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se comprob&#243; que&#44; en las edades gestacionales inferiores de 35 semanas&#44; la muestra poblacional era&#44; en su mayor&#237;a&#44; escasa e insuficiente para proporcionar validez a los estudios comparativos y a las curvas de crecimiento&#46; Quedaron&#44; pues&#44; incluidos en el estudio&#44; 15&#46;397 ni&#241;os y 14&#46;528 ni&#241;as para los valores de peso al nacer&#44; 4&#46;678 ni&#241;os y 4&#46;388 ni&#241;as para los valores de longitud&#44; y 4&#46;654 ni&#241;os y 4&#46;361 ni&#241;as para los valores de per&#237;metro occipitofrontal&#46;</p><p class="elsevierStylePara elsevierViewall">Para el an&#225;lisis estad&#237;stico se ha utilizado el paquete estad&#237;stico SPSS para Windows versi&#243;n 12&#46;0&#46; Para cada semana de gestaci&#243;n se ha calculado la media y desviaci&#243;n est&#225;ndar &#40;DE&#41; del peso en gramos&#44; la longitud y el per&#237;metro occipitofrontal en cent&#237;metros&#44; y la distribuci&#243;n en percentiles &#40;3&#44; 10&#44; 25&#44; 50&#44; 75&#44; 90 y 97&#41;&#46; Para la comparaci&#243;n de medias entre ambos sexos&#44; se aplic&#243; la prueba de la t de Student&#46; Tambi&#233;n se aplic&#243; para la comparaci&#243;n de medias entre los resultados de nuestro estudio y los publicados en un hospital p&#250;blico de tercer nivel de Barcelona<a class="elsevierStyleCrossRef" href="#bib9"><span class="elsevierStyleSup">9</span></a> y por la Generalitat de Catalunya en la poblaci&#243;n general de Catalu&#241;a<a class="elsevierStyleCrossRef" href="#bib15"><span class="elsevierStyleSup">15</span></a>&#46;</p></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStylePara elsevierViewall">En las <a class="elsevierStyleCrossRefs" href="#tbl1">tablas 1 y 2</a> se muestran los valores de peso&#44; longitud y per&#237;metro occipitofrontal para toda la poblaci&#243;n&#44; desde la semana 23 a la 42 de gestaci&#243;n&#46; Puede apreciarse que&#44; cuando se comparan los valores seg&#250;n sexo&#44; los tres par&#225;metros antropom&#233;tricos analizados son&#44; a partir de las 35 semanas&#44; significativamente mayores en los ni&#241;os que en las ni&#241;as &#40;<a class="elsevierStyleCrossRef" href="#tbl3">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl1"></elsevierMultimedia><elsevierMultimedia ident="tbl2"></elsevierMultimedia><elsevierMultimedia ident="tbl3"></elsevierMultimedia><p class="elsevierStylePara elsevierViewall">Las curvas suavizadas seg&#250;n los valores de media y DE se muestran en la <a class="elsevierStyleCrossRef" href="#fig1">figura 1</a> &#40;ni&#241;os&#41; y la <a class="elsevierStyleCrossRef" href="#fig2">figura 2</a> &#40;ni&#241;as&#41;&#46; Se han validado entre las semanas 35 y 42&#46; En edades gestacionales inferiores&#44; la muestra poblacional es insuficiente para la mayor&#237;a de los par&#225;metros antropom&#233;tricos analizados&#46;</p><elsevierMultimedia ident="fig1"></elsevierMultimedia><elsevierMultimedia ident="fig2"></elsevierMultimedia><p class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#fig3">figura 3</a> se muestra la representaci&#243;n gr&#225;fica del percentil 10 de peso al nacer en ni&#241;os y ni&#241;as de la poblaci&#243;n estudiada&#44; junto con los resultados publicados por Lubchenco et al<a class="elsevierStyleCrossRef" href="#bib1"><span class="elsevierStyleSup">1</span></a>&#44; Carrascosa et al<a class="elsevierStyleCrossRef" href="#bib9"><span class="elsevierStyleSup">9</span></a> y la Generalitat de Catalunya<a class="elsevierStyleCrossRef" href="#bib15"><span class="elsevierStyleSup">15</span></a>&#46;</p><elsevierMultimedia ident="fig3"></elsevierMultimedia><p class="elsevierStylePara elsevierViewall">Cuando se comparan los valores obtenidos en nuestro estudio con los de la poblaci&#243;n seleccionada en el Hospital de la Vall d&#8217;Hebron de Barcelona por Carrascosa et al<a class="elsevierStyleCrossRef" href="#bib9"><span class="elsevierStyleSup">9</span></a>&#44; se observa una tendencia a valores medios de peso al nacer mayores en nuestra poblaci&#243;n&#44; con significaci&#243;n estad&#237;stica a partir de la semana 35 de gestaci&#243;n en ambos sexos&#44; excepto en la semana 42&#46; Lo mismo ocurre al compararlos con los datos obtenidos de la poblaci&#243;n general publicados por la Generalitat de Catalunya<a class="elsevierStyleCrossRef" href="#bib15"><span class="elsevierStyleSup">15</span></a> a partir de la semana 38&#46; &#40;<a class="elsevierStyleCrossRef" href="#tbl4">tabla 4</a> y <a class="elsevierStyleCrossRef" href="#fig4">fig&#46; 