
Pediatrics, 110 (2002), pp. 1024-1027
[14.]
J.L. Ballard, J.C. Khoury, K. Wedig, L. Wang, B.L. Eilers-Walsman, R. Lipp.
New ballard score, expanded to include extremely premature infants.
J Pediatr, 119 (1991), pp. 417-423
[15.]
A.J. Rudolph, C.A. Smith.
Idiopathic respiratory distress syndrome of the newborn.
J Pediatr, 57 (1960), pp. 905-921
[16.]
M.C. Walsh, R.M. Kliegman.
Necrotizing enterocolitis: treatment based on staging criteria.
Ped Clin N Am, 33 (1986), pp. 179-201
[17.]
An International classification of retinopathy of prematurity.
Pediatrics, 74 (1984), pp. 127-133
[18.]
The international classification of retinopathy of prematurity revisited., International Committee for the Classification of Retinopathy of Prematurity.
Arch Ophthalmol, 123 (2005), pp. 991-999
[19.]
L.A. Papile, J. Burstein, R. Burstein.
Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birthweights less than 1500g.
J Pediatr, 92 (1978), pp. 529-534
[20.]
L. de Vries, J.M. Rennie.
Preterm brain injury.
Textbook of neonatology, 3rd edition., pp. 1252-1270
[21.]
E. Bancalari, N. Claure, I.R. Sosenko.
Bronchopulmonary dysplasia: changes in pathogenesis, epidemiology and definition.
Semin Neonatol, 8 (2003), pp. 63-71
[22.]
M. Walsh, W. Engle, A. Laptook, S.N. Kazzi, S. Buchter, M. Rasmussen, Q. Yao.
National Institute of Child Health and Human Development Neonatal Research Network. Oxygen delivery through nasal cannulae to preterm infants: can practice be improved?.
Pediatrics, 116 (2005), pp. 857-861
[23.]
P. Crowley.
Prophylactic corticosteroids for preterm birth.
Cochrane Database Syst Rev, 18 (2007),
[24.]
D. Roberts, S. Dalziel.
Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth.
Cochrane Database Syst Rev, 19 (2006),
[25.]
National Institutes of Health Consensus Development Panel.
Antenatal corticosteroids revisited: repeat courses – National Institutes of Health Consensus Development Conference Statement. August 17–18, 2000.
Obstet Gynecol, 98 (2001), pp. 144-150
[26.]
C.A. Crowther, J.E. Harding.
Repeat doses of prenatal corticosteroids for women at risk of preterm birth for preventing neonatal respiratory disease.
Cochrane Database Syst Rev, 18 (2007),
[27.]
Collaborative European Multicenter Study Group.
Surfactant replacement therapy for severe neonatal respiratory distress syndrome: an international randomized clinical trial.
Pediatrics, 82 (1988), pp. 683-691
[28.]
U. Chotigeat, N. Promwong, W. Kanjanapattanakul, M. Khorana, V. Sangtawesin, S. Horpaopan.
Comparison outcomes of surfactant therapy in respiratory distress syndrome in two periods.
J Med Assoc Thai, 91 (2008), pp. S109-S114
[29.]
Halliday HL, O'Neil CP. What is the evidence for drug therapy in the prevention and management of bronchopulmonary dysplasia? In: The newborn lung. Neonatal questions and controversies. Eduardo Bancalari. Ed Richard A Polin. Saunders Elsevier 2008; 208-232.
[30.]
T.P. Stevens, E.W. Harrington, M. Blennow, R.F. Soll.
Early surfactant administration with brief ventilation vs. selective surfactant and continued mechanical ventilation for preterm infants with or at risk for respiratory distress syndrome.
Cochrane Database Syst Rev, 17 (2007),
[31.]
R. Soll, E. Ozek.
Multiple versus single doses of exogenous surfactant for the prevention or treatment of neonatal respiratory distress syndrome.
Cochrane Database Syst Rev, 21 (2009),
[32.]
R.J. Ramanathan.
Surfactant therapy in preterm infants with respiratory distress syndrome and in nearterm or term newborns with acute RDS.
Perinatol, 26 (2006), pp. S63-S64
[33.]
VLBW infants in Portugal. National Multicenter Study, 1996–2000.
Portuguese Neonatal Network.
Bial Award of Clinical Medicine, (2002),
[34.]
R. Ramanathan.
Choosing a right surfactant for respiratory distress syndrome treatment.
Neonatology, 95 (2009), pp. 1-5
[35.]
W. Oh, B.B. Poindexter, R. Perritt, J.A. Lemons, C.R. Bauer, R.A. Ehrenkranz, B.J. Stoll, K. Poole, L.L. Wright, Neonatal Research Network.
Association between fluid intake and weight loss during the first ten days of life and risk of bronchopulmonary dysplasia in extremely low birth weight infants.
J Pediatr, 147 (2005), pp. 786-790
[36.]
B.E Stephens, M.J. Gargus, R.V. Walden, N. Mance, J. Nye, L. McKinley, R. Tucker, B.R. Vohr.
Fluid regimens in the first week of life may increase risk of patent ductus arteriosus in extremely low birth weight infants.
J Perinatol, 28 (2008), pp. 123-128
[37.]
E.F. Bell, M.J. Acarregui.
Restricted versus liberal water intake for preventing morbidity and mortality in preterm infants.
Cochrane Database Syst Rev, (2008),
[38.]
R. Ramanathan.
Optimal ventilatory strategies and surfactant to protect the preterm lungs.
Neonatology, 93 (2008), pp. 302-308
[39.]
K. Bohlin, B. Jonsson, A.S. Gustafsson, M. Blennow.
Continuous positive airway pressure and surfactant.
Neonatology, 93 (2008), pp. 309-315
[40.]
