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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">El alivio del dolor es un derecho humano b&#225;sico a cualquier edad&#46; En los reci&#233;n nacidos&#44; por un lado la inherente dificultad para la detecci&#243;n del dolor y&#44; por otro&#44; la falsa creencia de que los neonatos carec&#237;an de las v&#237;as fisiol&#243;gicas necesarias para presentar dolor han llevado a un infratratamiento hist&#243;rico en este grupo de edad<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">1</span></a>&#46; Hoy se sabe que los reci&#233;n nacidos ingresados en unidades de cuidados intensivos &#40;UCI&#41; se someten a m&#250;ltiples procedimientos dolorosos durante su estancia<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">2&#44;3</span></a>&#46; Adem&#225;s&#44; existen suficientes pruebas de que el dolor no tratado durante el per&#237;odo neonatal puede tener consecuencias perjudiciales a corto y a largo plazo<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">4-8</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Actualmente&#44; se dispone de una amplia variedad de recursos para el manejo de la sedaci&#243;n y&#47;o analgesia &#40;S&#47;A&#41;&#44; que incluyen medidas farmacol&#243;gicas y no farmacol&#243;gicas&#44; pero en la pr&#225;ctica muchas pautas se llevan a cabo en funci&#243;n de consensos de expertos&#44; protocolos locales o incluso preferencias personales&#46; En un intento de determinar la pr&#225;ctica cl&#237;nica habitual en cuanto al manejo del dolor en unidades neonatales&#44; en los &#250;ltimos a&#241;os se han publicado encuestas en diferentes pa&#237;ses&#58; Francia<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">9</span></a>&#44; Canad&#225;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">10</span></a>&#44; Reino Unido<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">11&#44;12</span></a>&#44; Australia<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">13&#44;14</span></a>&#44; Italia<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">15</span></a>&#44; Estados Unidos<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">16</span></a>&#44; Alemania&#44; Austria y Suiza<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">17&#44;18</span></a>&#44; y Suecia<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">19</span></a>&#46; Hasta donde conocemos&#44; en Espa&#241;a no existen actualmente datos sobre c&#243;mo se maneja la S&#47;A en reci&#233;n nacidos que permitan un an&#225;lisis cr&#237;tico y que constituyan un primer paso para la elaboraci&#243;n de gu&#237;as de pr&#225;ctica cl&#237;nica&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">En el marco del proyecto multic&#233;ntrico internacional Europain &#40;<a href="http://www.europainsurvey.eu/">www&#46;europainsurvey&#46;eu</a>&#41; se dise&#241;&#243; un estudio espec&#237;fico de la muestra espa&#241;ola con el objetivo de determinar las pr&#225;cticas cl&#237;nicas actuales y reales en relaci&#243;n con el uso de f&#225;rmacos sedantes y analg&#233;sicos en UCI neonatales en Espa&#241;a y los factores asociados a su uso&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material y m&#233;todos</span><p id="par0020" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8211;</span><p id="par0025" class="elsevierStylePara elsevierViewall">Dise&#241;o&#58; el estudio Europain-Espa&#241;a es de tipo observacional&#44; longitudinal y prospectivo&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8211;</span><p id="par0030" class="elsevierStylePara elsevierViewall">Selecci&#243;n de las unidades&#58; se solicit&#243; a la Sociedad Espa&#241;ola de Neonatolog&#237;a en el a&#241;o 2012 un listado de las UCI neonatales de la red sanitaria p&#250;blica espa&#241;ola&#46; Se invit&#243; a participar v&#237;a correo electr&#243;nico a 34 unidades que prestaban asistencia intensiva integral&#44; que inclu&#237;a todos los modos de ventilaci&#243;n mec&#225;nica invasiva&#46; Dos unidades declinaron la invitaci&#243;n&#44; no se obtuvo respuesta de una y otra abandon&#243; el estudio una vez comenzado&#46; Finalmente&#44; participaron 30 unidades neonatales distribuidas por todo el pa&#237;s &#40;<a class="elsevierStyleCrossRef" href="#sec0060">anexo 1</a>&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8211;</span><p id="par0035" class="elsevierStylePara elsevierViewall">Criterios de inclusi&#243;n&#58; en cada una de las unidades participantes se incluy&#243; a todos los reci&#233;n nacidos que ingresaron durante un mes &#40;noviembre del 2012&#41; hasta una edad corregida de 44 semanas y cuyos tutor&#47;es legal&#47;es firmaron el consentimiento informado para participar en el estudio&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8211;</span><p id="par0040" class="elsevierStylePara elsevierViewall">Recogida de datos&#58; de cada neonato se recogieron datos demogr&#225;ficos&#44; de los modos de asistencia respiratoria&#44; uso de sedantes&#44; analg&#233;sicos o relajantes musculares y manejo de la abstinencia de drogas&#46; La duraci&#243;n de la recogida de datos para cada reci&#233;n nacido incluido fue de 28 d&#237;as o hasta su alta&#44; traslado a otro hospital o defunci&#243;n&#46; Los coordinadores de las unidades proporcionaron adem&#225;s datos de los protocolos locales sobre S&#47;A y de las estad&#237;sticas generales de la unidad&#46; El control de calidad se realiz&#243; como una autoauditor&#237;a en cada hospital participante por una persona distinta de la que hab&#237;a introducido los datos&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8211;</span><p id="par0050" class="elsevierStylePara elsevierViewall">Aspectos &#233;ticos&#58; se obtuvo la aprobaci&#243;n de la Agencia Espa&#241;ola de Medicamentos y Productos Sanitarios y del comit&#233; de &#233;tica de investigaci&#243;n cl&#237;nica de referencia&#44; adem&#225;s de los comit&#233;s locales que as&#237; lo requirieron&#46; Se obtuvo el consentimiento informado de los padres y&#47;o tutores legales de todos los neonatos incluidos&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8211;</span><p id="par0055" class="elsevierStylePara elsevierViewall">An&#225;lisis de datos&#58; se realiz&#243; un an&#225;lisis descriptivo de las caracter&#237;sticas tanto de las unidades participantes como de los pacientes incluidos y su manejo&#44; indicando estimaciones por intervalo de los hallazgos principales&#46; Se analizaron las variables asociadas al uso de S&#47;A&#44; utilizando el test de la chi al cuadrado o el test exacto de Fisher y el test de Mann-Whitney&#44; calculando los valores de odds ratio y su intervalo de confianza del 95&#37;&#46; Para determinar las variables asociadas de forma independiente al uso de S&#47;A&#44; se ajust&#243; un modelo multivariante de regresi&#243;n log&#237;stica&#46; Dado que cada unidad incluy&#243; un n&#250;mero variable de neonatos&#44; se recurri&#243; para su ajuste a modelos de ecuaciones de estimaci&#243;n generalizada<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">20&#44;21</span></a>&#46; Este enfoque tiene en cuenta la dependencia que puede existir entre los datos de neonatos ingresados en una misma unidad y permite evitar los sesgos asociados a las t&#233;cnicas cl&#225;sicas cuando la hip&#243;tesis de independencia no se puede mantener&#46; Se sigui&#243; una estrategia de modelizaci&#243;n hacia delante&#44; introduciendo en el modelo todas aquellas variables que en el an&#225;lisis bivariado mostraron un valor de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;20&#46; Para el an&#225;lisis multivariante se clasificaron las unidades seg&#250;n n&#250;mero de ingresos anuales &#40;mayor o menor de 250&#41; y seg&#250;n el n&#250;mero de ingresos quir&#250;rgicos anuales &#40;mayor o menor de 25&#41;&#46; Se clasific&#243; igualmente a los pacientes seg&#250;n una puntuaci&#243;n de CRIB superior a 3 e inferior o igual a 3&#46; El an&#225;lisis estad&#237;stico se realiz&#243; con el programa SPSS 19&#46;0 para Windows&#46; Todas las pruebas se realizaron con un planteamiento bilateral&#46; Se consideraron significativos valores