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl4"></elsevierMultimedia><elsevierMultimedia ident="fig4"></elsevierMultimedia><p class="elsevierStylePara elsevierViewall">En cuanto a los valores de longitud al nacer y de per&#237;metro occipitofrontal de la poblaci&#243;n estudiada&#44; muestran tendencias similares respecto a las otras dos poblaciones referidas&#46; Los valores de longitud son ligeramente mayores&#44; pero con significaci&#243;n estad&#237;stica en ambos sexos a partir de la semana 39 en el Vall d&#8217;Hebron y de la 38 en la poblaci&#243;n general de Catalu&#241;a &#40;<a class="elsevierStyleCrossRef" href="#tbl4">tabla 4</a> y <a class="elsevierStyleCrossRef" href="#fig5">fig&#46; 5</a>&#41;&#46;</p><elsevierMultimedia ident="fig5"></elsevierMultimedia><p class="elsevierStylePara elsevierViewall">Los valores medios del per&#237;metro occipitofrontal tambi&#233;n son ligeramente mayores en nuestra poblaci&#243;n&#44; pero sin significaci&#243;n estad&#237;stica&#44; excepto para ni&#241;as de 35&#44; 39 y 42 semanas&#44; comparadas con la poblaci&#243;n del Vall d&#8217;Hebron&#44; y mayor significaci&#243;n estad&#237;stica entre las semanas 37 y 40 en comparaci&#243;n con la poblaci&#243;n de Catalu&#241;a &#40;<a class="elsevierStyleCrossRef" href="#tbl4">tabla 4</a> y <a class="elsevierStyleCrossRef" href="#fig6">fig&#46; 6</a>&#41;&#46;</p><elsevierMultimedia ident="fig6"></elsevierMultimedia></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discusi&#243;n</span><p class="elsevierStylePara elsevierViewall">&#191;Tiene sentido realizar unas curvas de crecimiento intrauterino propias&#63; La respuesta es compleja&#44; pero creemos que&#44; despu&#233;s de una revisi&#243;n exhaustiva de la literatura y a la vista de nuestro an&#225;lisis&#44; parece justificada&#46;</p><p class="elsevierStylePara elsevierViewall">La recogida de datos fidedignos&#44; aparentemente tan sencilla como es la que nos ocupa&#44; parece exenta de dificultades y&#44; sin embargo&#44; las hay y numerosas&#46; La valoraci&#243;n de la edad gestacional comporta problemas singulares&#44; especialmente en ambientes sociales m&#225;s desfavorecidos con escaso control de la embarazada&#46; Incluso en el supuesto de que sea conocida la fecha de la &#250;ltima menstruaci&#243;n y la concordancia con los datos obtenidos por el control ecogr&#225;fico&#44; la referencia de la edad gestacional var&#237;a seg&#250;n los autores&#46; Unos cuentan semanas &#171;redondeadas&#187;<a class="elsevierStyleCrossRefs" href="#bib18"><span class="elsevierStyleSup">18&#8211;20</span></a>&#44; otros contabilizan a partir del cuarto d&#237;a de la semana en curso y antes del tercero de la siguiente<a class="elsevierStyleCrossRef" href="#bib21"><span class="elsevierStyleSup">21</span></a>&#44; y para la mayor&#237;a&#44; incluidos nosotros&#44; por semanas cumplidas&#46;</p><p class="elsevierStylePara elsevierViewall">Otro factor a considerar es la selecci&#243;n de la muestra&#46; Pr&#225;cticamente&#44; no hay dos trabajos con criterios id&#233;nticos a la hora de seleccionar a la poblaci&#243;n analizada&#46; Incluir s&#243;lo los embarazos con feto &#250;nico parece un criterio bastante generalizado&#44; pero no universal&#44; a pesar de que el crecimiento intrauterino y posnatal hasta los 4 a&#241;os se ha mostrado significativamente diferente en las gestaciones m&#250;ltiples<a class="elsevierStyleCrossRef" href="#bib22"><span class="elsevierStyleSup">22</span></a>&#46; Distinguir por sexo se ha utilizado s&#243;lo en algunas publicaciones<a class="elsevierStyleCrossRef" href="#bib3"><span class="elsevierStyleSup">3</span></a>&#44; a pesar de mostrar todas ellas&#44; incluida la nuestra&#44; que hay diferencias significativas en todos los par&#225;metros antropom&#233;tricos estudiados<a class="elsevierStyleCrossRef" href="#bib19"><span class="elsevierStyleSup">19</span></a>&#44; especialmente a partir de la semana 35&#44; y con tendencia a ser mayores cuanto mayor es la edad gestacional&#46; Las poblaciones seleccionadas son reci&#233;n nacidos de un solo centro&#44; el nuestro&#44; por ejemplo&#44; o de m&#250;ltiples hospitales del mismo pa&#237;s&#44; se refieren a todos los nacidos o s&#243;lo a los ingresados en unidades neonatales<a class="elsevierStyleCrossRef" href="#bib19"><span class="elsevierStyleSup">19</span></a>&#46; Resulta curioso observar que&#44; despu&#233;s de aducir la altitud sobre el nivel del mar de Denver en las curvas de Lubchenco como factor diferenciador&#44; se haya publicado resultados no discordantes con ellas en poblaciones a nivel del mar<a