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Grupo de trabajo de la Asociación Española de Pediatría (AEP)" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:9 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: WHO (<span class="elsevierStyleInterRef" id="intr0010" href="https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200209-sitrep-20-ncov.pdf?sfvrsn=6f80d1b9_4">https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200209-sitrep-20-ncov.pdf?sfvrsn=6f80d1b9_4</span>)" "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1156 "Ancho" => 2403 "Tamanyo" => 150481 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Epidemic curve of confirmed cases of novel coronavirus (nCoV-2019) detected outside China by date of onset of symptoms, up to February 9, 2020.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">As stated by the Ministry of Health, on December 31, 2019, the Wuhan Municipal Health Committee (Hubei province, China) notified the identification of 27 cases of pneumonia of unknown aetiology with onset on December 8, including 7 severe cases, with a shared history of possible exposure in a market selling shellfish, seafood and live animals in Wuhan City, but no identified source of the outbreak. The market was shut down on January 1, 2020. On January 7, 2020, the Chinese authorities identified a new virus in the Coronaviridae family as the causative agent of the outbreak, temporarily named “new coronavirus” (2019-nCoV). The Chinese authorities shared the gene sequence of the virus on January 12, 2020.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">On January 30, the World Health Organization (WHO) declared the 2019-nCoV outbreak in China a global public health emergency.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">By February 12, more than 45 000 cases had been diagnosed in China, the majority clustered in the province of Hubei (33 000), while more than 450 cases had been notified outside China (<a href="https://www.worldometers.info/coronavirus/">https://www.worldometers.info/coronavirus/</a>), usually in association with cases imported from China (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). The reported fatality rates in confirmed cases has ranged from 2% to 3%, although these data must be interpreted with caution given how quickly the outbreak is evolving.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The age distribution reflects a low incidence in the paediatric age group (0.9%) associated with a milder course of disease.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> Based on data of inpatient case series published to date, a high proportion of hospitalised adults and nearly all individuals that died had underlying disease.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">On January 31, a case of infection by 2019-nCoV was confirmed in La Gomera (Canary Islands, Spain) a German national that was a close contact of another confirmed case in Germany, and on February 9, another positive case was detected in Majorca, corresponding to a citizen of the United Kingdom that was a close contact of a case in France. Both of these cases diagnosed in Spain were in adults and had a mild course.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Spain has no airports with direct flights to Wuhan. The cancellation of flights from Wuhan or to and from China decreases the probability of arrival of infected individuals. Nevertheless, it is possible that cases imported from the high-risk area may still arise in Spain. Under the current circumstances, it is estimated that the risk of an imported case emerging in Spain is moderate.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The recommendations presented in the current document are based on and adapted from the guidance for the clinical management of severe acute respiratory infection by 2019-nCoV published by the WHO on January 28,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> which in turn were adapted from the recommendations given for management of severe acute respiratory infection with suspected involvement of MERS-CoV, and the recently published recommendations of the National Clinical Research Center for Child Health de China<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> and expert’s consensus statement.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> These guidelines may change as the outbreak evolves, including the case definition, which could extend to a larger geographical area, and the recommendations for prevention, isolation, protection or treatment, based on emerging evidence. These clinical practice guidelines do not include recommendations on the management of close contacts.</p><p id="par0040" class="elsevierStylePara elsevierViewall">On February 11, 2020 the WHO changed the interim name of 2019-nCoV to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus infectious disease (COVID-19).</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Human coronavirus (HCoV)</span><p id="par0045" class="elsevierStylePara elsevierViewall">Since human coronaviruses (HCoV) were first identified in the 1960s, 6 viruses, including HCoV 229E, HCoV OC43, HCoV NL63, HCoV HKU1, severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) have been recognised as causative agents of a broad range of respiratory infections.</p><p id="par0050" class="elsevierStylePara elsevierViewall">HCoV NL63 and HCoV HKU1 were first described in 2004 and 2005, respectively, and combined with HCoV 229E and HCoV OC43 are responsible for 35% of upper respiratory tract infections, usually in the context of outbreaks. Human coronavirus OC43 is the most prevalent, with the majority of cases occurring in children under 5 years. They are often detected in cases of coinfection by other respiratory viruses, which makes it difficult to establish their particular role in disease. These viruses are associated with a greater severity of disease requiring hospital admission, usually due to bronchospasm, especially in children with underlying diseases. There have been fatal cases of HCoV NL63 infection in immunocompromised patients.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10–12</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The SARS-CoV was described in 2003 in relation to an outbreak originating in China that caused more than 700 deaths, with 20%–30% of cases requiring mechanical ventilation and a 10% case fatality rate and a very high mortality in patients with underlying disease. The MERS-CoV virus was first identified in 2012 in association with a similar clinical picture, but with a higher fatality rate (36%). This virus has not been fully eradicated and sporadic cases continue to emerge. Both are zoonotic diseases transmitted to humans through animal vectors, bats in the case of SARS and dromedary camels in the case of MERS, although cases of human-to-human transmission have been reported, mainly in health care settings, with a low rate of transmission.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">SARS-CoV-2 and COVID-19</span><p id="par0060" class="elsevierStylePara elsevierViewall">Like other human coronaviruses, SARS-CoV2 is an enveloped single-stranded RNA virus. It has a diameter of 60–140 nm and a round or oval shape, and exhibits some pleomorphism.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> There is evidence of a high sequence identity (percent identity of 86.9%–89%) with the genome of a SARS-like coronavirus found in bats (bat-SL-CoVZC45).