de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p></li></ul></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0075" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> se describen las caracter&#237;sticas de las 30 unidades participantes&#46; Se incluy&#243; a un total de 468 neonatos&#44; cuyas caracter&#237;sticas generales se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#46; Del total&#44; 202 neonatos &#40;43&#44;2&#37;&#44; IC del 95&#37;&#44; 38&#44;5-47&#44;7&#41; recibieron ventilaci&#243;n mec&#225;nica invasiva &#40;VM&#41;&#44; durante un tiempo medio &#177; DE de 126&#44;9 &#177; 173&#44;5 h&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Globalmente&#44; 198 neonatos &#40;42&#44;3&#37;&#44; IC del 95&#37;&#44; 37&#44;7-46&#44;8&#41; recibieron alg&#250;n tipo de medicaci&#243;n sedante o analg&#233;sica&#46; De estos&#44; 16 &#40;8&#37;&#41; la recibieron solo en perfusi&#243;n&#44; 85 &#40;42&#44;9&#37;&#41; solo en bolos y 97 &#40;48&#44;9&#37;&#41; en perfusi&#243;n y en bolos&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">De los 202 neonatos que recibieron VM invasiva&#44; 158 &#40;78&#44;2&#37;&#44; IC del 95&#37;&#44; 72&#44;2-84&#44;1&#41; recibieron alg&#250;n tipo de medicaci&#243;n sedante o analg&#233;sica&#46; En la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> se muestra la proporci&#243;n de neonatos que recibieron alg&#250;n tipo de medicaci&#243;n sedante o analg&#233;sica y su modo de administraci&#243;n seg&#250;n la asistencia respiratoria m&#225;xima recibida durante el per&#237;odo de estudio&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">El f&#225;rmaco m&#225;s utilizado fue el fentanilo&#44; tanto en perfusi&#243;n como en bolos&#44; us&#225;ndose en 138&#47;468 neonatos &#40;29&#44;4&#37;&#41;&#46; La <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> muestra la utilizaci&#243;n de los f&#225;rmacos m&#225;s habituales y su modo de administraci&#243;n &#40;perfusi&#243;n o bolos&#41;&#46; En total&#44; se usaron durante el per&#237;odo de estudio 19 f&#225;rmacos distintos&#46; Solo fentanilo&#44; midazolam&#44; morfina y paracetamol se usaron al menos en un 20&#37; de los neonatos que recibieron S&#47;A&#46; La <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a> recoge la proporci&#243;n de pacientes que reciben cada f&#225;rmaco en cada unidad participante y muestra gr&#225;ficamente la variabilidad entre centros en el uso de estos f&#225;rmacos&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">En los 113 neonatos que recibieron alg&#250;n f&#225;rmaco sedante o analg&#233;sico en perfusi&#243;n continua hubo 14 pautas distintas&#44; siendo la m&#225;s frecuente la infusi&#243;n de fentanilo &#40;46 neonatos&#44; 40&#44;7&#37;&#41; y la combinaci&#243;n de fentanilo y midazolam &#40;26 neonatos&#44; 23&#37;&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">De los 202 neonatos que recibieron VM invasiva&#44; 45 &#40;22&#44;2&#37;&#44; IC del 95&#37;&#44; 16&#44;2-28&#44;2&#41; recibieron alg&#250;n tipo de relajante muscular&#46; Diez neonatos lo recibieron en perfusi&#243;n continua &#40;9 vecuronio&#44; uno cisatracurio&#41; y 41 en bolos &#40;33 vecuronio&#44; 7 succinilcolina&#44; uno cisatracurio&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Un total de 180 neonatos &#40;38&#44;4&#37;&#44; IC del 95&#37;&#44; 33&#44;9-42&#44;9&#41; recibieron alg&#250;n tipo de soluci&#243;n dulce oral&#44; siendo la m&#225;s frecuente la sacarosa &#40;174 neonatos&#41;&#44; seguida de la glucosa &#40;6 neonatos&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Se diagnostic&#243; un s&#237;ndrome de abstinencia en 25 de los 165 neonatos que hab&#237;an recibido alg&#250;n opi&#225;ceo o benzodiacepina &#40;15&#44;2&#37;&#41;&#46; En 33 neonatos se us&#243; una escala cl&#237;nica para evaluar la abstinencia&#44; siendo la m&#225;s utilizada la escala de Finnegan &#40;27 neonatos&#44; 81&#44;8&#37;&#41;&#44; seguida de la escala de Lipstiz &#40;5 neonatos&#44; 15&#44;1&#37;&#41;&#46; Un total de 28 neonatos recibieron alguna medicaci&#243;n para tratar o prevenir espec&#237;ficamente los s&#237;ntomas de la abstinencia&#46; La medicaci&#243;n m&#225;s usada fue la morfina &#40;14 neonatos&#44; 50&#37;&#41;&#44; seguida de la clonidina &#40;9 neonatos&#44; 32&#44;1&#37;&#41; y la metadona &#40;8 neonatos&#44; 28&#44;5&#37;&#41;&#46;</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Factores asociados a recibir sedaci&#243;n y&#47;o analgesia</span><p id="par0115" class="elsevierStylePara elsevierViewall">Finalmente&#44; se analizaron aquellas variables relativas a los neonatos o a las unidades asociadas al hecho de utilizar S&#47;A &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46; Tras el an&#225;lisis multivariante&#44; las variables asociadas fueron el haber recibido VM invasiva &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>23&#44;79&#41;&#44; un score de CRIB<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>3 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;023&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;26&#41;&#44; la existencia en la unidad de gu&#237;as locales de evaluaci&#243;n del dolor &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;82&#41; y la existencia de un l&#237;der de dolor m&#233;dico en la unidad &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;034&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;35&#41;&#46; Por el contrario&#44; una edad gestacional inferior a 33 semanas se asoci&#243; de forma significativa a una menor probabilidad de recibir S&#47;A&#46; Ni el uso de herramientas de evaluaci&#243;n del dolor ni el tama&#241;o de la unidad &#40;seg&#250;n el n&#250;mero de ingresos o ingresos quir&#250;rgicos anuales&#41; se asociaron a la utilizaci&#243;n de S&#47;A &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discusi&#243;n</span><p id="par0120" class="elsevierStylePara elsevierViewall">Hasta donde conocemos&#44; este estudio es el primer estudio multic&#233;ntrico prospectivo sobre el manejo de la S&#47;A en una muestra de neonatos ingresados en unidades neonatales espa&#241;olas&#46; En este estudio&#44; un 42&#44;3&#37; de los neonatos recibieron alg&#250;n tipo de medicaci&#243;n sedante o analg&#233;sica&#44; una proporci&#243;n que alcanz&#243; el 78&#44;2&#37; en aquellos que recibieron VM invasiva&#46; Sobre el total de neonatos&#44; un 31&#44;8&#37; recibi&#243; un opi&#225;ceo y un 17&#44;9&#37; recibi&#243; midazolam&#46; El opi&#225;ceo m&#225;s utilizado fue el fentanilo&#44; que se administr&#243; a un 29&#44;4&#37; del total de neonatos&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Casi la mitad de los neonatos recibieron alg&#250;n tipo de f&#225;rmaco sedante o analg&#233;sico en este estudio&#46; A nivel internacional&#44; en el a&#241;o 2003&#44; el 60&#44;3&#37; de una muestra de 151 neonatos holandeses recibi&#243; alg&#250;n tipo de analgesia farmacol&#243;gica<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">3</span></a>&#44; pero este porcentaje se redujo significativamente&#44; al 36&#44;6&#37;&#44; en las mismas unidades 8 a&#241;os despu&#233;s tras la intensificaci&#243;n de medidas no farmacol&#243;gicas&#44; la aplicaci&#243;n de los cuidados NIDCAP y el desarrollo de un protocolo de tratamiento basado en la valoraci&#243;n cl&#237;nica del dolor<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">22</span></a>&#46; En el grupo de neonatos con VM invasiva el porcentaje de S&#47;A ascendi&#243; a un 78&#44;2&#37;&#46; El f&#225;rmaco m&#225;s usado fue el fentanilo&#44; seguido del midazolam&#44; el paracetamol y la morfina&#44; hallazgos similares a una encuesta previa italiana<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">15</span></a>&#46; La VM es una t&#233;cnica estresante y potencialmente dolorosa&#44; adem&#225;s la inadaptaci&#243;n o &#171;lucha&#187; con el respirador puede dificultar una adecuada ventilaci&#243;n y tener efectos perjudiciales<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">23</span></a>&#46; Se han publicado recomendaciones internacionales promoviendo el uso de opi&#225;ceos en neonatos ventilados<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">7</span></a> y su uso ha