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Viral respiratory tract infections in the neonatal intensive care unit
Infecciones virales de las vías respiratorias en la Unidad de Cuidados Intensivos Neonatales
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"apellidos" => "Casas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Neonatología y Pediatría, Hospital Severo Ochoa, Leganés, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Laboratorio de Virus Respiratorios y Gripe, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Infecciones virales de las vías respiratorias en la Unidad de Cuidados Intensivos Neonatales" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Viral respiratory infections are transmitted from person to person. Many of the viruses that cause them are carried asymptomatically in the nasopharynx<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">1</span></a> and symptoms may not show until several days later. Although these diseases are mild in most cases, newborns, and especially those born preterm or with low birth weight, are at high risk of respiratory tract infection with severe symptoms such as respiratory distress, apnoea or haemodynamic instability. These symptoms often cannot be distinguished from symptoms caused by bacterial infections or other diseases associated to prematurity, such as enterocolitis, nosocomial sepsis or apnoea of prematurity, so respiratory viruses are not the only causative agents under consideration. Yet, we know that common viral respiratory tract infections, such as infection by respiratory syncytial virus (RSV), cause considerable morbidity and mortality in preterm patients as well as severe disease outbreaks in neonatal intensive care units (NICUs).<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">2,3</span></a> In addition to classical viruses like RSV and influenza viruses, rhinovirus (RV), human metapneumovirus (hMPV), coronavirus (CoV) and human bocavirus (hBoV) play an increasingly important role in respiratory tract infections in infants. Very little is known about their role in neonatal units,<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">4,5</span></a> although we have demonstrated that they are associated with relevant pathology in our unit.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">6,7</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Neonatal units devote considerable effort to set up measures to prevent infection, such as the use of hygiene measures of proved effectiveness by any staff that comes in contact with the infants: applying alcohol gel before and after manipulating the child, wearing gloves, frequent handwashing, prevention of catheter-related sepsis by monitoring the catheter and withdrawing it as early as possible, and the prudent use of antibiotics.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Neonatal units have changed dramatically in recent years, offering a more holistic care to the neonate and his or her family and a more humane approach that is manifested in the full participation of parents in the care of the child at any time of day or night; that is, an open-door policy. Educating the parents on the hygiene protocols before and during their stay in the unit allows them to be part of the team that cares for the infant. Our NICU (which belongs to a secondary hospital that attends 1800 births a year) has an open-door policy that allows parents to be involved in the infant's care.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Our aim was to assess the presence (symptomatic and asymptomatic) of 16 respiratory viruses in term and preterm neonates admitted to the NICU, and to describe the associated clinical manifestations.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">We performed a prospective cohort study at the Hospital Severo Ochoa (Leganés, Madrid) to assess the incidence, aetiology and clinical characteristics of viral respiratory infections in neonates that required admission to the NICU for 2 or more weeks. Patients were enrolled between November 2011 and May 2013. The study was funded by grant number 09/00246 of the Fondo de Investigaciones Sanitarias and approved by the Medical Ethics Committee of the Hospital Severo Ochoa. The parents signed an informed consent form before patients were included in the study.</p><p id="par0030" class="elsevierStylePara elsevierViewall">We collected a nasopharyngeal aspirate (NPA) sample the first day of life and weekly until discharge. When infants developed respiratory symptoms such as cough, respiratory distress, rhinorrhoea and longer than usual apnoeic pauses with or without fever, an additional NPA sample was collected at the moment. The neonatologist filled out a clinical form for each episode.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The NPA specimens were sent to the Unidad de Virus Respiratorios y Gripe (Unit of Respiratory Viruses and Influenza) of the Centro Nacional de Gripe (National Influenza Centre) of the World Health Organisation, the Instituto de Salud Carlos III, in Madrid, Spain. This unit subjected the specimens to three nested real-time polymerase chain reaction (RT-PCR) assays for the detection of a total of 16 respiratory viruses, as reported in previous publications.