<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14,15</span></a> The sequence of the main protein in the viral envelope of SARS-CoV-2 also exhibits high identity with the sequences found in bat-SL-CoVZC45 (84%) and SARS-CoV (78%).</p><p id="par0065" class="elsevierStylePara elsevierViewall">The physical and chemical properties of the virus responsible for COVID-19 have not been fully established, but it is believed that it is sensitive to ultraviolet radiation and heating. For instance, based on previous research on SARS-CoV and MERS-CoV, the virus could be inactivated by heating it to a temperature of 56 °C for 30 min and using solvents effective on lipids such as 70% ethanol, disinfectants containing chlorine, peroxyacetic acid and chloroform, but not with chlorhexidine.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Epidemiology</span><p id="par0070" class="elsevierStylePara elsevierViewall">The main source of infection are individuals infected by SARS-CoV-2. There have been reports of transmission during the incubation period in asymptomatic individuals.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> The virus is transmitted in airborne droplets (>5 microns) when diseased individuals cough, speak or sneeze. Close contact is another potential source of transmission (such as touching the mouth, nose or the ocular conjunctiva with a contaminated hand). There are no documented cases of vertical transmission<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>, but there has been a case of infection in the newborn of an infected mother, who tested positive at 30 h post birth. It is not known whether the virus can be transmitted through breastfeeding. The paediatric cases documented to date have been less frequent and milder compared to adults, although it appears that the full spectrum of severity is possible in the paediatric population. There have been no reports of fatal cases in children. Familial clusters have been described, a salient one including the case of 2 children, one with mild disease and another asymptomatic with abnormal imaging findings.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Definitions and criteria</span><p id="par0075" class="elsevierStylePara elsevierViewall">At the time of this writing (11/2/2020), cases are identified applying the criteria presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Classification of cases</span><p id="par0080" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">•</span><p id="par0085" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Person under investigation (PUI)</span>: meeting at least 1 of the 3 criteria given in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0090" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Laboratory-confirmed case</span>: case that meets the laboratory criteria given in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">•</span><p id="par0095" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Probable case</span>: case under investigation in which the laboratory results are inconclusive or only 1 generic coronavirus polymerase chain reaction (PCR) test is positive.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">•</span><p id="par0100" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Ruled out case</span>: case under investigation in which laboratory tests do not detect infection by SARS-CoV-2.</p></li></ul></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Molecular diagnosis</span><p id="par0105" class="elsevierStylePara elsevierViewall">The diagnosis is made by reverse transcription PCR (RT-PCR) for detection of coronavirus RNA or by sequencing of the viral genome. Testing can be performed on pharyngeal swab, nasopharyngeal swab (more appropriate in children), sputum, stool or blood specimens. The virus can be isolated from airway epithelial cell cultures, but this can only be performed in referral laboratories.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">We recommend using a respiratory viral panel to rule out coinfection with other viruses, especially influenza viruses.</p><p id="par0115" class="elsevierStylePara elsevierViewall">Although several laboratories in the different autonomous communities of Spain can perform the microbiological diagnosis, samples for all positive cases must be submitted to the Centro Nacional de Microbiología (National Microbiology Centre, CNM) for definitive confirmation. Samples must be stored and transported at 4 °C and handled as a category B infectious substance.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Clinical picture of respiratory infection by SARS-CoV-2</span><p id="par0120" class="elsevierStylePara elsevierViewall">Infection by SARS-CoV-2 may present as mild, moderate or severe disease, including severe pneumonia, acute respiratory distress syndrome (ARDS), sepsis and septic shock.</p><p id="par0125" class="elsevierStylePara elsevierViewall">To date, few paediatric cases have been described in the literature,<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a> and they appear to be milder<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>. The incubation period lasts between 2–14 days (median, 3–7 days). In all cases, patients have recovered in 1–2 weeks. No paediatric deaths have been reported to date.</p><p id="par0130" class="elsevierStylePara elsevierViewall">Early identification of patients with severe disease (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>) allows prompt delivery of optimised supportive care and quick and safe admission (or referral to) an intensive care unit in accordance with regional or national criteria and protocols. <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> presents the most frequent laboratory and imaging abnormalities found in these patients. Overall, the findings are compatible with viral respiratory infection, similar to those of other such viral illnesses, such as influenza.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">In patients with mild disease, hospital admission may not be necessary unless there is concern for rapid deterioration. All discharged patients must be instructed to return to hospital if their symptoms worsen. For the time being, we recommend that all patients that test positive be hospitalised.</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Recommendations for the management of confirmed cases</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Uncomplicated infection</span><p id="par0140" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">1</span><p id="par0145" class="elsevierStylePara elsevierViewall">Adhere to general preventive measures. Have the patient (if possible) and family members wear surgical masks. Ideally, maintain the patient at least 2 m apart (minimum of 1 m) from all other patients at all times.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">2</span><p id="par0150" class="elsevierStylePara elsevierViewall">The staff caring for the patient must adhere to recommended preventive measures (contact and airborne precautions), wearing a FFP2 mask, gloves, a fluid-resistant gown and protective goggles to perform physical examinations, during history taking or during sample collection procedures.</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">3</span><p id="par0155" class="elsevierStylePara elsevierViewall">Administration of commonly used antipyretic agents as needed (paracetamol or ibuprofen).