sido evaluado en 2 estudios de buena calidad metodol&#243;gica<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">24&#44;25</span></a>&#44; y en un metaan&#225;lisis<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">26</span></a>&#46; Los resultados merecen una evaluaci&#243;n prudente&#46; Se ha observado un modesto efecto de la morfina sobre las escalas de valoraci&#243;n del dolor durante los procedimientos dolorosos&#44; y una ausencia de efecto sobre la prevenci&#243;n de lesiones neurol&#243;gicas o muerte<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">24&#44;25</span></a>&#46; Adem&#225;s&#44; la utilizaci&#243;n de morfina se ha asociado a un mayor tiempo para alcanzar la alimentaci&#243;n enteral completa en neonatos prematuros&#46; Sin embargo&#44; hay que resaltar el hecho que los opi&#225;ceos sint&#233;ticos como el fentanilo no han sido evaluados en esos aspectos y sobre todo que la utilizaci&#243;n de analg&#233;sicos para aliviar el dolor y el sufrimiento de los neonatos constituye en s&#237; una raz&#243;n suficiente para su utilizaci&#243;n incluso en ausencia de efecto sobre alg&#250;n resultado cl&#237;nico&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">En Espa&#241;a existen varios opi&#225;ceos disponibles&#44; pero en las unidades neonatales su uso pr&#225;cticamente se restringe al fentanilo y a la morfina&#44; sin poder recomendarse en este momento un opi&#225;ceo con respecto a otro&#46; Una explicaci&#243;n al elevado uso de fentanilo en las unidades espa&#241;olas es que este f&#225;rmaco puede tener algunas ventajas te&#243;ricas &#40;potente&#44; efecto r&#225;pido&#44; corta duraci&#243;n&#41; con un efecto analg&#233;sico similar a morfina<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">27</span></a>&#44; si bien existen muy pocos estudios aleatorizados al respecto y todos con un reducido n&#250;mero de pacientes<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">28&#44;29</span></a>&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">En cuanto a los f&#225;rmacos con acci&#243;n fundamentalmente sedante&#44; las benzodiacepinas son los f&#225;rmacos m&#225;s utilizados&#46; El midazolam se usa muy frecuentemente &#40;42&#44;4&#37; de los neonatos que recibieron alg&#250;n tipo de S&#47;A&#41; a pesar de la ausencia de beneficios demostrados&#44; de la preocupaci&#243;n sobre su influencia en el neurodesarrollo tanto en experimentaci&#243;n animal<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">30</span></a> como a nivel cl&#237;nico<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">6</span></a>&#44; y de recientes revisiones desaconsejando su uso rutinario<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">31</span></a>&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Como en otros estudios previos&#44; nuestros resultados indican una gran variabilidad en las pautas de S&#47;A entre las 30 unidades participantes<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">2</span></a>&#46; Los 19 f&#225;rmacos distintos utilizados&#44; las 14 combinaciones distintas de f&#225;rmacos en perfusi&#243;n y la dispersi&#243;n de los porcentajes de utilizaci&#243;n de los distintos f&#225;rmacos expresadas en la <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a> son reflejo de la carencia de pautas de consenso comunes a las unidades espa&#241;olas&#46; Esta gran variabilidad ha podido ser detectada gracias a una recogida de datos en la cabecera del paciente&#59; es muy probable que el uso de estas medicaciones no pudiese ser detectado en estudios tipo encuesta&#46; De forma similar&#44; Jenkins et al&#46;&#44; en un estudio prospectivo de 338 pacientes pedi&#225;tricos &#40;incluyendo 39 neonatos&#41; de 20 unidades en Reino Unido&#44; reportan 24 f&#225;rmacos sedantes o analg&#233;sicos distintos<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">32</span></a>&#46; Es f&#225;cil concluir que estas diferencias entre unidades dificultan la comparaci&#243;n de resultados y el estudio de la S&#47;A en nuestro pa&#237;s&#46;</p><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Soluciones dulces orales</span><p id="par0145" class="elsevierStylePara elsevierViewall">El uso de soluciones dulces orales durante procedimientos potencialmente dolorosos ha sido ampliamente recomendado<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">33&#44;34</span></a>&#46; Sin embargo&#44; en nuestro estudio solo el 38&#44;4&#37; de los neonatos recibieron alguna soluci&#243;n dulce oral &#40;sacarosa o glucosa&#41;&#46; Es posible que el registro de la administraci&#243;n de soluciones dulces orales fuese m&#225;s laxo que para los f&#225;rmacos&#44; aunque el car&#225;cter prospectivo del estudio deber&#237;a haber minimizado este posible error&#46; Otra posibilidad es que todav&#237;a existan reticencias a su uso debido al desconocimiento de su mecanismo de acci&#243;n exacto&#46; Es importante destacar el hecho de que 12 unidades utilizan soluciones dulces en m&#225;s de la mitad de sus pacientes y en cambio hubo 9 unidades que no las utilizaron en ninguno de los pacientes incluidos en el estudio&#46; Esta variabilidad&#44; aunque tambi&#233;n se observ&#243; con otros f&#225;rmacos&#44; es especialmente llamativa en el caso de las soluciones dulces orales&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Gu&#237;as locales de tratamiento y valoraci&#243;n del dolor</span><p id="par0150" class="elsevierStylePara elsevierViewall">A pesar de las recomendaciones internacionales al respecto de la conveniencia de establecer protocolos de manejo del dolor<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">35</span></a>&#44; un tercio de las unidades declararon no tener un protocolo por escrito&#44; porcentaje muy similar al observado en el estudio de Menc&#237;a et al&#46; en 36 UCI pedi&#225;tricas espa&#241;olas en el a&#241;o 2011&#44; en el cual un 64&#37; de las unidades declaraban tener un protocolo escrito de sedonalgesia<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">36</span></a>&#46; A nivel internacional&#44; la proporci&#243;n de unidades neonatales con protocolos por escrito var&#237;an desde un 15&#37;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">13</span></a> hasta un 88&#37;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">19</span></a>&#46; El porcentaje de nuestra muestra se sit&#250;a en valores similares a otros pa&#237;ses de nuestro entorno<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">9&#44;11&#44;14&#44;15&#44;17</span></a>&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Factores asociados a recibir sedaci&#243;n y&#47;o analgesia</span><p id="par0155" class="elsevierStylePara elsevierViewall">El an&#225;lisis multivariante mostr&#243; que las variables asociadas a un mayor uso de S&#47;A fueron la edad a t&#233;rmino&#44; la VM&#44; la gravedad al ingreso definida sobre la base de la puntuaci&#243;n de CRIB&#44; la existencia de gu&#237;as locales de evaluaci&#243;n del dolor y la existencia de un l&#237;der m&#233;dico del dolor&#46; El factor m&#225;s asociado al uso de S&#47;A fue la VM&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">En estudios previos&#44; se han descrito diferencias en el manejo del dolor asociadas al tama&#241;o de las unidades<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">17&#44;19</span></a>&#44; al nivel asistencial<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">11&#44;12</span></a> y a su car&#225;cter quir&#250;rgico<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">11</span></a>&#46; En nuestra muestra&#44; el n&#250;mero de ingresos anuales &#40;mayor o menor de 250&#41; y el n&#250;mero de ingresos quir&#250;rgicos anuales &#40;mayor o menor de 25&#41; no se asociaron al hecho de recibir S&#47;A&#46; Existen pocos datos sobre la influencia de las gu&#237;as locales en el manejo del dolor en unidades neonatales&#46; Algunos estudios previos indican diferencias significativas entre las unidades que disponen de protocolos por escrito y las que no<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">17&#44;37</span></a>&#46; En nuestra muestra&#44; solo la existencia de gu&#237;as locales de valoraci&#243;n del dolor se