Scientific Letter
Clinical and epidemiological characteristics of neonatal influenza
Características clínicas y epidemiológicas de la gripe neonatal
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Moreno-Pérez, A. Andrés Martín, A. Tagarro García, A. Escribano Montaner, J. Figuerola Mulet, J.J. García García, A. Moreno-Galdó, C. Rodrigo Gonzalo de Liria, J. Ruiz Contreras, J. Saavedra Lozano" "autores" => array:11 [ 0 => array:2 [ "nombre" => "D." "apellidos" => "Moreno-Pérez" ] 1 => array:2 [ "nombre" => "A. Andrés" "apellidos" => "Martín" ] 2 => array:2 [ "nombre" => "A. Tagarro" "apellidos" => "García" ] 3 => array:2 [ "nombre" => "A. Escribano" "apellidos" => "Montaner" ] 4 => array:2 [ "nombre" => "J. Figuerola" "apellidos" => "Mulet" ] 5 => array:2 [ "nombre" => "J.J. García" "apellidos" => "García" ] 6 => array:2 [ "nombre" => "A." "apellidos" => "Moreno-Galdó" ] 7 => array:2 [ "nombre" => "C. Rodrigo Gonzalo" "apellidos" => "de Liria" ] 8 => array:2 [ "nombre" => "J. Ruiz" "apellidos" => "Contreras" ] 9 => array:2 [ "nombre" => "J. Saavedra" "apellidos" => "Lozano" ] 10 => array:1 [ "colaborador" => "representing the Sociedad Española de Infectología Pediátrica (SEIP), Sociedad Española de Neumología Pediátrica (SENP) and the Comité Asesor de Vacunas de la Asociación Española de Pediatría (CAV-AEP)" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1695403314005219" "doi" => "10.1016/j.anpedi.2014.10.028" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403314005219?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287915001854?idApp=UINPBA00005H" "url" => "/23412879/0000008300000006/v2_201601190027/S2341287915001854/v2_201601190027/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S234128791500215X" "issn" => "23412879" "doi" => "10.1016/j.anpede.2015.10.016" "estado" => "S300" "fechaPublicacion" => "2015-12-01" "aid" => "1888" "copyright" => "Asociación Española de Pediatría" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "crp" "cita" => "An Pediatr (Barc). 2015;83:435-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 4791 "formatos" => array:3 [ "EPUB" => 157 "HTML" => 4110 "PDF" => 524 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Hepatic hemangiomas: Spectacular response to treatment with propranolol" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "435" "paginaFinal" => "437" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hemangiomas hepáticos: respuesta espectacular al tratamiento con propranolol" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1108 "Ancho" => 1800 "Tamanyo" => 240050 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Case 1: (A) abdominal ultrasound: area of altered echogenicity in liver 37<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>21<span class="elsevierStyleHsp" style=""></span>mm of axial diameter with increased vascularisation. CT angiogram: (B) axial plane, arterial phase. (C) Sagittal plane, portal venous phase. Lesion in hepatic parenchyma anterior to the vena cava in segment I and part of segments <span class="elsevierStyleSmallCaps">VII</span>, <span class="elsevierStyleSmallCaps">IV</span> and <span class="elsevierStyleSmallCaps">II</span>, 43<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>22<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>34<span class="elsevierStyleHsp" style=""></span>mm, with peripheral nodular enhancement in the arterial phase and centripetal fill-in in the portal venous phase. Case 2: (D) abdominal ultrasound: right hepatic lobe replaced by a homogeneous 90<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>50<span class="elsevierStyleHsp" style=""></span>mm mass with multiple intralesional vessels, with additional focal alterations of echogenicity in the left hepatic lobe. CT angiogram: (E) coronal plane in the arterial phase. (F) Axial plane in the portal venous phase: large liver mass, 90<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>86<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>70<span class="elsevierStyleHsp" style=""></span>mm, practically occupying the entire right hepatic lobe, sparing segments <span class="elsevierStyleSmallCaps">II</span>, <span class="elsevierStyleSmallCaps">III</span> and part of segment IV, showing marked peripheral nodular enhancement with centripetal progression during the portal venous phase. Several nodular foci with the same behaviour were also observed in the left hepatic lobe.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.A. Baena-Gómez, M.P. Priego Ruiz, E.M. González, M.J. Peña Rosa, R. Muñoz Sánchez" "autores" => array:5 [ 0 => array:2 [ "nombre" => "M.A." "apellidos" => "Baena-Gómez" ] 1 => array:2 [ "nombre" => "M.P." "apellidos" => "Priego Ruiz" ] 2 => array:2 [ "nombre" => "E.M." "apellidos" => "González" ] 3 => array:2 [ "nombre" => "M.J." "apellidos" => "Peña Rosa" ] 4 => array:2 [ "nombre" => "R." "apellidos" => "Muñoz Sánchez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S169540331500226X" "doi" => "10.1016/j.anpedi.2015.05.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S169540331500226X?