</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">4</span><p id="par0160" class="elsevierStylePara elsevierViewall">If the patient has fever, we recommend a chest x-ray, blood tests (complete blood count [CBC], C-reactive protein [CPR], procalcitonin [PCT], blood culture, liver enzymes, electrolytes and coagulation) to rule out bacterial superinfection.</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">5</span><p id="par0165" class="elsevierStylePara elsevierViewall">Depending on the epidemiological context and household conditions, choose between hospitalization or home care provision, in the latter case providing clear instructions on how to proceed in case the condition of the patient worsens. The WHO has published recommendations for outpatient follow-up.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a></p></li></ul></p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Mild lower respiratory tract infection</span><p id="par0170" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">1</span><p id="par0175" class="elsevierStylePara elsevierViewall">The same general measures applied in case of uncomplicated infection.</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">2</span><p id="par0180" class="elsevierStylePara elsevierViewall">We recommend hospitalization in isolation and monitoring for all patients.</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">3</span><p id="par0185" class="elsevierStylePara elsevierViewall">Non-invasive vital sign monitoring, including measurement of oxygen saturation (SatO<span class="elsevierStyleInf">2</span>) by means of pulse oximetry.</p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">4</span><p id="par0190" class="elsevierStylePara elsevierViewall">Performance of chest radiograph, blood tests (CBC, CPR, PCT, blood culture, blood chemistry including liver enzymes, electrolytes, coagulation and blood gas analysis) and placement of a peripheral catheter.</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">5</span><p id="par0195" class="elsevierStylePara elsevierViewall">Bronchodilators may be used when indicated based on the findings of physical examination (wheezing), preferably delivered with a metered-dose inhaler (MDI) and spacer.</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">6</span><p id="par0200" class="elsevierStylePara elsevierViewall">Commonly used analgesics (paracetamol or ibuprofen).</p></li></ul></p><p id="par0205" class="elsevierStylePara elsevierViewall">The option of admitting one of the parents along with the patient may be considered. Preferably a single individual, always the same one, would stay with the child, always adhering to the indicated precautions (mask, gown, gloves and goggles). There may also be cases in which both the parents and the child are infected, and all can be admitted together.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Severe lower respiratory tract infection</span><p id="par0210" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">1</span><p id="par0215" class="elsevierStylePara elsevierViewall">In addition to all the interventions mentioned in the previous sections:</p></li><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">2</span><p id="par0220" class="elsevierStylePara elsevierViewall">Conservative fluid management, as aggressive fluid resuscitation may worsen oxygenation (routine fluid therapy with administration of 2/3 of baseline requirements). We recommend against using hypotonic saline solutions (or hydroxyethyl starches or gelatines for fluid resuscitation).</p></li><li class="elsevierStyleListItem" id="lsti0090"><span class="elsevierStyleLabel">3</span><p id="par0225" class="elsevierStylePara elsevierViewall">Supplemental oxygen therapy with a target saturation of >92%.</p></li><li class="elsevierStyleListItem" id="lsti0095"><span class="elsevierStyleLabel">4</span><p id="par0230" class="elsevierStylePara elsevierViewall">In case of suspected bacterial superinfection (leucocytosis and elevation of CPR or PCT), start antibiotherapy with intravenous (IV) amoxicillin-clavulanic acid.</p></li></ul></p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Severe cases with admission to the paediatric intensive care unit (PICU)</span><p id="par0235" class="elsevierStylePara elsevierViewall">Admission to the PICU should be considered if the patient has lower respiratory tract infection that meets criteria for definition of severe disease or with extrapulmonary manifestations associated with severe illness (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>) and/or exhibiting progressive worsening. We recommend hospitalization in an isolation room with verified negative pressure. If performance of aerosol-generated procedures (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>) is necessary to provide appropriate care, the level of protection should be heightened due to the increased risk of contamination. The staff that gets exposed should be kept to the minimum necessary and should wear FFP3 masks, in addition to long-sleeve fluid-resistant gowns, fitted goggles or face shields and gloves. Given the limited information that is currently available and until the mechanisms of transmission and associated risks are well understood, when this additional level of risk occurs in the PICU it would be reasonable to add the use of a coverall or long impermeable gown with a hood to completely avoid exposure to the generated droplets.</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0240" class="elsevierStylePara elsevierViewall">The entire care team and support staff and the person accompanying the patient in the PICU should use the recommended personal protective equipment (PPE), following the established protocol for putting it on and taking it off, under supervision, and having received previous training on the PPE and related procedures.</p><p id="par0245" class="elsevierStylePara elsevierViewall">Transport routes to and from the PICU should be predetermined, and necessary precautions and infection control measures should be implemented during transport to prevent transmission during the transfer process.</p><p id="par0250" class="elsevierStylePara elsevierViewall">During the hospital stay, transport of the patient should be kept to a minimum, performing the necessary diagnostic examinations (such as radiographs or ultrasound scans) with portable equipment in the isolation box whenever possible. If diagnostic equipment cannot be exclusively dedicated to these patients, it should be disinfected following preventive medicine guidelines. Disposable supplies should be used whenever possible and supplies that are not disposable should be disinfected following the established protocol. Medical waste from the care of these patients is considered biohazardous and should be handled and disposed of following the corresponding protocol.</p><p id="par0255" class="elsevierStylePara elsevierViewall">Health care staff will plan their tasks in advance and stay in the room the minimum time required to perform them. If possible, the staff should remain at least 2 m away from the patient. A record should be kept of every staff member that comes into contact with the patient.</p><p id="par0260" class="elsevierStylePara elsevierViewall">Based on current knowledge, supportive care delivered at the PICU for severe patients presenting with ARDS, sepsis or organ failure does not significantly differ from the international guidelines that already exist for management of these conditions.