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">8–10</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">We have expressed discrete variables as percentages and continuous variables as mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>standard deviation (SD). We compared the variables corresponding to clinical and laboratory characteristics by means of Student's <span class="elsevierStyleItalic">t</span> test, the Mann–Whitney <span class="elsevierStyleItalic">U</span> test, the χ<span class="elsevierStyleSup">2</span> test and Fisher's exact test. We set the level of statistical significance (for two-tailed tests) at <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.05. The statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS), version 13.0.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">The study included 66 infants (all but one born preterm), six of which (9%) were withdrawn from the study by their parents during followup. We analysed the data for a total of 60 infants: 33 (55%) were female; 30 (50%) had a gestational age below 32 weeks; and 36 (60%) weighed less than 1500<span class="elsevierStyleHsp" style=""></span>g. Mechanical ventilation was required by 41.7% of the patients (mean duration<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>SD, 2.31<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.73 days) and continuous positive airway pressure (CPAP) by 31.7% (mean duration<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>SD, 2.45<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.74<span class="elsevierStyleHsp" style=""></span>h).</p><p id="par0050" class="elsevierStylePara elsevierViewall">A total of 256 NPA samples were collected, and 24 tested positive (9.3%); none of the positive specimens had been collected in the first day of life. The virus identified most frequently was RV, detected in 19 (79%) of the positive samples, followed by adenovirus (2 cases), CoV (3 cases) and hMPV (1 case). One patient had a RV and CoV coinfection. There were no cases of RSV or influenza. The positive NPA specimens were obtained at a mean of 35<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>21 days (range, 8–68; median, 30). We observed a higher frequency of samples positive for respiratory viruses in patients younger than 32 weeks and with weights below 1500<span class="elsevierStyleHsp" style=""></span>g (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.05 and <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001, respectively).</p><p id="par0055" class="elsevierStylePara elsevierViewall">The 24 positive samples corresponded to 13 infants (21.6% of the patients), of which 9 (69%) developed symptoms, with a total 11 infectious episodes (2 patients had 2 separate episodes with a negative test result in between). <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the clinical characteristics of the episodes of respiratory infection. The symptoms found most frequently were the presence or greater number of apnoeic episodes (75%) and the need for oxygen therapy. None of the patients required mechanical ventilation, and only one patient received noninvasive ventilation. Fever occurred in 45% of the infectious episodes.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Laboratory analyses were performed in 7 (64%) of the 11 infectious episodes; only one patient had leukocytosis (32,000/mL). Blood cultures were performed in 4 (36%) cases, and the results were negative for all. Antibiotic therapy was initiated in one patient for suspected sepsis. Five infants underwent chest radiographs, and atelectasis was found in one. All patients recovered.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Four of the children with positive samples did not develop clinical symptoms (three had RV 3 and one CoV OC43). One of the symptomatic infants had prolonged shedding of RV for 8 weeks. No tests were performed on the healthcare staff or the parents.</p><p id="par0070" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> compares the clinical data of the patients, (symptomatic and asymptomatic), with obtaining a positive result in the viral assays. Of the 13 infants that had a positive viral isolate, 5 (38%) developed bronchopulmonary dysplasia. One of them had an asymptomatic infection by CoV OC43 and the other 4 symptomatic infections by RV or adenovirus. Of the children that did not have a positive viral isolate, 3 (6.4%) were diagnosed with bronchopulmonary dysplasia (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">.</span>009).</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">Nosocomial infections are among the major causes of morbidity, prolonged hospitalisation and mortality in neonates, especially in those born preterm. Most of the scientific literature focuses on bacterial or fungal infections and does not consider respiratory viruses, except for RSV.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">11</span></a> We present the results of a prospective cohort study in 16 viral respiratory infections conducted in the NICU of a secondary hospital. Viral respiratory infections, especially those by RV, are fairly frequent in the neonatal unit and are associated with episodes of apnoea and the need for respiratory support, especially in preterm newborns of less than 32 weeks of gestational age or with weights below 1500<span class="elsevierStyleHsp" style=""></span>g.</p><p id="par0080" class="elsevierStylePara elsevierViewall">The advent of PCR techniques has revealed the involvement in lower respiratory tract infections in children, and that this is one of the most important viruses overall in the epidemiology of respiratory infections. Various groups have recently identified RV as the causative agent of respiratory infection outbreaks in neonatal units. Reid et al.