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S234128791500215X?idApp=UINPBA00005H" "url" => "/23412879/0000008300000006/v2_201601190027/S234128791500215X/v2_201601190027/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Clinical and epidemiological characteristics of neonatal influenza" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "437" "paginaFinal" => "438" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J. Reina, F. Ferrés" "autores" => array:2 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Reina" "email" => array:1 [ 0 => "jorge.reina@ssib.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "F." "apellidos" => "Ferrés" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad de Virología, Servicio de Microbiología, Hospital Universitario Son Espases, Palma de Mallorca, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Urgencias, Servicio de Pediatría, Hospital Universitario Son Espases, Palma de Mallorca, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Características clínicas y epidemiológicas de la gripe neonatal" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Influenza is a viral infection affecting the general population, but especially the very old and the very young. Paediatric influenza is found primarily in children under 5 years old. The symptoms are fairly non-specific below 2 years of age and it is only from the age of 4–5 years that its clinical manifestations can guide us towards this disease.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">There are few existing studies on neonatal influenza (at less than 28 days of age) that focus on the influenza A (H1N1) pandemic.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">2–4</span></a> For this reason we present a prospective study on the cases detected in the last 3 influenza seasons (2012/13, 2013/14 and 2014/15).</p><p id="par0015" class="elsevierStylePara elsevierViewall">A nasopharyngeal aspirate was taken from patients who attended the emergency department during the flu months. Influenza viruses were detected using a real-time RT-PCR (reverse transcription polymerase chain reaction) technique (Anyplex<span class="elsevierStyleSup">®</span> RV16; Seegene, South Korea). The medical records of neonates diagnosed with influenza were reviewed.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Over the course of the 3 seasons 1215 cases of flu were diagnosed, 631 (51.9%) of which were in children under 15 years of age. Of these, 21 cases presented in neonates (3.3% of the total number of influenza cases studied). The mean age was 24.1 days (range, 5–28 days). The youngest patients (5 and 9 days old) had an influenza A strain (H3N2). <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> presents the general characteristics of the neonates studied. Three patients had a history of prematurity and one had previously had bronchiolitis due to RSV (respiratory syncytial virus). None of the patients died as a consequence or by reason of influenza. None of the mothers had been vaccinated against influenza during pregnancy.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">No gender differences between the various influenza viruses were observed in the neonates studied, except in the cases of influenza B, although the number is too small to allow conclusions to be drawn; nor were differences detected in the mean age at presentation. However, Martic et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> reported that the mean age of neonates infected with the A (H1N1)p virus was 19.2 days and in 70% of cases they were female. The mean age of our patients in this same viral group was 24.5 days and 40% were female, which indicates possible variations depending on the population or geographical area studied.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In most of the patients the symptoms presented were mild and hospitalisation was not required except in one case, which was due to the prematurity of the infant. Of the neonates infected with influenza A (H1N1)p virus described by Martic et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> 100% required hospitalisation; our patient was also infected by this same virus type. This contrasts with the point reported by Martic et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> that 50% of the neonates were treated with oseltamivir on account of their prevailing neurological symptoms. In 4 patients (19.1%) antibiotic treatment with amoxicillin/clavulanic acid was initiated because they presented with an acute middle ear infection. In an earlier study it was reported that 40% of neonates with influenza received antibiotic therapy due to bacterial complications (pneumonia, middle ear infection and urinary infection).<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">We observed that despite the fact that 61.9% of the neonates had been breastfed, they were infected with influenza. Thus it could be said that breastfeeding was not a protective factor in this study group. It should be emphasised that vaccination of the mother during pregnancy is a protective factor against neonatal influenza.</p><p id="par0040" class="elsevierStylePara elsevierViewall">We agree with other studies<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">3,4</span></a> that the main risk factor for neonatal influenza is the presence of influenza in the household (57.1%), and that this is especially important for cases of influenza A (H3N2) and influenza B. This family factor was detected in 90% of the neonates with influenza A (H1N1)p in our study.