asoci&#243; de forma independiente a un mayor uso de S&#47;A&#44; si bien la propia aplicaci&#243;n de las herramientas de valoraci&#243;n del dolor no se asoci&#243; de forma significativa&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Limitaciones</span><p id="par0165" class="elsevierStylePara elsevierViewall">Una preocupaci&#243;n habitual es la de la generabilidad de los resultados&#44; que aqu&#237; tiene potencial importancia&#46; En nuestro estudio han participado la gran mayor&#237;a de las unidades neonatales invitadas&#44; con representaci&#243;n de unidades de todo el pa&#237;s e inclusi&#243;n de un n&#250;mero elevado de pacientes consecutivos no seleccionados&#44; por lo que creemos que constituyen un reflejo fiel de la situaci&#243;n real de la S&#47;A en Espa&#241;a&#46; No se puede descartar que el hecho de participar en el estudio&#44; por saberse observado&#44; modifique las pr&#225;cticas &#40;efecto Hawthorne&#41;&#46; Este aspecto se intent&#243; minimizar con un tiempo relativamente largo de inclusi&#243;n &#40;un mes&#41; y de seguimiento &#40;28 d&#237;as&#41;&#44; que garantiza la rotaci&#243;n del personal&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Aunque el desarrollo inicial de la escala CRIB se llev&#243; a cabo en neonatos de menos de 32 semanas<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">38</span></a>&#44; se eligi&#243; utilizarla en este estudio como medidora de la gravedad principalmente por su sencillez y su amplia difusi&#243;n<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">39</span></a>&#44; pero tambi&#233;n porque la prematuridad fue el principal diagn&#243;stico al ingreso y por su uso previo en estudios de naturaleza similar al presente<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">No se evaluaron las dosis de los f&#225;rmacos utilizados ni se evaluaron las medidas no farmacol&#243;gicas para el manejo del dolor&#46; La decisi&#243;n de no recoger estos datos fue para facilitar la recogida de informaci&#243;n y hacer viable el estudio&#44; aspecto en el que tuvo &#233;xito&#44; pero limita la posibilidad de discusi&#243;n de aspectos de indudable inter&#233;s&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclusiones</span><p id="par0180" class="elsevierStylePara elsevierViewall">Nuestros resultados permiten conocer las pautas reales de S&#47;A utilizadas en Espa&#241;a y demuestran una importante variabilidad entre las distintas unidades&#46; Este &#171;estado del arte&#187; puede servir de base para la elaboraci&#243;n de gu&#237;as de pr&#225;ctica cl&#237;nica a nivel nacional<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">40</span></a>&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">A pesar de que el manejo de la S&#47;A es un campo en continuo cambio y que a&#250;n existen muchas &#225;reas en las que son necesarios m&#225;s estudios&#44; la creaci&#243;n de grupos de trabajo y la elaboraci&#243;n de gu&#237;as o protocolos consensuados entre las distintas unidades puede disminuir la variabilidad en la pr&#225;ctica cl&#237;nica y permitir una m&#225;s f&#225;cil evaluaci&#243;n de las pautas de S&#47;A en Espa&#241;a&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicto de intereses</span><p id="par0190" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El manejo del dolor y la sedaci&#243;n es una prioridad de los cuidados intensivos neonatales&#46; Se dise&#241;&#243; un estudio con el objetivo de determinar la pr&#225;ctica cl&#237;nica actual en relaci&#243;n con la sedaci&#243;n y la analgesia en unidades de cuidados intensivos neonatales en Espa&#241;a e identificar factores asociados al uso de f&#225;rmacos sedantes o analg&#233;sicos&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio multic&#233;ntrico&#44; observacional&#44; longitudinal y prospectivo&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Participaron 30 unidades neonatales y se reclut&#243; a 468 neonatos&#46; De estos&#44; 198 &#40;42&#44;3&#37;&#41; recibieron medicaci&#243;n sedante o analg&#233;sica&#46; En total&#44; se usaron durante el per&#237;odo de estudio 19 f&#225;rmacos distintos&#44; de los cuales el m&#225;s utilizado fue el fentanilo&#46; Solo fentanilo&#44; midazolam&#44; morfina y paracetamol se usaron al menos en un 20&#37; de los neonatos que recibieron sedaci&#243;n y&#47;o analgesia&#46; Se usaron 14 pautas distintas de f&#225;rmacos en perfusi&#243;n&#44; siendo las m&#225;s frecuentes la infusi&#243;n de fentanilo y la combinaci&#243;n de fentanilo y midazolam&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Las variables asociadas a recibir sedaci&#243;n y&#47;o analgesia fueron el haber precisado ventilaci&#243;n invasiva &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#60; 0&#44;001&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>23&#44;79&#41;&#44; un score de CRIB<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>3 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;023&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;26&#41;&#44; la existencia en la unidad de gu&#237;as de evaluaci&#243;n del dolor &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;82&#41; y de un l&#237;der de dolor &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;034&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;35&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Casi la mitad de los neonatos ingresados en cuidados intensivos recibe medicaci&#243;n sedante y&#47;o analg&#233;sica&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Existe una importante variabilidad entre las unidades neonatales espa&#241;olas en relaci&#243;n con las pautas de sedaci&#243;n y analgesia&#46; Nuestros resultados permiten conocer el &#171;estado del arte&#187; y pueden servir de base para la elaboraci&#243;n de gu&#237;as de pr&#225;ctica cl&#237;nica a nivel nacional&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Pain management and sedation is a priority in neonatal intensive care units&#46; A study was designed with the aim of determining current clinical practice as regards sedation and analgesia in neonatal intensive care units in Spain&#44; as well as to identify factors associated with the use of sedative and analgesic drugs&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Method</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A multicenter&#44; observational&#44; longitudinal and prospective study&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Thirty neonatal units participated and included 468 neonates&#46; Of these&#44; 198 &#40;42&#44;3&#37;&#41; received sedatives or analgesics&#46; A total of 19 different drugs were used during the study period&#44; and the most used was fentanyl&#46; Only fentanyl&#44; midazolam&#44; morphine and paracetamol were used in at least 20&#37; of the neonates who received sedatives and&#47;or analgesics&#46; In infusions&#44; 14 different drug prescriptions were used&#44; with the most frequent being fentanyl and the combination of fentanyl and midazolam&#46;</p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The variables associated with receiving sedation and&#47;or analgesia were&#44; to have required invasive ventilation <span class="elsevierStyleItalic">&#40;P</span>&#60;&#46;001&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>23&#46;79&#41;&#44; a CRIB score &#62;3 <span class="elsevierStyleItalic">&#40;P</span>&#61;&#46;023&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;26&#41;&#44; the existence of pain evaluation guides in the unit &#40;P&#60;&#46;001&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#46;82&#41;&#44; and a pain leader <span class="elsevierStyleItalic">&#40;P</span>&#61;&#46;034&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;35&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Almost half of the neonates admitted to intensive care units receive sedatives or analgesics&#46;</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">There is significant variation between Spanish neonatal units as regards sedation and analgesia prescribing&#46; Our results provide evidence on the &#8220;state of the art&#8221;&#44; and could serve as the basis of preparing clinical practice guidelines at a national level&#46;</p></span>"