class="elsevierStyleCrossRef" href="#bib19"><span class="elsevierStyleSup">19</span></a>&#46; Sin embargo&#44; parece claro que estas curvas ya no son aplicables&#44; en la actualidad&#44; para nuestra poblaci&#243;n si definimos el percentil 10 como l&#237;mite inferior de normalidad para cada edad gestacional &#40;<a class="elsevierStyleCrossRef" href="#fig3">fig&#46; 3</a>&#41;&#46;</p><p class="elsevierStylePara elsevierViewall">La exclusi&#243;n de los reci&#233;n nacidos muertos es casi un&#225;nime&#44; pero no absoluta<a class="elsevierStyleCrossRef" href="#bib20"><span class="elsevierStyleSup">20</span></a>&#46; La exclusi&#243;n de ni&#241;os con malformaciones&#44; con criterios dispares<a class="elsevierStyleCrossRefs" href="#bib1"><span class="elsevierStyleSup">1&#44;7&#8211;9&#44;19</span></a>&#44; est&#225; justificada por diferentes autores como causa conocida de crecimiento intrauterino restringido&#46; Sin embargo&#44; debe contemplarse la posibilidad de que otras anomal&#237;as o enfermedades cong&#233;nitas y&#47;o gen&#233;ticas no excluidas puedan pasar inicialmente inadvertidas y ser tambi&#233;n causa de bajo peso al nacer&#46; Algunas publicaciones excluyen a hijos de madres con determinadas enfermedades durante el embarazo por considerar que tambi&#233;n son causa conocida de un crecimiento intrauterino an&#243;malo<a class="elsevierStyleCrossRefs" href="#bib1"><span class="elsevierStyleSup">1&#44;7&#8211;9&#44;21</span></a>&#46; Ejemplo son la diabetes&#44; la enfermedad hipertensiva del embarazo&#44; el alcoholismo&#44; la drogadicci&#243;n&#46; O&#44; simplemente&#44; excluyen a quienes les parecen demasiado grandes o demasiado peque&#241;os para su edad gestacional o discordantes con su apreciaci&#243;n cl&#237;nica<a class="elsevierStyleCrossRef" href="#bib1"><span class="elsevierStyleSup">1</span></a>&#46; Creemos que es extraordinariamente dif&#237;cil establecer criterios de exclusi&#243;n a fin de obtener curvas de crecimiento &#171;&#243;ptimas&#187; o &#171;normales&#187;&#44; &#171;representativas&#187; de una poblaci&#243;n&#44; tras pretender eliminar multitud de factores&#44; algunos conocidos y otros no&#44; que pueden incidir en el crecimiento y la nutrici&#243;n fetales<a class="elsevierStyleCrossRefs" href="#bib4"><span class="elsevierStyleSup">4&#44;12&#44;16&#44;23&#8211;25</span></a>&#46; En nuestro estudio&#44; se decidi&#243; hacer un an&#225;lisis basado en una poblaci&#243;n sin exclusiones por enfermedades maternas&#44; del embarazo&#44; fetales o neonatales&#44; de los reci&#233;n nacidos vivos consecutivos&#44; fruto de embarazo &#250;nico&#44; de raza cauc&#225;sica y separados por sexo&#46; El estudio poblacional m&#225;s homog&#233;neo respecto al nuestro es el de la Generalitat de Catalunya<a class="elsevierStyleCrossRef" href="#bib15"><span class="elsevierStyleSup">15</span></a>&#46; Las diferencias que hallamos entre ambas poblaciones pueden reflejar una realidad socioecon&#243;mica distinta&#44; expresada&#44; principalmente&#44; en el mayor peso al nacer&#44; probablemente debido a la atenci&#243;n a la embarazada y a las condiciones socioecon&#243;micas de una poblaci&#243;n m&#225;s favorecida&#46; A resaltar que&#44; cuando se compara nuestra poblaci&#243;n con la del Hospital de la Vall d&#8217;Hebron de Barcelona&#44; estas diferencias se mantienen&#46; El factor socioecon&#243;mico debe pesar m&#225;s que la selecci&#243;n realizada en el estudio de Carrascosa et al<a class="elsevierStyleCrossRef" href="#bib9"><span class="elsevierStyleSup">9</span></a>&#44; puesto que excluyen todas las enfermedades materna&#44; fetal o neonatal reconocidas como probables causas de un retraso en el crecimiento intrauterino&#46; Aqu&#237; cabe hacer menci&#243;n&#44; sin embargo&#44; de los resultados mostrados por los mismos autores cuando comparan a la poblaci&#243;n aut&#243;ctona con la inmigrante<a class="elsevierStyleCrossRef" href="#bib26"><span class="elsevierStyleSup">26</span></a>&#46; Resulta sorprendente que&#44; contando con los factores raciales&#44; a pesar de los factores socioecon&#243;micos razonablemente considerados como desfavorables en esta poblaci&#243;n&#44; muestren valores antropom&#233;tricos mayores que los de una poblaci&#243;n aut&#243;ctona muy seleccionada en cuanto a exenta de enfermedad reconocida&#46; Quiz&#225; tenga alg&#250;n papel la heterogeneidad de las poblaciones comparadas&#46;</p><p class="elsevierStylePara elsevierViewall">Las menores diferencias existentes en la longitud y&#44; especialmente&#44; el per&#237;metro occipitofrontal&#44; con respecto al peso en las poblaciones