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">5</span></a> described an outbreak of infection by RV type C in 7 infants in a paediatric and neonatal intensive care unit, 5 of which had clinically relevant episodes of apnoea and required respiratory support or oxygen therapy. Van Piggelen et al.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">12</span></a> described 7 severe nosocomial infections associated to RV in the NICU over a period of 5 years, all of which were associated with respiratory distress and required ventilatory support. In both studies, respiratory infections were suspected and a viral aetiology was actively explored. The clinical data of these two studies are similar to those obtained in our cohort.</p><p id="par0085" class="elsevierStylePara elsevierViewall">However, our data show that respiratory viruses are responsible for a considerable number of disease episodes that worsen respiratory status and that are attributed to prematurity when in fact they are due to viral infections. We only found a similar study that focused on detecting unrecognised respiratory viral infections in preterm neonates admitted after delivery. In this prospective study, which had a design similar to ours, Bennett et al.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">13</span></a> observed that 52% of the 60 preterm neonates tested for viral detection had positive results during their stay. This group of neonates had longer lengths of stay, prolonged respiratory support, and a higher incidence of bronchopulmonary dysplasia. In our patients, the proportion of bronchopulmonary dysplasia was also greater in infants in whom a virus had been detected, but the group of children that tested negative for viruses had a greater gestational age, a circumstance that may lead to misinterpretation of the results. The proportions of the viruses detected by Bennett et al. differed somewhat from ours, with a high prevalence of RSV, parainfluenza virus and hMPV, especially in the winter. Rhinovirus was detected in only 27% of the patients. The lower incidence of viral infections by RSV or influenza in our group may have been due to our meticulous adherence to the preventive measures against nosocomial infections.</p><p id="par0090" class="elsevierStylePara elsevierViewall">We agree with Bennett in thinking that while there are descriptions of outbreaks of viral respiratory infections in NICUs, these studies substantiate the importance of systematic surveillance for detecting infections that would otherwise not be recognised. Preterm infants may present few or atypical symptoms, and the detection of viral infections may have profound clinical consequences. Our study was limited by the small number of patients included in it, so it is important that other prospective studies are performed to elucidate the actual role of viral respiratory infections in neonatal units.</p><p id="par0095" class="elsevierStylePara elsevierViewall">We did not explore the sources of the infections, but the infants only had contact with their parents and the healthcare staff. And while we presumably adhere rigorously to preventive measures against nosocomial infections including the use of gloves, handwashing before and after each contact with a patient, and having any individual with respiratory symptoms wear a mask, transmission of respiratory viruses does occur and we should explore new preventive strategies.</p><p id="par0100" class="elsevierStylePara elsevierViewall">In short, we found that RV may be the cause of respiratory infections in preterm neonates during their stay in the NICU, and that preterm infants are at high risk of acquiring clinically significant infections of this kind. Viral respiratory infections should be ruled out in infants with rhinorrhoea, apnoea, high oxygen requirements and clinical suspicion of sepsis. We must apply rigorous measures for infection prevention and possibly introduce additional hygiene measures.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Funding</span><p id="par0105" class="elsevierStylePara elsevierViewall">This study has been funded by the <span class="elsevierStyleGrantSponsor" id="gs1">Instituto Nacional de Salud de España</span> (ISCIII, Fondo de Investigaciones Sanitarias), PI 09/00246 and PI 12/0129.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflicts of interest</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres502757" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec523915" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres502758" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec523916" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Patients and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-04-23" "fechaAceptado" => "2014-05-26" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec523915" "palabras" => array:4 [ 0 => "Rhinovirus" 1 => "Respiratory syncytial virus" 2 => "Respiratory tract infections" 3 => "Preterm infants" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec523916" "palabras" => array:4 [ 0 => "Rinovirus" 1 => "Virus respiratorio sincitial" 2 => "Infecciones del tracto respiratorio" 3 => "Pretérmino" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Viral respiratory infections cause major morbidity and mortality in preterm infants. We have performed a prospective study in our neonatal intensive care unit (NICU) to determine the incidence of respiratory infections, their impact and the epidemiology and outcome in high risk neonates.