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            "apendice" => "<p id="par0195" class="elsevierStylePara elsevierViewall">Helena Viana&#44; Paloma Lopez Ortego &#40;Hospital Infantil Universitario La Paz&#44; Madrid&#41;&#46; Pilar Saenz Gonzalez&#44; Raquel Escrig &#40;Hospital Universitari i Politecnic La Fe&#44; Valencia&#41;&#46; Eva Bargall&#243; Ailagas&#44; Concepcio Carles &#40;Hospital Universitari Josep Trueta&#44; Girona&#41;&#46; Laura San Feliciano&#44; Ana Bel&#233;n Mateo &#40;Hospital Universitario de Salamanca&#41;&#46; In&#233;s Esteban Di&#233;z&#44; Rosa Gonz&#225;lez Crespo &#40;Hospital San Pedro de Logro&#241;o&#41;&#46; Ersilia Gonz&#225;lez Carrasco&#44; Isabel de la Nogal Tagarro &#40;Hospital Universitario Severo Ochoa&#44; Legan&#233;s&#41;&#46; Mar&#237;a Dolores Elorza Fern&#225;ndez&#44; Nerea Benito Guerra &#40;Hospital Universitario de Donostia&#41;&#46; Salud Luna Lagares&#44; Pedro Jim&#233;nez Parrilla &#40;Hospital Virgen Macarena&#44; Sevilla&#41;&#46; Francesc Botet&#44; Anna Ciurana&#44; Rebeca Tarjuelo &#40;Hospital Clinic de Barcelona&#41;&#46; Mar&#237;a Jos&#233; Garc&#237;a Borau&#44; Nuria Ib&#225;&#241;ez &#40;Hospital de la Santa Creu i Sant Pau&#44; Barcelona&#41;&#46; Gloria Di&#225;&#241;ez Vega &#40;Hospital Universitario Puerta del Mar&#44; C&#225;diz&#41;&#46; Mar&#237;a Arriaga Redondo &#40;Hospital General Universitario Gregorio Mara&#241;&#243;n&#44; Madrid&#41;&#46; Gloria Herranz&#44; Virginia de la Fuente Iglesias &#40;Hospital Cl&#237;nico San Carlos&#44; Madrid&#41;&#46; Amaya P&#233;rez Oc&#243;n&#44; Sagrario Santiago Aguinaga &#40;Complejo Hospitalario de Navarra&#41;&#46; Bel&#233;n Mart&#237;n Parra&#44; Antonia Valero Cardona &#40;Hospital General de Castell&#243;n&#41;&#46; Mar&#237;a Dolores S&#225;nchez-Redondo&#44; Antonio Arroyos Plana &#40;Hospital Virgen de la Salud&#44; Toledo&#41;&#46; Zenaida Galve Pradel&#44; Nuria Clavero Monta&#241;&#233;s &#40;Hospital Universitario Miguel Servet&#44; Zaragoza&#41;&#46; Mar&#237;a Jes&#250;s Ripalda Crespo&#44; Raquel Nogales Ju&#225;rez &#40;Hospital Universitario Pr&#237;ncipe de Asturias&#44; Alcal&#225; de Henares&#41;&#46; Aintzane Euba Lopez&#44; Sonia Fern&#225;ndez de Retana &#40;Hospital Universitario de &#193;lava&#41;&#46; Mar Reyn&#233; Vergeli&#44; Raquel Vidal &#40;Hospital Sant Joan de D&#233;u&#44; Barcelona&#41;&#46; Jose Luis Fernandez-Trisac&#44; Mar&#237;a Taboada &#40;Complexo Hospitalario Universitario de A Coru&#241;a&#41;&#46; Aurora Montoro Exp&#243;sito&#44; F&#225;tima Camba Longueira &#40;Hospital Vall d¿Hebron&#44; Barcelona&#41;&#46; Gonzalo Sol&#237;s S&#225;nchez &#40;Hospital Universitario Central de Asturias&#44; Oviedo&#41;&#46; Mar&#237;a Purificaci&#243;n Ventura Faci&#44; Marivi Mallen &#40;Hospital Cl&#237;nico Universitario Lozano Blesa&#44; Zaragoza&#41;&#46; Pilar Crespo Su&#225;rez&#44; Elvira de Sola &#40;Complexo Hospitalario de Pontevedra&#41;&#46; Caridad Tapia Collados &#40;Hospital General de Alicante&#41;&#46; Isabel de las Cuevas&#44; Beatriz Mart&#237;n &#40;Hospital Universitario Marqu&#233;s de Valdecilla&#44; Santander&#41;&#46; Mar&#237;a Luz Couce Pico&#44; Alejandro P&#233;rez Mu&#241;uzuri&#44; Salom&#233; Quint&#225;ns &#40;Complexo Hospitalario Universitario de Santiago&#41;&#46; Ana Melgar Bonis&#44; Eugenia Bodas &#40;Hospital Universitario 12 de Octubre&#44; Madrid&#41;&#46; Ana Concheiro Guisan&#44; Bego&#241;a P&#233;rez Costas &#40;Complexo Hospitalario Universitario de Vigo&#41;&#46;</p>"
            "etiqueta" => "Anexo 1"
            "titulo" => "Grupo espa&#241;ol del estudio Europain"
            "identificador" => "sec0060"
          ]
        ]
      ]
    ]
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          "es" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Proporci&#243;n de neonatos &#40;&#37;&#41; que recibieron alg&#250;n tipo de medicaci&#243;n sedante o analg&#233;sica y su modo de administraci&#243;n seg&#250;n la asistencia respiratoria m&#225;xima recibida durante el per&#237;odo de estudio&#46;</p> <p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">VM&#58; ventilaci&#243;n mec&#225;nica invasiva&#59; VNI&#58; ventilaci&#243;n no invasiva&#46;</p>"
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        "mostrarFloat" => true
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        "figura" => array:1 [
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          "es" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Representaci&#243;n gr&#225;fica del uso de los f&#225;rmacos m&#225;s habituales en cada una de las 30 unidades participantes&#46; La l&#237;nea horizontal se&#241;ala el porcentaje de cada variable en la muestra total&#46; Los puntos representan el porcentaje de pacientes que reciben cada f&#225;rmaco en cada una de las unidades participantes&#46;</p>"
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          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">DE&#58; desviaci&#243;n est&#225;ndar&#46;</p>"
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Unidadesn<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Existencia de gu&#237;as locales de tratamiento del dolor en 2012&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;66&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Existencia de gu&#237;as locales de evaluaci&#243;n del dolor en 2012&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13 &#40;43&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">272&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>137&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mediana &#40;rango&#41;&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="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">N&#250;mero de ingresos quir&#250;rgicos&#47;a&#241;o</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Media<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>54&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mediana &#40;rango&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mediana &#40;rango&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
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        "mostrarFloat" => true
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          "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">CRIB es una medida de la gravedad validada en neonatos pret&#233;rmino compuesto por 6 &#237;tems recogidos en las primeras 12 h de vida&#44; Su valor va de 0 a 23&#44; en donde valores mayores indican mayor gravedad&#44;</p><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">DE&#58; desviaci&#243;n est&#225;ndar&#59; IQ&#58; rango intercuart&#237;lico&#59; NA&#58; no aplicable&#46;</p>"
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total n &#61; 468&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Ventilaci&#243;n mec&#225;nica invasiva n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>202 &#40;43&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Ventilaci&#243;n no invasiva n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>149 &#40;31&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Edad gestacional &#40;semanas&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Media<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#44;9 &#40;29&#44;1-38&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70 &#40;34&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34 &#40;22&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;2&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24 &#40;11&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37 &#40;24&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;12&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>33-36&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">115 &#40;24&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38 &#40;18&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45 &#40;30&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32 &#40;27&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>37-42&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">170 &#40;36&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70 &#40;34&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33 &#40;22&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">67 &#40;57&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Peso al nacer &#40;g&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Media<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;182&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>976&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;051<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;985<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>849&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;663<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>919&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mediana &#40;IQ&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;081 &#40;1&#46;390-3&#46;025&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;050 &#40;1&#46;089-2&#46;905&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;880 &#40;1&#46;350-2&#46;425&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;720 &#40;1&#46;805-3&#46;310&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Hombre&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">256 &#40;54&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">113 &#40;55&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75 &#40;50&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68 &#40;58&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;228&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Nacido en el propio hospital&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">377 &#40;80&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">143 &#40;70&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">138 &#40;92&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">96 &#40;82&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Edad al ingreso &#40;h&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Media<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">64&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>237&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>309&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>152&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>171&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;114&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mediana &#40;IQ&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;5 &#40;0&#44;23-6&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;5 &#40;0&#44;3-7&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;3 &#40;0&#44;2-1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;5 &#40;0&#44;2-48&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">CRIB score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Media<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mediana &#40;IQ&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;0&#44;0-3&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;1-6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0-1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0-1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Apgar a los 5</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">min &#40;n</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">467&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Media<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#44;8&#177; 1&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mediana &#40;IQ&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 &#40;8-10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;6-9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;8-10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;9-10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Ya intubado al ingreso&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">112 &#40;23&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">112 &#40;55&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Defunci&#243;n durante el per&#237;odo de estudio&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21 &#40;3&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21 &#40;10&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Duraci&#243;n de la hospitalizaci&#243;n &#40;d&#237;as&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Media<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mediana &#40;IQ&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14 &#40;6-28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;7-28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17 &#40;8-28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;4-14&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "es" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas de los neonatos incluidos en el estudio&#44; en la muestra total y sobre la base de la asistencia respiratoria m&#225;xima recibida durante el per&#237;odo de estudio</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Modo de administraci&#243;n</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>468&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">En bolos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">En perfusi&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Fentanilo&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">138 &#40;29&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">111 &#40;23&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">97 &#40;20&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Midazolam&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84 &#40;17&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75 &#40;16&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40 &#40;8&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Paracetamol&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66 &#40;14&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66 &#40;14&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Morfina&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40 &#40;8&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30 &#40;6&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23 &#40;4&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Metamizol&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;3&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;3&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;0&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Fenobarbital&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;2&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;2&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Clonidina&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;2&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;1&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Propofol&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;2&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;2&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Ketamina&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Remifentanilo&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;1&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;0&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Meperidina&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Diazepam&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Penthotal&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;0&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;0&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Fenito&#237;na&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;0&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;0&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Bupivaca&#237;na&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;0&#44;4&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;0&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Lorazepam&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Hidrato de cloral&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Levomepromazina&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Sevoflurano&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#44;2&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "es" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Proporci&#243;n de pacientes tratados con los diferentes f&#225;rmacos sedantes o analg&#233;sicos durante el per&#237;odo de estudio y modo de administraci&#243;n&#46; Se muestran los porcentajes del total de pacientes &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>468&#41; que reciben cada f&#225;rmaco</p>"