comparadas&#44; podr&#237;a especularse que se deben a que este par&#225;metro es el m&#225;s afectado en los casos de retraso de crecimiento intrauterino&#44; especialmente el del tercer trimestre&#44; ya que el feto preserva&#44; siempre que le es posible&#44; el crecimiento craneal ante una situaci&#243;n de hipoxia cr&#243;nica intrauterina&#46;</p><p class="elsevierStylePara elsevierViewall">Otro punto de discusi&#243;n es el tama&#241;o de la muestra analizada y la metodolog&#237;a&#46; Es evidente que&#44; incluso en trabajos prospectivos&#44; la utilizaci&#243;n de una u otra metodolog&#237;a en la obtenci&#243;n de los datos antropom&#233;tricos explica que las variaciones puedan ser muy significativas<a class="elsevierStyleCrossRef" href="#bib27"><span class="elsevierStyleSup">27</span></a>&#46; Cuanto menor es el tama&#241;o de la muestra&#44; mayor es la repercusi&#243;n de los sesgos en la interpretaci&#243;n de los resultados&#46; Llama la atenci&#243;n que una de las curvas de referencia m&#225;s usadas&#44; como es la de Usher et al<a class="elsevierStyleCrossRef" href="#bib21"><span class="elsevierStyleSup">21</span></a>&#44; parte de una poblaci&#243;n extremadamente peque&#241;a en cada grupo de edad gestacional&#46; Tambi&#233;n llama la atenci&#243;n el corte de selecci&#243;n de poblaci&#243;n para determinadas edades gestacionales cuando se supera tama&#241;os de muestra que se considera arbitrariamente suficientes&#44; mientras se sigue recogiendo datos de otros de edades gestacionales m&#225;s cortas<a class="elsevierStyleCrossRef" href="#bib1"><span class="elsevierStyleSup">1</span></a>&#46; Parece evidente que&#44; en este tipo de an&#225;lisis&#44; cuanto mayor es la poblaci&#243;n&#44; los errores metodol&#243;gicos&#44; especialmente mediante datos retrospectivos&#44; influyen menos en los resultados&#46; En nuestra poblaci&#243;n&#44; se reconoce el escaso valor de los datos obtenidos en edades gestacionales cortas&#44; con menos de 30 reci&#233;n nacidos en cada grupo&#46; La curva de peso obtenida a partir de las 35 semanas contiene una muestra que confiere valor estad&#237;stico&#44; igual que para la longitud y el per&#237;metro occipitofrontal&#46;</p><p class="elsevierStylePara elsevierViewall">Creemos que la heterogeneidad metodol&#243;gica en la literatura revisada impide comparar adecuadamente los resultados con otros publicados&#46; &#218;nicamente nos sirven para mostrar que hay diferencias antropom&#233;tricas neonatales en diferentes poblaciones&#44; y la dificultad estriba en establecer si las diferencias existentes entre las diversas curvas de crecimiento intrauterino responden a diferencias metodol&#243;gicas o&#44; realmente&#44; a diferencias interpoblacionales&#46;</p><p class="elsevierStylePara elsevierViewall">Para atribuir valor predictivo a los datos obtenidos hace falta establecer una l&#237;nea de corte&#44; de m&#225;ximo y m&#237;nimo&#44; y con ello determinar su probable repercusi&#243;n&#44; tanto por exceso como por defecto&#46; En este &#250;ltimo caso&#44; esencialmente para el crecimiento intrauterino restringido&#44; habitualmente relacionado con malnutrici&#243;n fetal &#40;no siempre evidente o excluyente&#41; y la posible repercusi&#243;n en la edad adulta&#44; que favorece afecciones cardiovasculares&#44; s&#237;ndrome plurimetab&#243;lico&#44; obesidad&#44; diabetes e hipertensi&#243;n<a class="elsevierStyleCrossRefs" href="#bib10"><span class="elsevierStyleSup">10&#44;13&#44;25</span></a>&#46; En el establecimiento de estos l&#237;mites tambi&#233;n hay discrepancias metodol&#243;gicas&#46; Desde la publicaci&#243;n de Lubchenco et al<a class="elsevierStyleCrossRef" href="#bib1"><span class="elsevierStyleSup">1</span></a>&#44; muchos autores&#44; especialmente en Am&#233;rica del Norte&#44; utilizan el percentil 10 y 90 como l&#237;mites inferior y superior&#44; respectivamente&#46; Sin embargo&#44; otros han definido el percentil 2&#44;5&#44; 3&#44; 5 y hasta el 25 como el l&#237;mite inferior de normalidad en sus poblaciones<a class="elsevierStyleCrossRef" href="#bib4"><span class="elsevierStyleSup">4</span></a>&#46; La OMS y la mayor&#237;a de los endocrin&#243;logos<a class="elsevierStyleCrossRef" href="#bib4"><span class="elsevierStyleSup">4</span></a>&#44; cuando se refieren a crecimiento&#44; llegan al consenso de utilizar 2 DE por encima y por debajo de la media como l&#237;mites de la normalidad&#46; En el presente trabajo se muestran los valores hallados en nuestra poblaci&#243;n en percentiles&#44; media y DE&#46;</p><p class="elsevierStylePara elsevierViewall">El peso al nacer