R. Ramanathan, S. Sardesai.
Lung protective ventilatory strategies in very low birth weight infants.
J Perinatol, 28 (2008), pp. S41-S46
[41.]
D. Patel, A. Greenough.
Does nasal CPAP reduce bronchopulmonary dysplasia (BPD)?.
Acta Paediatr, 97 (2008), pp. 1314-1317
[42.]
O.D. Saugstad.
Take a breath – but do not add oxygen (if not needed).
Acta Paediatr, 96 (2007), pp. 798-800
[43.]
O.D. Saugstad, S. Ramji, R.F. Soll, M. Vento.
Resuscitation of newborn infants with 21% or 100% oxygen: an updated systematic review and meta-analysis.
Neonatology, 94 (2008), pp. 176-182
[44.]
W. Tin, S. Gupta.
Optimum oxygen therapy in preterm babies.
Arch Dis Child Fetal Neonatal., 92 (2007), pp. F143-F147
[45.]
A. Sola.
Oxygen in neonatal anesthesia: friend or foe?.
Curr Opin Anaesthesiol, 21 (2008), pp. 332-339
[46.]
STOP-ROP Multicenter Study Group.
Supplemental therapeutic oxygen for pretreshold retinopathy of prematurity (STOP-ROP), a randomized controlled trial. I: Primary outcomes.
Pediatrics, 105 (2000), pp. 295-310
[47.]
W. Tin, T.E. Wiswell.
Adjunctive therapies in chronic lung disease: examining the evidence.
Semin Fetal Neonatal Med, 13 (2008), pp. 44-52
[48.]
C.P. Speer.
Inflammation and bronchopulmonary dysplasia: a continuing story.
Semin Fetal Neonatal Med, 11 (2006), pp. 354-362
[49.]
C.L. Bose, C.E. Dammann, M.M. Laughon.
Bronchopulmonary dysplasia and inflammatory biomarkers in the premature neonate.
Arch Dis Child Fetal Neonatal, 93 (2008), pp. F455-F461
[50.]
P. Groneck, J. Schmale, V. Soditt, H. Stützer, B. Götze-Speer, C.P. Speer.
Bronchoalveolar inflammation following airway infection in preterm infants with chronic lung disease.
Pediatr Pulmonol, 31 (2001), pp. 331-338
[51.]
G. Rocha, E. Proença, C. Quintas, T. Rodrigues, H. Guimarães.
Chorioamnionitis and lung damage in the extremely low birth weight infant.
Rev Port Pneumol, 3 (2007), pp. 745-754
[52.]
A. Gonzalez, I.R. Sosenko, J. Chandar, H. Hummler, N. Claure, E. Bancalari.
Influence of infection on patent ductus arteriosus and chronic lung disease in premature infants weighing 1000 grams or less.
J Pediatr, 128 (1996), pp. 470-478
[53.]
M. Liljedahl, L. Bodin, J. Schollin.
Coagulase-negative staphylococcal sepsis as a predictor of bronchopulmonary dysplasia.
Acta Paediatr, 93 (2004), pp. 211-215
[54.]
M. Moro, J. Pérez-Rodriguez, J. Figueras-Aloy, C. Fernández, E. Doménech, R. Jiménez, V. Pérez-Sheriff, J. Quero, V. Roques.
Predischarge morbidities in extremely and very low-birth-weight infants in spanish neonatal units.
Am J Perinatol, (2008), pp. 17
[55.]
S.G. Golombek, A. Sola, H. Baquero, D. Borbonet, F. Cabañas, C. Fajardo, G. Goldsmit, L. Lemus, E. Miura, A. Pellicer, J.M. Pérez, M. Rogido, G. Zambosco, B. van Overmeire, S.G. Golombek, A. Sola, R. Clyman, B. van Overmeire, G. Goldsmit, D. Natta, G. Zambosco, E. Miura, J.M. Péerez, C. Weissheimer, H. Baquero, J. García Harker, A.N. Oviedo Barrantes, M. Morgues, J.L. Tapia, F. Domínguez, M. Majano, F. Cabañas, Pellicer A., H. Cruz, C. Fajardo, M. Rogido, L. Lemus, A.V. Origel, Lacarruba J.M., M. Lee, J. Tresierra, H. Guimarães, R. Bustos, D. Borbonet, J.L. Perales.
First SIBEN clinical consensus: diagnostic and therapeutic approach to patent ductus arteriosus in premature newborns.
An Pediatr, 69 (2008), pp. 454-481
[56.]
A. Ohlsson, R. Walia, S. Shah.
Ibuprofen for the treatment of patent ductus arteriosus in preterm and/or low birth weight infants.
Cochrane Database Syst Rev, 23 (2008),
[57.]
R. Mosalli, K. Alfaleh.
Prophylactic surgical ligation of patent ductus arteriosus for prevention of mortality and morbidity in extremely low birth weight infants.
Cochrane Database Syst Rev, 23 (2008),
[58.]
D. McCurnin, S. Seidner, L.Y. Chang, N. Waleh, M. Ikegami, J. Petershack, B. Yoder, L. Giavedoni, K.H. Albertine, M.J. Dahl, Z.M. Wang, R.I. Clyman.
Ibuprofen-induced patent ductus arteriosus closure: physiologic, histologic, and biochemical effects on the premature lung.
Pediatrics, 121 (2008), pp. 945-956
[59.]
P. Lundqvist, K. Källén, I. Hallström, L.H. Westas.
Trends in outcomes for very preterm infants in the southern region of Sweden over a 10-year period.
Acta Paediatr, 98 (2009), pp. 648-653
Copyright © 2010. Sociedade Portuguesa de Pneumologia
Download PDF
Pulmonology
Article options
Tools

Are you a health professional able to prescribe or dispense drugs?