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Neonatal influenza seems to be a mild or moderate condition that does not require hospitalisation due to its limited general impact. Most cases are contracted within the household and do not involve respiratory complications.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as: Reina J, Ferrés F. Características clínicas y epidemiológicas de la gripe neonatal. An Pediatr (Barc). 2015;83:437–438.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Type of influenza</th></tr><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">A(H1N1)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">A(H3N2) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">B \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Total \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>10) \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>8) \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>3) \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>21) \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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (60)<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (62.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (52.3) \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">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (40) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (37.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (47.7) \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">Mean age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.5 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23.5 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.3 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.1 days \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">Temperature >38<span class="elsevierStyleHsp" style=""></span>°C \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (80) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (62.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 (76.1) \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">Nasopharyngeal secretions \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (60) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (62.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (66.6) \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">Cough \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (80) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (37.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (33.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (57.1) \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">Lethargy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (70) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (37.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (33.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (52.3) \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">Breastfeeding \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (50) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (61.9) \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">Formula feeding \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (40) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (66.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (28.5) \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">Mixed feeding \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (33.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (9.6) \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">Influenza in the household \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (50) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (62.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (66.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (57.1) \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">Antibiotic treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (25.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (33.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (19.1) \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">Hospitalisation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (4.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab976901.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">A(H1N1)pdm09.</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Number of cases (percentage).</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">General characteristics of the patients diagnosed with neonatal influenza.