es &#250;nicamente una simple medida de corte sectorial sumativo&#44; tomada al final de un per&#237;odo durante el cual el crecimiento es r&#225;pido pero no lineal<a class="elsevierStyleCrossRef" href="#bib17"><span class="elsevierStyleSup">17</span></a>&#46; Debe mostrarse un gran rigor cuando se habla de crecimiento intrauterino restringido o peque&#241;o para su edad gestacional&#44; t&#233;rminos que no son&#44; obviamente&#44; sin&#243;nimos a pesar de poder coexistir<a class="elsevierStyleCrossRefs" href="#bib4"><span class="elsevierStyleSup">4&#44;28</span></a>&#46; Para determinar un retraso de crecimiento intrauterino son precisas dos mediciones&#44; como m&#237;nimo&#44; en fechas suficientemente distantes<a class="elsevierStyleCrossRef" href="#bib28"><span class="elsevierStyleSup">28</span></a>&#46; Con los datos obtenidos al nacer&#44; lo &#250;nico que podemos aseverar es si son &#171;peque&#241;os&#187; o &#171;grandes&#187; para lo esperado por su edad gestacional&#46; Adem&#225;s&#44; el crecimiento quiz&#225; deber&#237;a referirse al par&#225;metro longitud m&#225;s que solamente al peso&#46; Con todos los datos antropom&#233;tricos podremos afirmar si un reci&#233;n nacido es&#44; seg&#250;n nuestra propia poblaci&#243;n&#44; adecuado o no&#44; para su edad gestacional&#44; en peso&#44; longitud y per&#237;metro occipitofrontal&#46; La armon&#237;a o disarmon&#237;a entre los tres par&#225;metros se relacionan con etiolog&#237;as y evoluciones distintas y con pron&#243;sticos tambi&#233;n muy diferentes&#46;</p><p class="elsevierStylePara elsevierViewall">Como conclusiones&#44; afirmar&#237;amos que son necesarios m&#225;s estudios&#44; en nuestro medio&#44; sobre los valores de normalidad seg&#250;n edad gestacional y sexo&#46; Que estos valores cambian mucho entre los diferentes trabajos y que no es posible aclarar si es debido a las diferencias metodol&#243;gicas o si se trata de caracter&#237;sticas propias de cada poblaci&#243;n&#44; especialmente cuando hay variedad &#233;tnica en ella<a class="elsevierStyleCrossRef" href="#bib26"><span class="elsevierStyleSup">26</span></a>&#46; Ser&#237;a conveniente disponer de valores antropom&#233;tricos obtenidos con una metodolog&#237;a robusta desde el punto de vista epidemiol&#243;gico&#44; actualizados peri&#243;dicamente&#44; y que reflejaran la realidad poblacional de la zona geogr&#225;fica a la que se pertenece&#46; A partir de ah&#237;&#44; con la m&#225;xima homogeneidad metodol&#243;gica&#44; realizar estudios comparativos para determinadas circunstancias poblacionales o de enfermedad&#46;</p></span></span>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Introducci&#243;n y objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">la clasificaci&#243;n del reci&#233;n nacido seg&#250;n peso&#44; longitud y per&#237;metro occipitofrontal al nacer en relaci&#243;n con la edad gestacional se ha utilizado como indicador de morbimortalidad neonatal&#44; as&#237; como factor pron&#243;stico de enfermedades de la edad adulta&#46; Las diferentes poblaciones analizadas y metodolog&#237;as en la recogida de datos hacen que los resultados sean dispares entre publicaciones&#46; El objetivo es establecer los valores antropom&#233;tricos de referencia para nuestro hospital&#44; que atiende a una poblaci&#243;n caracterizada por un nivel socioecon&#243;mico medio-alto&#44; distinta&#44; probablemente&#44; de otras publicadas recientemente en nuestro entorno&#44; y compararlas&#46;</p> <span class="elsevierStyleSectionTitle">Pacientes y m&#233;todo</span><p class="elsevierStyleSimplePara elsevierViewall">an&#225;lisis del peso&#44; la longitud y el per&#237;metro occipitofrontal al nacimiento de 31&#46;397 reci&#233;n nacidos vivos consecutivos en SCIAS-Hospital de Barcelona&#44; de 1992 a 2006&#44; con edades gestacionales entre 23 y 42 semanas&#46; Se seleccionaron las gestaciones &#250;nicas y se separaron seg&#250;n sexo&#46; Todos ellos de raza cauc&#225;sica&#46; No hubo exclusiones por enfermedad materna&#44; fetal o neonatal&#46; Se obtuvieron los valores en percentiles&#44; media y desviaci&#243;n estandar&#44; y se compararon seg&#250;n sexo&#46; Se realizaron curvas seg&#250;n la edad gestacional a partir de las 35 semanas&#46; Se compararon con los resultados de publicaciones recientes referidas a poblaciones de nuestro entorno geogr&#225;fico&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">se aprecian diferencias significativas en el peso&#44; la longitud y el per&#237;metro occipitofrontal al nacer seg&#250;n sexo a partir de las 36 semanas&#44; con valores m&#225;s altos