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24–29</span></a></p><p id="par0265" class="elsevierStylePara elsevierViewall">If patients with COVID-19 require respiratory support, non-invasive ventilation (NIV) poses a higher risk of contamination due to the generation of aerosols. In case of deterioration of respiratory function, use of invasive mechanical ventilation should be considered, following the lung-protective strategies recommended at the Pediatric Acute Lung Injury Consensus Conference (PALICC)<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24,26</span></a> for management of ARDS in the paediatric population (low tidal volumes (4−8 mL/kg), optimised positive end-expiratory pressure, inspiratory plateau pressure of up to 28–32 cmH<span class="elsevierStyleInf">2</span>O, driving pressure of less than 15 cmH<span class="elsevierStyleInf">2</span>O, permissive hypercapnia, etc.), prone positioning and, if necessary, neuromuscular blockade.</p><p id="par0270" class="elsevierStylePara elsevierViewall">Fluids must be managed appropriately, avoiding fluid overload and preventing a positive balance, both of which are associated with poorer respiratory outcomes and increased morbidity and mortality. Patients with sepsis, in addition to cautious volume expansion during the initial resuscitation, may require vasoactive drugs, to be delivered in adherence with current international paediatric guidelines.<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">28,29</span></a> These patients may also require continuous renal replacement therapy.</p><p id="par0275" class="elsevierStylePara elsevierViewall">In case of severe respiratory failure or cardiorespiratory arrest refractory to conventional treatment, the use of extracorporeal membrane oxygenation (ECMO) may be considered based on the same indications applied for other health conditions.</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Empirical antibiotherapy</span><p id="par0280" class="elsevierStylePara elsevierViewall">Antibiotherapy should be used in case of suspected bacterial superinfection and in patients with sepsis or septic shock (in the latter case, it is essential that antibiotherapy is given within one hour or as soon as possible). The regimen should be individualised, considering the previous condition and characteristics of the patient (comorbidities, healthy patient, mechanical ventilation etc.). Samples for microbiological testing should be obtained before initiation of antibiotherapy whenever possible, remembering to withdraw or taper down treatment as necessary based on the results.</p><p id="par0285" class="elsevierStylePara elsevierViewall">In the cases described at the beginning of the outbreak,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> there was radiological evidence of infiltrates in every patient, and all received empirical antibiotherapy, but at present, close monitoring is recommended, reserving antibiotherapy for cases of suspected bacterial superinfection.</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Systemic steroids and immunomodulators</span><p id="par0290" class="elsevierStylePara elsevierViewall">Systemic steroids are not generally recommended. Previous studies in patients with SARS, MERS and even influenza have shown that they offer no benefits and may even delay viral clearance.<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20,30,31</span></a> Their use can be considered in patients with ARDS, septic shock, encephalitis, hemophagocytic syndrome or with severe bronchospasm associated with wheezing. If indicated, we recommend: IV methylprednisolone (1−2 mg/kg/day) for 3–5 days, avoiding prolonged use.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a></p><p id="par0295" class="elsevierStylePara elsevierViewall">Intravenous immunoglobulin therapy has been used in severe cases, but its indications and efficacy need to be evaluated. The recommended doses are: 1 g/kg/day for 2 days, or 400 mg/kg/day for 5 days.</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Specific antiviral treatment</span><p id="par0300" class="elsevierStylePara elsevierViewall">There is no specific antiviral agent proven to be effective in case of infection by HCoV, SARS or MERS. The WHO does not recommend any antiviral agents.</p><p id="par0305" class="elsevierStylePara elsevierViewall">There are several drugs currently being tried on an experimental basis.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a><ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0100"><span class="elsevierStyleLabel">•</span><p id="par0310" class="elsevierStylePara elsevierViewall">Oseltamivir: neuraminidase inhibitors have been used in cases of MERS-CoV infection, and oseltamivir has been used in the initial response to the COVID-19 outbreak in China. Its efficacy is not clear and it may have been used to manage influenza coinfection. Its use is not recommended at present.</p></li><li class="elsevierStyleListItem" id="lsti0105"><span class="elsevierStyleLabel">•</span><p id="par0315" class="elsevierStylePara elsevierViewall">Inhaled interferon-alfa has been recommended in combination with antiviral therapy with lopinavir/ritonavir in adults, and a clinical trial has been set up to assess its efficacy. Interferon-alfa has broad-spectrum antiviral effects and is used to treat hepatitis B virus. Formulations of this drug for inhalation are not currently available in Spain. Chinese guidelines recommend nebulisation of interferon-α2b at a dose of 100 000–200 000 IU/kg in mild cases and 200 000–400 000 IU/kg in severe cases, given in twice a day for 5–7 days.</p></li><li class="elsevierStyleListItem" id="lsti0110"><span class="elsevierStyleLabel">•</span><p id="par0320" class="elsevierStylePara elsevierViewall">Lopinavir is a protease inhibitor use for management of HIV in combination with ritonavir as a booster. Lopinavir and/or lopinavir/ritonavir have exhibited activity against coronavirus in vitro. In the management of the SARS outbreak in Hong Kong, there was evidence that compared to ribavirin alone, treatment with lopinavir/ritonavir plus ribavirin decreased the risk of ARDS or death.<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">33,34</span></a></p></li><li class="elsevierStyleListItem" id="lsti0115"><span class="elsevierStyleLabel">•</span><p id="par0325" class="elsevierStylePara elsevierViewall">Remdesivir could be the best possible option for treatment of COVID-19. It is an antiviral agent originally developed to fight Ebola in the class of nucleotide analogues. Experiments in animals infected with MERS-CoV found reduced viral titres and an improvement in lung tissue damage in animals treated with remdesivir compared to controls, and that outcomes were better in the group treated with remdesivir compared to the group treated with lopinavir/ritonavir combined with interferon-β. A phase III clinical trial of remdesivir for treatment of infection by Ebola virus has been completed, and there is ample data on its pharmacokinetics and safety. However, the efficacy and safety of remdesivir in patients with SARS-CoV-2 infection remains to be established. This drug is not available in Spain. In the United States, it has been used in at least one patient with favourable results.<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">35,36</span></a></p></li><li class="elsevierStyleListItem" id="lsti0120"><span class="elsevierStyleLabel">•</span><p id="par0330" class="elsevierStylePara elsevierViewall">Other drugs such as chloroquine (antimalarial) or baricitinib (Janus kinase inhibitor) have been considered as alternative treatment options, although their use has not been assessed in clinical trials.