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Influenza A and B virus infections in children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "V. Peltola" 1 => "T. Ziegler" 2 => "O. Ruuskanen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1086/345909" "Revista" => array:6 [ "tituloSerie" => "Clin Infect Dis" "fecha" => "2003" "volumen" => "36" "paginaInicial" => "299" "paginaFinal" => "305" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12539071" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0030" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An unusual cause of fever in a neonate: influenza A (H1N1) virus pneumonia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Sert" 1 => "A. Yazar" 2 => "D. Odabas" 3 => "H. Bilgin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ppul.21245" "Revista" => array:6 [ "tituloSerie" => "Pediatr Pulmonol" "fecha" => "2010" "volumen" => "45" "paginaInicial" => "734" "paginaFinal" => "736" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20575093" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0035" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Novel H1N1 influenza in neonates: from mild to fatal disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. Martic" 1 => "N. Savic" 2 => "P. Minic" 3 => "S. Pasic" 4 => "J. Nedeljkovic" 5 => "B. Jankovic" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/jp.2010.194" "Revista" => array:6 [ "tituloSerie" => "J Perinatol" "fecha" => "2011" "volumen" => "31" "paginaInicial" => "446" "paginaFinal" => "448" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21617702" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0040" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Two season's experience with pandemic A H1N1 influenza infection in neonates" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Martic" 1 => "N. Savic" 2 => "B. Jankovic" 3 => "J. Nedeljkovic" 4 => "Z. Rakonjac" 5 => "K. Pejic" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Turk J Pediatr" "fecha" => "2012" "volumen" => "54" "paginaInicial" => "612" "paginaFinal" => "616" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23692787" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23412879/0000008300000006/v2_201601190027/S2341287915002628/v2_201601190027/en/main.assets" "Apartado" => array:4 [ "identificador" => "38181" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23412879/0000008300000006/v2_201601190027/S2341287915002628/v2_201601190027/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287915002628?idApp=UINPBA00005H" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 11 | 10 | 21 |
| 2024 October | 54 | 33 | 87 |
| 2024 September | 75 | 25 | 100 |
| 2024 August | 93 | 59 | 152 |
| 2024 July | 109 | 27 | 136 |
| 2024 June | 106 | 26 | 132 |
| 2024 May | 76 | 42 | 118 |
| 2024 April | 88 | 33 | 121 |
| 2024 March | 74 | 25 | 99 |
| 2024 February | 79 | 33 | 112 |
| 2024 January | 70 | 16 | 86 |
| 2023 December | 84 | 22 | 106 |
| 2023 November | 54 | 23 | 77 |
| 2023 October | 66 | 28 | 94 |
| 2023 September | 52 | 15 | 67 |
| 2023 August | 41 | 18 | 59 |
| 2023 July | 109 | 40 | 149 |
| 2023 June | 93 | 28 | 121 |
| 2023 May | 80 | 26 | 106 |
| 2023 April | 69 | 14 | 83 |
| 2023 March | 96 | 27 | 123 |
| 2023 February | 92 | 18 | 110 |
| 2023 January | 72 | 19 | 91 |
| 2022 December | 88 | 27 | 115 |
| 2022 November | 81 | 43 | 124 |
| 2022 October | 49 | 29 | 78 |
| 2022 September | 38 | 29 | 67 |
| 2022 August | 49 | 40 | 89 |
| 2022 July | 31 | 32 | 63 |
| 2022 June | 43 | 42 | 85 |
| 2022 May | 43 | 39 | 82 |
| 2022 April | 52 | 43 | 95 |
| 2022 March | 68 | 41 | 109 |
| 2022 February | 58 | 32 | 90 |
| 2022 January | 65 | 33 | 98 |
| 2021 December | 65 | 33 | 98 |
| 2021 November | 82 | 46 | 128 |
| 2021 October | 69 | 50 | 119 |
| 2021 September | 52 | 33 | 85 |
| 2021 August | 43 | 34 | 77 |
| 2021 July | 35 | 28 | 63 |
| 2021 June | 41 | 34 | 75 |
| 2021 May | 43 | 40 | 83 |
| 2021 April | 144 | 44 | 188 |
| 2021 March | 88 | 35 | 123 |
| 2021 February | 48 | 15 | 63 |
| 2021 January | 58 | 21 | 79 |
| 2020 December | 44 | 21 | 65 |
| 2020 November | 51 | 15 | 66 |
| 2020 October | 45 | 16 | 61 |
| 2020 September | 32 | 30 | 62 |
| 2020 August | 51 | 30 | 81 |
| 2020 July | 53 | 33 | 86 |
| 2020 June | 38 | 35 | 73 |
| 2020 May | 55 | 22 | 77 |
| 2020 April | 45 | 28 | 73 |
| 2020 March | 69 | 29 | 98 |
| 2020 February | 51 | 19 | 70 |
| 2020 January | 61 | 16 | 77 |
| 2019 December | 55 | 25 | 80 |
| 2019 November | 31 | 9 | 40 |
| 2019 October | 36 | 8 | 44 |
| 2019 September | 32 | 10 | 42 |
| 2019 August | 50 | 17 | 67 |
| 2019 July | 47 | 26 | 73 |
| 2019 June | 51 | 20 | 71 |
| 2019 May | 71 | 29 | 100 |
| 2019 April | 110 | 51 | 161 |
| 2019 March | 51 | 20 | 71 |
| 2019 February | 50 | 21 | 71 |
| 2019 January | 47 | 26 | 73 |
| 2018 December | 49 | 23 | 72 |
| 2018 November | 75 | 32 | 107 |
| 2018 October | 102 | 24 | 126 |
| 2018 September | 28 | 11 | 39 |
| 2018 August | 1 | 0 | 1 |
| 2018 June | 3 | 0 | 3 |
| 2018 May | 2 | 0 | 2 |
| 2018 April | 29 | 0 | 29 |
| 2018 March | 14 | 0 | 14 |
| 2018 February | 16 | 0 | 16 |
| 2018 January | 18 | 0 | 18 |
| 2017 December | 14 | 0 | 14 |
| 2017 November | 12 | 0 | 12 |
| 2017 October | 20 | 0 | 20 |
| 2017 September | 11 | 0 | 11 |
| 2017 August | 15 | 0 | 15 |
| 2017 July | 23 | 0 | 23 |
| 2017 June | 17 | 9 | 26 |
| 2017 May | 24 | 9 | 33 |
| 2017 April | 16 | 5 | 21 |
| 2017 March | 8 | 3 | 11 |
| 2017 February | 12 | 4 | 16 |
| 2017 January | 5 | 2 | 7 |
| 2016 December | 12 | 11 | 23 |
| 2016 November | 23 | 5 | 28 |
| 2016 October | 25 | 2 | 27 |
| 2016 September | 18 | 7 | 25 |
| 2016 August | 20 | 5 | 25 |
| 2016 July | 9 | 3 | 12 |
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