en los varones&#46; Se observa una tendencia a valores m&#225;s altos en nuestra poblaci&#243;n al compararlos con otras de nuestro entorno geogr&#225;fico&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">la influencia del factor socioecon&#243;mico sobre el crecimiento fetal parece evidente&#46; Sin embargo&#44; es dif&#237;cil asegurar que las diferencias observadas sean debidas&#44; exclusivamente&#44; a las caracter&#237;sticas poblacionales o a las diferentes metodolog&#237;as en la selecci&#243;n de la muestra&#46; Es recomendable disponer de valores antropom&#233;tricos poblacionales de referencia de la zona geogr&#225;fica a la que pertenecemos&#44; obtenidos a partir de metodolog&#237;as epidemiol&#243;gicas&#44; para clasificar al reci&#233;n nacido de forma adecuada y poder establecer comparaciones con sectores poblacionales diferenciados seg&#250;n factores raciales&#44; socioecon&#243;micos o por enfermedades&#46;</p>"
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      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Background and objective</span><p class="elsevierStyleSimplePara elsevierViewall">gestational age and anthropometric measurements&#44; i&#46;e&#46; weight&#44; length and head circumference at birth&#44; have all been used as predictors of neonatal morbidity-mortality and adult morbidity&#46; Differences in ethnic or socioeconomic background of newborn cohorts&#44; as well as methodological differences between studies limit the validity and application of current anthropometric curves across different populations&#46; Thus&#44; we conducted a study to obtain local reference data in a Hospital that had a medium-high socio-economic class population&#44; probably different to others recently published in our geographic area&#44; and to compare them&#46;</p> <span class="elsevierStyleSectionTitle">Patients and method</span><p class="elsevierStyleSimplePara elsevierViewall">Weight&#44; length and head circumference at birth were retrospectively analysed in 31&#44;397 live Caucasian neonates born at 23&#8211;42 weeks in SCIAS-Hospital de Barcelona between 1992 and 2006&#46; Only single gestations were selected and no other exclusion by materno-fetal or neonatal pathology criteria were applied&#46; Percentile values&#44; mean and standard deviation for each anthropometric measurement were calculated according to gestational age and gender&#46; They were compared with the results from recent publications of our geographic area&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">Males were found to have significantly higher weight&#44; length and head circumference values than females from 36 weeks&#46; There was a trend towards higher values in our population when compared with others in our geographic area&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">The influence of socioeconomic factors on fetal growth seems evident&#46; Nevertheless&#44; it is difficult to assume that the observed differences must be exclusively due to the population characteristics or the different methodologies in the selection of the sample&#46; Thus&#44; it is desirable to have anthropometric reference curves obtained from populations of surrounding areas&#44; with epidemiological methodologies that might be more appropriate in identifying valid outcome predictors&#44; and enable us to compare with others groups according to racial&#44; socioeconomic and disease factors&#46;</p>"
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      2 => array:7 [
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          "es" => "<p class="elsevierStyleSimplePara elsevierViewall">Curvas obtenidas con los valores del percentil 10 de peso en ni&#241;os &#40;A&#41; y ni&#241;as &#40;B&#41; en el Hospital de Barcelona &#40;H de BCN&#41;&#44; Hospital Vall d&#8217;Hebron<a class="elsevierStyleCrossRef" href="#bib9"><span class="elsevierStyleSup">9</span></a> &#40;V Hebron&#41;&#44; en la poblaci&#243;n catalana publicados por la Generalitat de Catalunya<a class="elsevierStyleCrossRef" href="#bib15"><span class="elsevierStyleSup">15</span></a> &#40;GenCat&#41; y los publicados en Denver por Lubchenco et al<a class="elsevierStyleCrossRef" href="#bib1"><span class="elsevierStyleSup">1</span></a>&#46;</p>"
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          "es" => "<p class="elsevierStyleSimplePara elsevierViewall">Gr&#225;fica de los valores medios de peso al nacer en relaci&#243;n con la edad gestacional en los ni&#241;os &#40;A&#41; y ni&#241;as &#40;B&#41; nacidos en el Hospital de Barcelona &#40;H de BCN&#41;&#44; Hospital Vall d&#8217;Hebron<a class="elsevierStyleCrossRef" href="#bib9"><span class="elsevierStyleSup">9</span></a> &#40;V Hebron&#41; y en la poblaci&#243;n catalana publicados por la Generalitat de Catalunya<a class="elsevierStyleCrossRef" href="#bib15"><span class="elsevierStyleSup">15</span></a> &#40;GenCat&#41;&#46;</p>"