<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">37,38</span></a></p></li></ul></p><p id="par0335" class="elsevierStylePara elsevierViewall">In conclusion, there currently is no evidence in support or against the use of antiviral therapy or a specific antiviral agent. <a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a> presents the dosage of different antiviral agents.</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0340" class="elsevierStylePara elsevierViewall">The following could be considered:<ul class="elsevierStyleList" id="lis0030"><li class="elsevierStyleListItem" id="lsti0125"><span class="elsevierStyleLabel">•</span><p id="par0345" class="elsevierStylePara elsevierViewall">In mild cases requiring uncomplicated management. Consider oseltamivir in case of coinfection with influenza only at an early stage. Another possible option is lopinavir/ritonavir.</p></li><li class="elsevierStyleListItem" id="lsti0130"><span class="elsevierStyleLabel">•</span><p id="par0350" class="elsevierStylePara elsevierViewall">In severe cases requiring hospital admission, consider initiating treatment with lopinavir/ritonavir.</p></li><li class="elsevierStyleListItem" id="lsti0135"><span class="elsevierStyleLabel">•</span><p id="par0355" class="elsevierStylePara elsevierViewall">If remdesivir can be obtained, it may be useful in severe cases.</p></li></ul></p><p id="par0360" class="elsevierStylePara elsevierViewall">It is important to take into account that lopinavir/ritonavir often causes gastrointestinal adverse events at treatment initiation (diarrhoea, vomiting).</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicts of interest</span><p id="par0365" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:16 [ 0 => array:3 [ "identificador" => "xres1336776" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1230937" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1336777" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1230938" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Human coronavirus (HCoV)" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "SARS-CoV-2 and COVID-19" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Epidemiology" ] 8 => array:3 [ "identificador" => "sec0025" "titulo" => "Definitions and criteria" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Classification of cases" ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Molecular diagnosis" ] 2 => array:2 [ "identificador" => "sec0040" "titulo" => "Clinical picture of respiratory infection by SARS-CoV-2" ] ] ] 9 => array:3 [ "identificador" => "sec0045" "titulo" => "Recommendations for the management of confirmed cases" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0050" "titulo" => "Uncomplicated infection" ] 1 => array:2 [ "identificador" => "sec0055" "titulo" => "Mild lower respiratory tract infection" ] 2 => array:2 [ "identificador" => "sec0060" "titulo" => "Severe lower respiratory tract infection" ] ] ] 10 => array:2 [ "identificador" => "sec0065" "titulo" => "Severe cases with admission to the paediatric intensive care unit (PICU)" ] 11 => array:2 [ "identificador" => "sec0070" "titulo" => "Empirical antibiotherapy" ] 12 => array:2 [ "identificador" => "sec0075" "titulo" => "Systemic steroids and immunomodulators" ] 13 => array:2 [ "identificador" => "sec0080" "titulo" => "Specific antiviral treatment" ] 14 => array:2 [ "identificador" => "sec0085" "titulo" => "Conflicts of interest" ] 15 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-02-13" "fechaAceptado" => "2020-02-14" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1230937" "palabras" => array:6 [ 0 => "Coronavirus" 1 => "Respiratory infection" 2 => "2019-nCoV" 3 => "COVID-19" 4 => "SARS-CoV2" 5 => "Children" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1230938" "palabras" => array:6 [ 0 => "Coronavirus" 1 => "Infección respiratoria" 2 => "2019 nCoV" 3 => "COVID-19" 4 => "SARS-CoV2" 5 => "Niños" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">On 31 December 2019, the Wuhan Municipal Committee of Health and Healthcare (Hubei Province, China) reported that there were 27 cases of pneumonia of unknown origin with symptoms starting on the 8 December. There were 7 serious cases with common exposure in market with shellfish, fish, and live animals, in the city of Wuhan. On 7 January 2020, the Chinese authorities identified that the agent causing the outbreak was a new type of virus of the <span class="elsevierStyleItalic">Coronaviridae</span> family, temporarily called «new coronavirus», 2019-nCoV. On January 30th, 2020, the World Health Organisation (WHO) declared the outbreak an International Emergency. On 11 February 2020 the WHO assigned it the name of SARS-CoV2 and COVID-19 (SARS-CoV2 and COVID-19).</p><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">The Ministry of Health summoned the Specialties Societies to prepare a clinical protocol for the management of COVID-19. The Spanish Paediatric Association appointed a Working Group of the Societies of Paediatric Infectious Diseases and Paediatric Intensive Care to prepare the present recommendations with the evidence available at the time of preparing them.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">El 31 de diciembre de 2019, la Comisión Municipal de Salud y Sanidad de Wuhan (provincia de Hubei, China) informó sobre la existencia de 27 casos de neumonía de etiología desconocida con inicio de síntomas el 8 de diciembre, incluyendo siete casos graves, con exposición común a un mercado de marisco, pescado y animales vivos en la ciudad de Wuhan. El 7 de enero de 2020, las autoridades chinas identificaron como agente causante del brote un nuevo tipo de virus de la familia Coronaviridae, denominado temporalmente “nuevo coronavirus”, 2019-nCoV. El 30 de enero de 2020 la Organización Mundial de la Salud declara el brote un Emeregencia Internacional. El día 11 de febrero la OMS le asigna el nombre de COVID-19 (Coronavirus Infectious Disease). El Ministerio de Sanidad convoca a las Sociedades de Especialidades para la elaboración de un protocolo clínico de manejo de la infección por COVID -19. La Asociación Española de Pediatría nombra un grupo de trabajo de las Sociedades de Infectologia Pediátrica y Cuidados Intensivos Pediátricos que se encargan de elaborar las presentes recomendaciones con la evidencia disponible en el momento de su realización.</p></span>" ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0045">Please cite this article as: Calvo C, López-Hortelano MG, Vicente JCdC, Martínez JLV. Recomendaciones sobre el manejo clínico de la infección por el «nuevo coronavirus» SARS-CoV2. Grupo de trabajo de la Asociación Española de Pediatría (AEP). An Pediatr (Barc). 2020;92:241.</p>" ] 1 => array:3 [ "etiqueta" => "1" "nota" => "<p class="elsevierStyleNotepara" id="npar0050">The Appendix <a class="elsevierStyleCrossRef" href="#sec0095">A</a>lists the names of the authors members of the Working Group of the Asociación Española de Pediatría (AEP).