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">From September 2011 to May 2013 a prospective study was conducted in all preterm infants <32 weeks gestational age and in all term newborns admitted to NICU for any pathology that was anticipated to have an admission exceeding two weeks. A nasopharyngeal aspirate (NPA) was collected the first day of life and weekly until discharge for virologic study with polymerase chain reaction. When these babies presented respiratory symptoms a new NPA was collected at this moment. A clinical form was filled by the physician.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 60 infants were analysed: 30 (50%) had a gestational age <32 weeks and 36 (60%) weighed less than 1500<span class="elsevierStyleHsp" style=""></span>g. We collected a total of 256 nasopharyngeal aspirate samples, 24 of them being positive (9.3%). These 24 positive samples corresponded to 13 infants in our cohort (21.6% of the patients). Of them, 9 were symptomatic and had 11 episodes of infection (2 patients had two different episodes with negative control between them). The most frequently identified virus was rhinovirus in (19) 79% of cases. The most frequent clinical data was the presence or increase in apneas (75%) and the need for oxygenotherapy.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">HRV infections are prevalent in the NICU, and preterm infants have a high risk of infections with clinical relevance.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Las infecciones virales respiratorias son causa de importante morbimortalidad en recién nacidos prematuros. Hemos realizado un estudio prospectivo en nuestra unidad de cuidados intensivos neonatales (UCIN) para determinar la incidencia de infecciones respiratorias, su impacto, epidemiología y pronóstico en neonatos de alto riesgo.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio prospectivo realizado entre septiembre del 2011 y mayo del 2013 entre todos los recién nacidos < 32 semanas de edad gestacional y aquellos niños cuya patología pudiera dar lugar a pensar en un ingreso superior a las 2 semanas. Se recogieron aspirados nasofaríngeos (ANF) el primer día de vida y semanalmente hasta el alta para estudio virológico mediante reacción en cadena de polimerasa. En los casos en los que los niños presentaban síntomas respiratorios, se procedió a recoger un nuevo ANF. El pediatra cumplimentó un cuestionario con los datos clínicos.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se estudió a 60 niños; 30 (50%) de ellos con una edad gestacional <32 semanas y 36 (60%) con un peso <1.500<span class="elsevierStyleHsp" style=""></span>g. Se recogió un total de 256 ANF, 24 de los cuales resultaron positivos (9,3%). Estas 24 muestras positivas correspondieron solo a 13 niños (21,6% de los pacientes). De ellos, 9 resultaron sintomáticos y presentaron 11 episodios de infección (2 pacientes experimentaron 2 episodios diferentes con control negativo entre ellos). El virus más frecuentemente identificado – el 79% de las muestras (19) – fue el rinovirus (RV). El dato clínico más frecuente fue la presencia o incremento de apneas (75%) y la necesidad de oxigenoterapia.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Las infecciones por RV son frecuentes en la UCIN y los recién nacidos pretérmino tienen un alto riesgo de presentar infecciones de relevancia clínica.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Gonzalez-Carrasco E, Calvo C, García-García ML, Beato M, Muñoz-Archidona C, Pozo F, et al. Infecciones virales de las vías respiratorias en la Unidad de Cuidados Intensivos Neonatales. An Pediatr (Barc). 2015;82:242–246.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">CMV: conventional mechanical ventilation; CPAP: continuous positive airway pressure; NSD: no significant differences.</p>" "tablatextoimagen" => array:2 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Viral infection \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">No infection \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>13 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>47 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Male sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (54%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 (46%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NSD \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Weight<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>1500<span class="elsevierStyleHsp" style=""></span>g \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (84%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 (51%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">.</span>03 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Weight (g) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1151<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>347 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1551<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>603 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">.</span>026 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Gestational age<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>31 weeks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (61.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 (32%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">.</span>05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Gestational age (weeks) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29.4<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>3.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31.4<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>2.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">.