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          "es" => "<p class="elsevierStyleSimplePara elsevierViewall">Gr&#225;fica de los valores medios de longitud al nacer en relaci&#243;n con la edad gestacional en los ni&#241;os &#40;A&#41; y ni&#241;as &#40;B&#41; nacidos en el Hospital de Barcelona &#40;H de BCN&#41;&#44; Hospital Vall d&#8217;Hebron<a class="elsevierStyleCrossRef" href="#bib9"><span class="elsevierStyleSup">9</span></a> &#40;V Hebron&#41; y en la poblaci&#243;n catalana publicados por la Generalitat de Catalunya<a class="elsevierStyleCrossRef" href="#bib15"><span class="elsevierStyleSup">15</span></a> &#40;GenCat&#41;&#46;</p>"
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          "es" => "<p class="elsevierStyleSimplePara elsevierViewall">Gr&#225;fica de los valores medios de per&#237;metro occipitofrontal al nacer en relaci&#243;n con la edad gestacional en los ni&#241;os &#40;A&#41; y ni&#241;as &#40;B&#41; nacidos en el Hospital de Barcelona &#40;H de BCN&#41;&#44; Hospital Vall d&#8217;Hebron<a class="elsevierStyleCrossRef" href="#bib9"><span class="elsevierStyleSup">9</span></a> &#40;V Hebron&#41; y en la poblaci&#243;n catalana publicados por la Generalitat de Catalunya<a class="elsevierStyleCrossRef" href="#bib15"><span class="elsevierStyleSup">15</span></a> &#40;GenCat&#41;&#46;</p>"
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">33&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">35&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">35&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">35&#44;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t">38&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">34&#44;6&#177;1&#44;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">32&#44;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">33&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">34&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">36&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">34&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">36&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="" valign="\n
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                  \t\t\t\t">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">33&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">34&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&#44;5&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&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="" valign="\n
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                  \t\t\t\t">36&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="" valign="\n
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                  \t\t\t\t">36&#44;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&nbsp;\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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">395&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#44;3&#177;1&#44;1&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&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="" valign="\n
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                  \t\t\t\t">34&#44;5&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#44;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">37&#44;5&nbsp;\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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#44;3&#177;1&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#44;5&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#44;5&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#44;5&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab189848.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p class="elsevierStyleSimplePara elsevierViewall">Datos antropom&#233;tricos de los ni&#241;os seg&#250;n edad gestacional &#40;EG&#41;</p>"
        ]
      ]
      7 => array:7 [
        "identificador" => "tbl2"