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          "leyenda" => "<p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">CRIB es una medida de la gravedad validada en neonatos pret&#233;rmino compuesto por 6 &#237;tems recogidos en las primeras 12 h de vida&#46; Su valor va de 0 a 23&#44; en donde valores mayores indican mayor gravedad&#46;</p><p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">DE&#58; desviaci&#243;n est&#225;ndar&#59; OR&#58; odds ratio&#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="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Recibir alguna medicaci&#243;n sedante&#47;analgesia</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">S&#237;n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Non &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR &#40;IC del 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Edad gestacional</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>24-29 semanas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51 &#40;47&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56 &#40;52&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;9 &#40;0&#44;5-1&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>30-32 semanas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23 &#40;30&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53 &#40;69&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;4 &#40;0&#44;2-0&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>33-36 semanas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39 &#40;33&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76 &#40;66&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;5 &#40;0&#44;3-0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>37-42 semanas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85 &#40;50&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85 &#40;50&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Prematuridad &#40;&#8804; 36 semanas&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">113 &#40;37&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">185 &#40;62&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;6 &#40;0&#44;4-0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85 &#40;50&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85 &#40;50&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Ventilaci&#243;n mec&#225;nica invasiva</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">158 &#40;78&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44 &#40;21&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#44;2 &#40;12&#44;6-32&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40 &#40;15&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">226 &#40;85&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Uso de herramientas de evaluaci&#243;n del dolor</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46 &#40;58&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32 &#40;41&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;2 &#40;1&#44;3-3&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">152 &#40;38&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">238 &#40;61&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Gu&#237;as locales de tratamiento del dolor</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;553&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">140 &#40;43&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">184 &#40;56&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;1 &#40;0&#44;7-1&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58 &#40;40&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">86 &#40;59&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Gu&#237;as locales de evaluaci&#243;n del dolor</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">113 &#40;58&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80 &#40;41&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;1 &#40;2&#44;1-4&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85 &#40;30&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">190 &#40;70&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">L&#237;der de dolor m&#233;dico en la unidad</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;088&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43 &#40;50&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42 &#40;49&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;5 &#40;0&#44;9-2&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">155 &#40;40&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">228 &#40;59&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">L&#237;der de dolor enfermer&#237;a en la unidad</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;291&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26 &#40;49&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27 &#40;51&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;3 &#40;0&#44;7-2&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">172 &#40;41&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">243 &#40;58&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Equipo del dolor en la unidad</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;524&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">95 &#40;40&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">141 &#40;59&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;8 &#40;0&#44;6-1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">98 &#40;43&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">129 &#40;56&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Visitas de los padres permitidas 24 h</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;268&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">184 &#40;43&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">243 &#40;57&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;6 &#40;0&#44;7-3&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;34&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27 &#40;65&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">Media<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">Media<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">OR &#40;IC del 95&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0020"><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" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Gravedad &#40;CRIB score&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;5 &#40;1&#44;3-1&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">N&#250;mero de camas en la unidad</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;008&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">329&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>138&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">296&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>130&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;01 &#40;1&#44;00-1&#44;01&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">N&#250;mero de ingresos quir&#250;rgicos anuales</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>66&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>57&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;01 &#40;1&#44;00-1&#44;01&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0020">OR por cada unidad de cambio de la variable independiente&#46;</p>"
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        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Variables asociadas al hecho de recibir alguna medicaci&#243;n sedante o analg&#233;sica&#46; An&#225;lisis univariado</p>"
        ]
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        "identificador" => "tbl0025"
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        "mostrarFloat" => true
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        "tabla" => array:3 [