</p>" "identificador" => "fn0005" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:3 [ "apendice" => "<p id="par0375" class="elsevierStylePara elsevierViewall">Members of the Working Group of the AEP: José Tomás Ramos<span class="elsevierStyleSup">1</span> (Infectious Disease Unit. Department of Paediatrics. Hospital Clínico San Carlos. Department of Public Health and Mother and Child Health. Madrid), Fernando Baquero-Artigao<span class="elsevierStyleSup">1,2,3</span>, Maria Luisa Navarro<span class="elsevierStyleSup">1</span> (Department of Paediatrics and Infectious Diseases. Hospital Universitario Gregorio Marañón. Madrid), Carlos Rodrigo<span class="elsevierStyleSup">1</span> (Paediatrics Clinical Management, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona), Olaf Neth<span class="elsevierStyleSup">1</span> (Department of infectious Diseases, Rheumatology and Immunodeficiencies. Hospital Infantil Universitario Virgen del Rocio, Instituto de Biomedicina de Sevilla [IBIS], Seville), Victoria Fumadó<span class="elsevierStyleSup">1</span> (Infectious and Imported Disease Unit [CSUR]. Infectious Disease High Level Isolation Unit [CSUR]. Hospital Universitario Sant Joan de Deú, Barcelona), Juan José Menendez Suso<span class="elsevierStyleSup">4</span>. Department of Intensive Care and High Level Isolation Unit. Hospital Universitario La Paz-Hospital Carlos III (Madrid), María Slocker Barrio<span class="elsevierStyleSup">4</span> and Amaya Bustinza Arriortua<span class="elsevierStyleSup">4</span> (Paediatric Intensive Care Unit. Hospital Materno Infantil Gregorio Marañón. Madrid), Iolanda Jordán García<span class="elsevierStyleSup">4</span> (Paediatric Intensive Care Unit. Hospital Sant Joan de Dèu. Barcelona), Javier Pilar Orive<span class="elsevierStyleSup">4</span> (Paediatric Intensive Care Unit. Hospital Universitario de Cruces. Bizkaia).</p>" "etiqueta" => "Appendix A" "identificador" => "sec0095" ] ] ] ] "multimedia" => array:7 [ 0 => array:9 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: WHO (<span class="elsevierStyleInterRef" id="intr0005" href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports">https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports</span>)" "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1408 "Ancho" => 2500 "Tamanyo" => 318248 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Countries, territories or areas with reported confirmed cases of 2019-nCoV, 11 February 2020.</p>" ] ] 1 => array:9 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: WHO (<span class="elsevierStyleInterRef" id="intr0010" href="https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200209-sitrep-20-ncov.pdf?sfvrsn=6f80d1b9_4">https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200209-sitrep-20-ncov.pdf?sfvrsn=6f80d1b9_4</span>)" "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1156 "Ancho" => 2403 "Tamanyo" => 150481 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Epidemic curve of confirmed cases of novel coronavirus (nCoV-2019) detected outside China by date of onset of symptoms, up to February 9, 2020.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "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=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Epidemiological and clinical criteria:</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">A</span></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Any individual with clinical manifestations compatible with acute respiratory infection of any severity presenting with fever and any of the following symptoms: shortness of breath, cough or malaise \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AND \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">History of travel to Hubei province, China, in the 14 days preceding onset \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " rowspan="6" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">B</span></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Any individual with fever of respiratory manifestations such as shortness of breath or cough \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AND \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">History of close contact with a probable or confirmed case in the 14 days preceding onset, with close contact defined as follows: \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Caring for an individual with probable or confirmed case while the case was symptomatic (health care workers that did not use appropriate protective measures, family members or other individuals with similar physical contact with the case). \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Having been in the same space as a probable or confirmed case, at a distance of less than 2 metres, while the case was symptomatic (such as household members or visits). \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- In an airplane, close contact is defined as being a passenger seated within a 2-seat radius from a probable or confirmed case while the case was symptomatic, or a member of the crew coming in contact with a case (see Appendix <a class="elsevierStyleCrossRef" href="#sec0095">A</a>). \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">C</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Any individual requiring hospital admission for fever and clinical features of severe acute respiratory illness \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AND \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">History of travel to mainland China in the 14 days preceding onset. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Laboratory criteria:</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Positive result of PCR screening and positive result in the confirmatory PCR analysis of an alternative gene</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2291954.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Epidemiological, clinical and laboratory criteria for assessment and identification of infection by novel coronavirus.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">ARDS, acute respiratory distress syndrome; CPAP, continuous positive airway pressure; CT, computed tomography; ECG, electrocardiogram; HR, heart rate; NIV, non-invasive ventilation; OI, oxygenation index; OSI; oxygen saturation index; SBP, systolic blood pressure; SD, standard deviation; SIRS, systemic inflammatory response syndrome; SpO<span class="elsevierStyleInf">2</span>, peripheral capillary oxygen saturation; US, ultrasound.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Uncomplicated infection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patients with uncomplicated upper respiratory tract infection may develop nonspecific symptoms, such as fever, cough, sore throat, nasal congestion, headache, muscle aches or malaise. No signs of dehydration, sepsis or respiratory distress. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mild lower respiratory tract infection<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cough, respiratory distress and rapid breathing (in breaths per minute): <2 months, \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≥60 bpm; 2–11 months, ≥50 bpm; 1–5 years, ≥40 bpm in absence of features of severe pneumonia. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ambient oxygen >92%. May or may not have fever. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Severe lower respiratory tract infection<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="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cough or respiratory distress and at least 1 of the following: central cyanosis or SatO2 <92% (<90% in preterm infants); severe respiratory distress (such as grunting, severe chest retractions); inability to feed or difficulty feeding, lethargy or loss of consciousness or convulsions. May present with other features, such as chest retractions, rapid breathing (in breaths per minute): age <1 year, ≥70 bpm; age ≥1 year, ≥50 bpm. Blood gases: PaO2 < 60 mmHg, PaCO2 > 50 mmHg. This is a clinical diagnosis, chest imaging can rule out complications (atelectasis, infiltration, effusion). \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Other manifestations associated with severe illness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Coagulation disorders (prolonged prothrombin time and D-dimer elevation), myocardial damage (elevation of cardiac enzymes, ST-T wave changes on ECG, cardiomegaly and heart failure), intestinal failure, elevation of liver enzymes and rhabdomyolysis. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Acute respiratory distress syndrome<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">Onset</span>: onset with ARDS or worsening of respiratory symptoms in the past 10 days. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chest X-ray, <span class="elsevierStyleBold">CT or</span> US: new infiltrate(s) compatible with acute involvement of lung parenchyma. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">Origin of pulmonary oedema</span>: respiratory failure in absence of other possible causes such as heart failure or volume overload. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">Oxygenation</span> (OI and OSI calculated using the SpO<span class="elsevierStyleInf">2</span>): \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Bilevel NIV or CPAP ≥ 5 cmH2O using full face mask: PaO<span class="elsevierStyleInf">2</span> / FiO<span class="elsevierStyleInf">2</span> ≤ 300 mmHg o SpO<span class="elsevierStyleInf">2</span>/ FiO<span class="elsevierStyleInf">2</span> ≤ 264 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Mild ARDS (invasive ventilation): 4 ≤ OI <8 or 5 ≤ OSI <7.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Moderate ARDS (invasive ventilation):8 ≤ OI < 16 or 7.5 ≤ OSI <12.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Severe ARDS (invasive ventilation): OI ≥ 16 or OSI ≥ 12.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sepsis<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Suspected or confirmed infection with ≥ 2 criteria for SIRS, which should include either abnormal body temperature or abnormal white blood cell count. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Septic shock<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Any degree of hypotension (SBP <5th percentile or more than 2 SD below normal for age) or 2–3 of the following: altered mental status; tachycardia o bradycardia (HR < 90 bpm or >160 bpm in infants and <70 bpm or >150 bpm in children); prolonged capillary refill time (>2 s) or warm shock with normal pulses; tachypnoea; mottled skin or petechial or purpuric rash; lactate elevation, oliguria, hyperthermia or hypothermia. \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2291955.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Equivalent to WHO definition of mild pneumonia.</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Equivalent to WHO definition of severe pneumonia.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Clinical presentations associated with COVID-19.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mild \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Severe \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Clinical features \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fever (not always present), cough, nasal congestion, rhinorrhoea, coughing with phlegm, diarrhoea, headache. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Malaise, irritability, food refusal, hypoactivity 1 week from onset. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">In some cases, rapid progression (1–3 days) with respiratory failure refractory to supplemental oxygen, septic shock, metabolic acidosis, coagulation disorder or haemorrhage. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Complete blood count \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Normal white blood cells or mild leukopenia and lymphopenia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Progressive lymphopenia \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">C-reactive protein \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Normal or elevated (suggestive of bacterial superinfection) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Procalcitonin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PCT > 0.5 ng/mL (suggestive of bacterial superinfection). \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Blood chemistry \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Elevation of transaminases, muscle enzymes, myoglobin, D-dimers \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chest X-ray \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Normal or peripheral interstitial infiltrates \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bilateral ground glass opacity and consolidation in several locations. Pleural effusion is infrequent \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chest CT scan \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ground glass opacities and infiltrates are more discernible in CT compared to X-ray. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Possible multilobar consolidation \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2291953.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Possible clinical manifestations and laboratory and laboratory changes in COVID-19 in children.</p>" ] ] 5 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">MDI, metered-dose inhaler; MV, mechanical ventilation; NIV, non-invasive ventilation.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Procedure \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Strategy<a class="elsevierStyleCrossRefs" href="#tblfn0035"><span class="elsevierStyleSup">b,c</span></a> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Aspiration of respiratory secretions \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Only perform when strictly necessary. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Closed suction in case of MV \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Aerosol therapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Use MDI with spacer. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Collection of respiratory samples \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Only perform when strictly necessary. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bronchoalveolar lavage \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Avoid if possible. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">High flow oxygen therapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Avoid. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Non-invasive ventilation (NIV) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Avoid if possible. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">If necessary, ensure correct seal of the interface. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Use a double-limb configuration. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Manual ventilation with bag-valve-mask \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">If possible, avoid ventilation with a bag-valve-mask system and, if absolutely necessary, use a system with a high efficiency filter between the self-inflating bag and the mask to prevent viral contamination, avoiding hyperventilation and leaks. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intubation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Use cuffed endotracheal tubes to prevent leaks with cuff pressures <25 cmH<span class="elsevierStyleInf">2</span>O. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">If required, deliver preoxygenation with a non-rebreather mask and carry out rapid sequence intubation. Intubation should be performed by experienced staff to minimise the completion time and the number of intubation attempts. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mechanical ventilation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Use of high-efficiency filters preventing viral contamination in both the inspiratory and expiratory limbs. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Use closed suction systems. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Use a heat-moisture exchanger fitted with a high-efficacy filter preventing viral contamination instead of active heated humidifiers. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prevent accidental disconnection. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cardiopulmonary resuscitation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2291957.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0030" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0030">There is insufficient evidence on the impact of these procedures or precautions on the transmission of infection, and the proposed precautions are based on recommendations given for infections with similar mechanisms of transmission.</p>" ] 1 => array:3 [ "identificador" => "tblfn0035" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0035">Avoid if possible.</p>" ] 2 => array:3 [ "identificador" => "tblfn0040" "etiqueta" => "c" "nota" => "<p class="elsevierStyleNotepara" id="npar0040">Personal protective equipment (PPE) including FFP3 mask (see PPE recommendations in the text).</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Potential aerosol-generating procedures and strategies recommended to reduce their risk if they are strictly necessary<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">a</span></a>.</p>" ] ] 6 => array:8 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0035" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The volume in mL of oral solution represents the average dose for the weight range = . Weight-based dosing recommendations are based on limited data.</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">BSA, body surface area.</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">BSA can be calculated with the following equation: √ (length (cm) x weight (kg)/3600).</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Use of lopinavir/ritonavir is not recommended before 15 days post birth.</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="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Paediatric dosing guidelines based on body weight (age >6 months and <18 years)</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Body weight (kg) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Dose (mg/kg every 12 h) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Volume of oral solution given with food every 12 h (80 mg lopinavir/20 mg ritonavir per mL solution) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 to 15 kg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12/3 mg/kg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 to 10 kg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.25 mL \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">>10 kg to <15 kg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.75 mL \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15–40 kg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10/2.5 mg/kg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15−20 kg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.25 mL \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">>20−25 kg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.75 mL \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">>25−30 kg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.50 mL \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">>30−35 kg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 mL \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">>35-40 kg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.75 mL \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">>40 kg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Adult dose \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">400 mg/100 mg every 12 h \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2291956.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="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Dosage in infants aged 2 weeks to 6 months</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">By weight (mg/kg) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">By BSA (mg/m<span class="elsevierStyleSup">2</span>) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Frequency \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16/4 mg/kg (equivalent to 0.2 mL/kg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">300/75 mg/m<span class="elsevierStyleSup">2</span> (equivalent to 3.75 mL/m<span class="elsevierStyleSup">2</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Given twice daily with food \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2291952.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Dosage of antiviral drugs. 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Year/Month | Html | Total | |
---|---|---|---|
2024 November | 12 | 10 | 22 |
2024 October | 87 | 47 | 134 |
2024 September | 109 | 36 | 145 |
2024 August | 94 | 52 | 146 |
2024 July | 121 | 28 | 149 |
2024 June | 100 | 31 | 131 |
2024 May | 117 | 38 | 155 |
2024 April | 124 | 35 | 159 |
2024 March | 108 | 35 | 143 |
2024 February | 60 | 32 | 92 |
2024 January | 56 | 32 | 88 |
2023 December | 112 | 21 | 133 |
2023 November | 169 | 55 | 224 |
2023 October | 85 | 39 | 124 |
2023 September | 74 | 57 | 131 |
2023 August | 83 | 35 | 118 |
2023 July | 68 | 51 | 119 |
2023 June | 75 | 30 | 105 |
2023 May | 73 | 26 | 99 |
2023 April | 44 | 16 | 60 |
2023 March | 77 | 35 | 112 |
2023 February | 69 | 22 | 91 |
2023 January | 53 | 30 | 83 |
2022 December | 99 | 47 | 146 |
2022 November | 120 | 46 | 166 |
2022 October | 106 | 52 | 158 |
2022 September | 95 | 47 | 142 |
2022 August | 90 | 45 | 135 |
2022 July | 120 | 68 | 188 |
2022 June | 79 | 45 | 124 |
2022 May | 120 | 53 | 173 |
2022 April | 108 | 41 | 149 |
2022 March | 131 | 82 | 213 |
2022 February | 88 | 32 | 120 |
2022 January | 158 | 84 | 242 |
2021 December | 101 | 68 | 169 |
2021 November | 105 | 64 | 169 |
2021 October | 131 | 110 | 241 |
2021 September | 88 | 72 | 160 |
2021 August | 108 | 40 | 148 |
2021 July | 118 | 57 | 175 |
2021 June | 100 | 66 | 166 |
2021 May | 118 | 71 | 189 |
2021 April | 292 | 153 | 445 |
2021 March | 181 | 81 | 262 |
2021 February | 141 | 67 | 208 |
2021 January | 155 | 71 | 226 |
2020 December | 223 | 49 | 272 |
2020 November | 158 | 36 | 194 |
2020 October | 184 | 41 | 225 |
2020 September | 213 | 81 | 294 |
2020 August | 309 | 76 | 385 |
2020 July | 427 | 125 | 552 |
2020 June | 853 | 147 | 1000 |
2020 May | 1032 | 164 | 1196 |
2020 April | 143 | 63 | 206 |