        "etiqueta" => "Tabla 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p class="elsevierStyleSimplePara elsevierViewall">DE&#58; desviaci&#243;n est&#225;ndar&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">EG&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Media&#177;DE&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">P<span class="elsevierStyleInf">50</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">P<span class="elsevierStyleInf">75</span>&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" style="border-bottom: 2px solid black">P<span class="elsevierStyleInf">97</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="10" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Peso &#40;g&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">2&#46;480&#177;360&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">2&#46;650&#177;362&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">2&#46;635&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&#60;0&#44;0001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">35&#44;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">0&#44;8&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="" valign="\n
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                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab189849.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p class="elsevierStyleSimplePara elsevierViewall">Comparaci&#243;n de los valores medios de peso&#44; longitud y per&#237;metro occipitofrontal al nacer seg&#250;n sexo y edad gestacional &#40;EG&#41;</p>"
        ]
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      9 => array:7 [
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        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p class="elsevierStyleSimplePara elsevierViewall">DE&#58; desviaci&#243;n est&#225;ndar&#59; NS&#58; sin significaci&#243;n estad&#237;stica&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
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                  \t\t\t\t" style="border-bottom: 2px solid black">Semanas&nbsp;\t\t\t\t\t\t\n
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                  """
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              "imagenFichero" => array:1 [
                0 => "xTab189850.png"
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          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p class="elsevierStyleSimplePara elsevierViewall">Comparaci&#243;n de los valores de media aritm&#233;tica de peso&#44; longitud y per&#237;metro occipitofrontal al nacer&#44; en el Hospital de Barcelona &#40;H de BCN&#41;&#44; Hospital Infantil Vall d&#8217;Hebron<span class="elsevierStyleSup">9</span> &#40;V Hebron&#41; y los datos de la poblaci&#243;n catalana publicados por la Generalitat de Catalunya<span class="elsevierStyleSup">15</span> &#40;GenCat&#41;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliograf&#237;a"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:28 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intrauterine growth as estimated from liveborn birth-weight data at 24 to 42 weeks of gestation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "L&#46;O&#46; Lubchenco"
                            1 => "C&#46; Hansaman"
                            2 => "M&#46; Dressler"
                            3 => "E&#46; Boyd"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "1963"
                        "volumen" => "32"
                        "paginaInicial" => "793"
                        "paginaFinal" => "800"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14075621"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A practical classification of newborn infants by weight and gestational age"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "F&#46;C&#46; Battaglia"
                            1 => "L&#46;O&#46; Lubchenco"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr"
                        "fecha" => "1967"
                        "volumen" => "71"
                        "paginaInicial" => "159"
                        "paginaFinal" => "163"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6029463"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intrauterine growth retardation&#58; standards for diagnosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "R&#46;L&#46; Goldenberg"
                            1 => "G&#46;R&#46; Cutre"
                            2 => "H&#46;J&#46; Hoffman"
                            3 => "J&#46;M&#46; Foster"
                            4 => "K&#46;G&#46; Nelson"
                            5 => "J&#46;C&#46; Hauth"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Obstet Gynecol"
                        "fecha" => "1989"
                        "volumen" => "161"
                        "paginaInicial" => "271"
                        "paginaFinal" => "277"
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