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with severe MAS presenting with other problems in addition to meconium aspiration such as infection or chronic asphyxia&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a> The risk factors associated with severe MAS have been classified into maternal&#44; intrapartum and neonatal factors&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and many studies have been devoted to the subject&#44; some with contradictory results&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The presence of MSAF in itself does not explain severe cases of MAS&#44; and given the importance of early diagnosis&#44; we decided to carry out a study with the aim of identifying factors associated with more severe presentations of MAS in our catchment population&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">We conducted a retrospective descriptive study including all cases of MAS managed in the neonatal intensive care unit &#40;NICU&#41; of our hospital between January 2012 and May 2018&#46; We collected data by reviewing obstetric and neonatal electronic health records in our hospital&#8217;s system&#46; We classified the risk factors under study into three groups&#58; maternal variables&#44; intrapartum variables and neonatal variables &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; We classified MAS cases by severity into 2 categories using the scheme proposed by Cleary and Wiswell<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#58; severe&#44; defined as requiring mechanical ventilation &#40;MV&#41; for 48&#8239;h&#44; and nonsevere &#40;mild&#47;moderate&#41;&#44; defined as not requiring MV or MV lasting less than 48&#8239;h&#46; We performed the statistical analysis with the software SPSS &#40;version 23&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">During the study period&#44; the hospital managed a total of 31 324 deliveries and 48 cases of MAS&#44; corresponding to an incidence of 0&#46;15&#37;&#46; Of all cases&#44; we were able to collect data for 29 patients&#44; 51&#46;7&#37; female and 48&#46;3&#37; male&#46; In terms of severity&#44; 52&#37; of the cases of MAS were severe &#40;<span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;15&#41; and 48&#37; nonsevere &#40;<span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;14&#41;&#46; In the group of severe MAS&#44; 1 patient died &#40;6&#46;6&#37;&#41; and 3 &#40;20&#37;&#41; had long-term neurologic sequelae&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">None of the maternal variables under study &#40;maternal age&#44; primiparity or duration of pregnancy&#41;&#44; was associated significantly with severe MAS&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">When it came to the intrapartum variables&#44; intrapartum fever&#44; the Apgar scores and resuscitation with intubation&#44; chest compressions or vasoactive drugs were not significantly associated with severe MAS in our sample&#44; either&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The intrapartum variables significantly associated with severe MAS were urgent caesarean section due to non-reassuring foetal status &#40;NRFS&#41; and the total duration of rupture of membranes &#40;ROM&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The neonatal variables associated with severe MAS were the pH at admission&#44; contrary to previous studies that did not find a significant association&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> a high fraction of inspired oxygen &#40;FiO<span class="elsevierStyleInf">2</span>&#41; at admission &#40;28&#46;6&#37; of infants with severe MAS required a FiO<span class="elsevierStyleInf">2</span> of 30&#37;&#8211;60&#37; and 85&#46;7&#37; a FiO<span class="elsevierStyleInf">2</span>&#8239;&#62;&#8239;60&#37;&#41;&#44; the need of surfactant and treatment with inhaled nitric oxide &#40;iNO&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Although the association with the need for surfactant and with treatment with iNO were statistically significant&#44; we did not consider these factors predictors of poorer outcomes&#44; as their use intrinsically implies more severe MAS and therefore this would be an expected association&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In the multivariate logistic regression analysis performed to identify predictors of severe MAS&#44; the only variable that remained significant for prediction of severe disease after adjusting for all other variables &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;&#46;01&#41;&#46; We generated receiver-operating characteristic &#40;ROC&#41; curves to establish the optimal cut-off points for the FiO<span class="elsevierStyleInf">2</span> at admission&#44; the pH at admission and the total duration of ROM &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Based on our findings&#44; patients with a diagnosis of MAS that required urgent caesarean delivery due to NRFS&#44; duration of ROM of less than 6&#8239;h&#44; a FiO<span class="elsevierStyleInf">2</span> at admission greater than 35&#37; and a pH at admission of less than 7&#46;22 are at higher risk of developing severe disease&#44; and FiO<span class="elsevierStyleInf">2</span> was the best predictor after adjusting for the rest of the variables&#46; These conclusions must be interpreted with caution&#44; as the main limitation of the study was its small sample size&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Please cite this article as&#58; Nogueira-Cobas C&#44; Ant&#250;ez-Fern&#225;ndez C&#44; Salda&#241;a-Garc&#237;a N&#44; Salda&#241;a-Garc&#237;a J&#44; S&#225;nchez-Tamayo T&#46; S&#237;ndrome de aspiraci&#243;n meconial&#58; factores sugerentes de mala evoluci&#243;n&#46; An Pediatr &#40;Barc&#41;&#46; 2021&#59;94&#58;333&#8211;335&#46;</p>"
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        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">ROC curves for FiO<span class="elsevierStyleInf">2</span> &#40;A&#41;&#44; pH at admission &#40;B&#41; and duration of ROM &#40;C&#41;&#46; A&#58; FiO<span class="elsevierStyleInf">2</span>&#8239;&#62;&#8239;35&#37; predicts severe MAS with a sensitivity &#40;Sen&#41; of 93&#37; and a specificity &#40;Spe&#41; of 72&#37;&#59; FiO<span class="elsevierStyleInf">2</span>&#8239;&#62;&#8239;65&#37; showed a Sen of 73&#37; and a Spe of 93&#37; for severe MAS&#44; with an area under the curve &#40;AUC&#41; of 0&#46;93 &#40;95&#37; confidence interval &#91;CI&#93;&#44; 0&#46;85&#8211;1&#41;&#46; B&#58; A pH at admission &#60;7&#46;22 was associated with severe MAS&#44; with a Sen of 71&#46;4&#37; and a Spe of 75&#37;&#59; a pH at admission &#60;7&#46;12 was associated with severe MAS with a Sen of 50&#37; and a Spe of 91&#46;7&#37;&#44; with an AUC of 0&#46;789 &#40;95&#37; CI&#44; 0&#46;616&#8211;0&#46;962&#41;&#46; C&#58; A duration of ROM&#8239;&#60;&#8239;6&#8239;h was associated with severe MAS with a Sen of 85&#46;7&#37;&#44; a Spe of 64&#46;3&#37; and an AUC of 0&#46;737 &#40;95&#37; CI&#44; 0&#46;541&#8211;0&#46;933&#41;&#46;</p>"