</span>04 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Bronchopulmonary dysplasia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (38.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (6.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">.</span>03 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Length of stay (days) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51.8<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40.1<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">.</span>171 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab802078.png" ] ] 1 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>11 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Clinical data (signs and symptoms)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Greater number of apnoea episodes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 (72%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Rhinorrhoea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 (63%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Fever \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 (45%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cough \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Respiratory support</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Environmental oxygen \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9 (81%) (maximum FiO<span class="elsevierStyleInf">2</span>, 0.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Nasal cannula \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 (45%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>CPAP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1(9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>CMV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (18%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab802079.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Clinical characteristics of patients with and without viral respiratory infection (symptomatic or asymptomatic).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:13 [ 0 => array:3 [ "identificador" => "bib0070" "etiqueta" => "1" 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 9 | 13 |
| 2024 October | 43 | 35 | 78 |
| 2024 September | 53 | 23 | 76 |
| 2024 August | 53 | 60 | 113 |
| 2024 July | 36 | 25 | 61 |
| 2024 June | 54 | 39 | 93 |
| 2024 May | 38 | 34 | 72 |
| 2024 April | 49 | 39 | 88 |
| 2024 March | 32 | 26 | 58 |
| 2024 February | 43 | 20 | 63 |
| 2024 January | 31 | 22 | 53 |
| 2023 December | 41 | 23 | 64 |
| 2023 November | 28 | 17 | 45 |
| 2023 October | 35 | 31 | 66 |
| 2023 September | 25 | 23 | 48 |
| 2023 August | 38 | 24 | 62 |
| 2023 July | 29 | 30 | 59 |
| 2023 June | 32 | 30 | 62 |
| 2023 May | 48 | 22 | 70 |
| 2023 April | 24 | 14 | 38 |
| 2023 March | 55 | 28 | 83 |
| 2023 February | 56 | 20 | 76 |
| 2023 January | 37 | 20 | 57 |
| 2022 December | 67 | 25 | 92 |
| 2022 November | 72 | 35 | 107 |
| 2022 October | 49 | 40 | 89 |
| 2022 September | 51 | 25 | 76 |
| 2022 August | 61 | 51 | 112 |
| 2022 July | 33 | 29 | 62 |
| 2022 June | 41 | 35 | 76 |
| 2022 May | 72 | 35 | 107 |
| 2022 April | 67 | 31 | 98 |
| 2022 March | 89 | 66 | 155 |
| 2022 February | 58 | 26 | 84 |
| 2022 January | 49 | 29 | 78 |
| 2021 December | 51 | 29 | 80 |
| 2021 November | 49 | 45 | 94 |
| 2021 October | 101 | 51 | 152 |
| 2021 September | 51 | 45 | 96 |
| 2021 August | 50 | 35 | 85 |
| 2021 July | 34 | 30 | 64 |
| 2021 June | 46 | 22 | 68 |
| 2021 May | 49 | 24 | 73 |
| 2021 April | 168 | 83 | 251 |
| 2021 March | 107 | 31 | 138 |
| 2021 February | 49 | 17 | 66 |
| 2021 January | 70 | 16 | 86 |
| 2020 December | 51 | 9 | 60 |
| 2020 November | 54 | 24 | 78 |
| 2020 October | 90 | 21 | 111 |
| 2020 September | 123 | 20 | 143 |
| 2020 August | 80 | 31 | 111 |
| 2020 July | 63 | 42 | 105 |
| 2020 June | 62 | 3 | 65 |
| 2020 May | 43 | 21 | 64 |
| 2020 April | 48 | 23 | 71 |
| 2020 March | 44 | 21 | 65 |
| 2020 February | 50 | 22 | 72 |
| 2020 January | 50 | 15 | 65 |
| 2019 December | 53 | 19 | 72 |
| 2019 November | 38 | 10 | 48 |
| 2019 October | 42 | 16 | 58 |
| 2019 September | 42 | 25 | 67 |
| 2019 August | 43 | 21 | 64 |
| 2019 July | 34 | 24 | 58 |
| 2019 June | 24 | 33 | 57 |
| 2019 May | 64 | 46 | 110 |
| 2019 April | 54 | 28 | 82 |
| 2019 March | 51 | 15 | 66 |
| 2019 February | 52 | 24 | 76 |
| 2019 January | 42 | 23 | 65 |
| 2018 December | 41 | 16 | 57 |
| 2018 November | 67 | 32 | 99 |
| 2018 October | 94 | 18 | 112 |
| 2018 September | 59 | 18 | 77 |
| 2018 August | 1 | 0 | 1 |
| 2018 June | 6 | 0 | 6 |
| 2018 May | 3 | 0 | 3 |
| 2018 April | 20 | 0 | 20 |
| 2018 March | 27 | 0 | 27 |
| 2018 February | 9 | 0 | 9 |
| 2018 January | 21 | 0 | 21 |
| 2017 December | 21 | 0 | 21 |
| 2017 November | 26 | 0 | 26 |
| 2017 October | 22 | 0 | 22 |
| 2017 September | 20 | 0 | 20 |
| 2017 August | 17 | 0 | 17 |
| 2017 July | 15 | 0 | 15 |
| 2017 June | 30 | 22 | 52 |
| 2017 May | 19 | 11 | 30 |
| 2017 April | 18 | 7 | 25 |
| 2017 March | 13 | 21 | 34 |
| 2017 February | 8 | 14 | 22 |
| 2017 January | 12 | 2 | 14 |
| 2016 December | 44 | 19 | 63 |
| 2016 November | 34 | 9 | 43 |
| 2016 October | 55 | 13 | 68 |
| 2016 September | 57 | 7 | 64 |
| 2016 August | 47 | 12 | 59 |
| 2016 July | 18 | 8 | 26 |
| 2016 March | 1 | 0 | 1 |
| 2016 February | 1 | 0 | 1 |
| 2016 January | 2 | 0 | 2 |
| 2015 December | 10 | 14 | 24 |
| 2015 November | 2 | 9 | 11 |
| 2015 October | 13 | 10 | 23 |
| 2015 September | 1 | 8 | 9 |
| 2015 August | 2 | 13 | 15 |
| 2015 July | 4 | 0 | 4 |
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