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          "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Continues variables expressed as mean&#8239;&#177;&#8239;standard deviation&#46; Qualitative variables expressed as <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">iNO&#44; inhaled nitric oxide&#59; NRFS&#44; non-reassuring foetal status&#59; RDR&#44; resuscitation in delivery room&#59; ROM&#44; rupture of membranes&#59; WBC&#44; white blood cell count&#46;</p>"
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                  <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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mild&#47;moderate MAS &#40;<span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">MAS severe &#40;<span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;15&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Statistical significance &#40;<span class="elsevierStyleItalic">P</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Maternal variables</span></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"><span class="elsevierStyleHsp" style=""></span>Maternal age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#46;50&#8239;&#177;&#8239;5&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#46;92&#8239;&#177;&#8239;6&#46;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;999<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Primiparity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;85&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;103<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Gestational age &#40;weeks&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#46;72&#8239;&#177;&#8239;1&#46;93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&#46;06&#8239;&#177;&#8239;1&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;847<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></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="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Intrapartum variables</span></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"><span class="elsevierStyleHsp" style=""></span>Duration of ROM &#40;h&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;86&#8239;&#177;&#8239;7&#46;86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;16&#8239;&#177;&#8239;12&#46;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;031<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Intrapartum fever&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;14&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;6&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;598<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>REA IV-V&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;14&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;13&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;999<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>1&#8217; Apgar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;71&#8239;&#177;&#8239;2&#46;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;86&#8239;&#177;&#8239;2&#46;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;427<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>5&#8217; Apgar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;50&#8239;&#177;&#8239;2&#46;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;71&#8239;&#177;&#8239;1&#46;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;227<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Caesarean due to NRFS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">4 &#40;28&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">11 &#40;73&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">6 &#40;42&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;57&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#46;337&#46;86&#8239;&#177;&#8239;473&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">3&#46;356&#46;53&#8239;&#177;&#8239;385&#46;37&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&#46;29&#8239;&#177;&#8239;0&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">7&#46;12&#8239;&#177;&#8239;0&#46;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">33&#46;57&#8239;&#177;&#8239;17&#46;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">81&#46;20&#8239;&#177;&#8239;24&#46;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;&#46;001<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6&#46;36&#8239;&#177;&#8239;6&#46;40&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">19&#46;63&#8239;&#177;&#8239;33&#46;35&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#46;247<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">21&#46;544&#8239;&#177;&#8239;10&#46;080&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">19&#46;905&#8239;&#177;&#8239;10&#46;829&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#46;720<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Need of surfactant&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;21&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11 &#40;73&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#60;&#46;01<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Administration of iNO&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9 &#40;69&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;&#46;001<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                    0 => array:2 [
                      "titulo" => "Meconium-stained amniotic fluid and the meconium aspiration syndrome&#46; An update"
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                          "etal" => false
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                        "tituloSerie" => "Pediatr Clin North Am"
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                          "autores" => array:6 [
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                            2 => "S&#46;J&#46; Choi"
                            3 => "S&#46;Y&#46; Oh"
                            4 => "J&#46;S&#46; Kim"
                            5 => "C&#46;R&#46; Roh"
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                            4 => "M&#46; Zibolen"
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                      "doi" => "10.1080/17476348.2019.1562340"
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                        "tituloSerie" => "Expert Rev Respir Med"
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