          "leyenda" => "<p id="spar0130" class="elsevierStyleSimplePara elsevierViewall">CRIB es una medida de la gravedad validada en neonatos pret&#233;rmino compuesto por 6 &#237;tems recogidos en las primeras 12 h de vida&#46; Su valor va de 0 a 23&#44; en donde valores mayores indican mayor gravedad&#46;</p><p id="spar0135" class="elsevierStyleSimplePara elsevierViewall">B&#58; coeficiente de regresi&#243;n&#59; EE&#58; error est&#225;ndar&#59; IC&#58; intervalo de confianza&#59; OR&#58; odds ratio&#46;</p>"
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;5806&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;210&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;072&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;609&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>30-32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;1&#44;126&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;324&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;142&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;742&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#40;ref&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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              ]
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              "identificador" => "tblfn0025"
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0025">OR de &#171;s&#237;&#187; con respecto a &#171;no&#187; cuando la referencia no est&#225; indicada&#46;</p>"
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          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">Modelo multivariante de regresi&#243;n log&#237;stica mediante ecuaciones de estimaci&#243;n generalizada&#44; de factores asociados al uso de sedaci&#243;n o analgesia en neonatos</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliograf&#237;a"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:40 [
            0 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Stevens B&#44; Anand KJ&#46; An overview in neonatal pain&#46; En&#58; Anand KJ&#44; Stevens B&#44; McGrath P&#44; editores&#46; Pain in neonates&#46; 1st ed&#46; &#193;msterdan&#58; Elsevier Science&#59; 2000&#46; p&#46; 1-7"
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiology and treatment of painful procedures in neonates in intensive care units"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Carbajal"
                            1 => "A&#46; Rousset"
                            2 => "C&#46; Danan"
                            3 => "S&#46; Coquery"
                            4 => "P&#46; Nolent"
                            5 => "S&#46; Ducrocq"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jama.300.1.60"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA&#46;"
                        "fecha" => "2008"
                        "volumen" => "300"
                        "paginaInicial" => "60"
                        "paginaFinal" => "70"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18594041"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Do we still hurt newborn babies&#63; A prospective study of procedural pain and analgesia in neonates"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46;H&#46;P&#46; Simons"
                            1 => "M&#46; van Dijk"
                            2 => "K&#46;S&#46; Anand"
                            3 => "D&#46; Roofthooft"
                            4 => "R&#46;A&#46; van Lingen"
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ORIGINAL
Manejo de la sedación y la analgesia en unidades de cuidados intensivos neonatales españolas
Sedation and analgesia practices among Spanish neonatal intensive care units
A. Avila-Alvareza,
Autor para correspondencia
alejandro.avila.neonatologia@gmail.com

Autor para correspondencia.
, R. Carbajalb, E. Courtoisb, S. Pertega-Diazc, J. Muñiz-Garciad, K.J.S. Anande, Grupo Español del proyecto Europain ◊
a Unidad de Neonatología, Servicio de Pediatría, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade de A Coruña (UDC), A Coruña, España
b Service d’Urgences Pédiatriques, Hôpital d’enfants Armand Trousseau, Inserm UMR 1153, Equipe de recherche en Epidémiologie Obstétricale, Périnatale et Pédiatrique (EPOPé), Université Pierre et Marie Curie, París, Francia
c Grupo de Investigación de Epidemiología Clínica y Bioestadística, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade de A Coruña (UDC), A Coruña, España
d Instituto Universitario de Ciencias de la Salud, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade de A Coruña (UDC), A Coruña, España
e University of Tennessee Health Science Center, Menphis, Estados Unidos
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            "entidad" => "Grupo de Investigaci&#243;n de Epidemiolog&#237;a Cl&#237;nica y Bioestad&#237;stica&#44; Instituto de Investigaci&#243;n Biom&#233;dica de A Coru&#241;a &#40;INIBIC&#41;&#44; Complexo Hospitalario Universitario de A Coru&#241;a &#40;CHUAC&#41;&#44; Sergas&#44; Universidade de A Coru&#241;a &#40;UDC&#41;&#44; A Coru&#241;a&#44; Espa&#241;a"
            "etiqueta" => "c"
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            "entidad" => "Instituto Universitario de Ciencias de la Salud&#44; Instituto de Investigaci&#243;n Biom&#233;dica de A Coru&#241;a &#40;INIBIC&#41;&#44; Complexo Hospitalario Universitario de A Coru&#241;a &#40;CHUAC&#41;&#44; Sergas&#44; Universidade de A Coru&#241;a &#40;UDC&#41;&#44; A Coru&#241;a&#44; Espa&#241;a"
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        "titulo" => "Sedation and analgesia practices among Spanish neonatal intensive care units"
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          "es" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Proporci&#243;n de neonatos &#40;&#37;&#41; que recibieron alg&#250;n tipo de medicaci&#243;n sedante o analg&#233;sica y su modo de administraci&#243;n seg&#250;n la asistencia respiratoria m&#225;xima recibida durante el per&#237;odo de estudio&#46;</p> <p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">VM&#58; ventilaci&#243;n mec&#225;nica invasiva&#59; VNI&#58; ventilaci&#243;n no invasiva&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">El alivio del dolor es un derecho humano b&#225;sico a cualquier edad&#46; En los reci&#233;n nacidos&#44; por un lado la inherente dificultad para la detecci&#243;n del dolor y&#44; por otro&#44; la falsa creencia de que los neonatos carec&#237;an de las v&#237;as fisiol&#243;gicas necesarias para presentar dolor han llevado a un infratratamiento hist&#243;rico en este grupo de edad<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">1</span></a>&#46; Hoy se sabe que los reci&#233;n nacidos ingresados en unidades de cuidados intensivos &#40;UCI&#41; se someten a m&#250;ltiples procedimientos dolorosos durante su estancia<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">2&#44;3</span></a>&#46; Adem&#225;s&#44; existen suficientes pruebas de que el dolor no tratado durante el per&#237;odo neonatal puede tener consecuencias perjudiciales a corto y a largo plazo<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">4-8</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Actualmente&#44; se dispone de una amplia variedad de recursos para el manejo de la sedaci&#243;n y&#47;o analgesia &#40;S&#47;A&#41;&#44; que incluyen medidas farmacol&#243;gicas y no farmacol&#243;gicas&#44; pero en la pr&#225;ctica muchas pautas se llevan a cabo en funci&#243;n de consensos de expertos&#44; protocolos locales o incluso preferencias personales&#46; En un intento de determinar la pr&#225;ctica cl&#237;nica habitual en cuanto al manejo del dolor en unidades neonatales&#44; en los &#250;ltimos a&#241;os se han publicado encuestas en diferentes pa&#237;ses&#58; Francia<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">9</span></a>&#44; Canad&#225;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">10</span></a>&#44; Reino Unido<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">11&#44;12</span></a>&#44; Australia<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">13&#44;14</span></a>&#44; Italia<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">15</span></a>&#44; Estados Unidos<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">16</span></a>&#44; Alemania&#44; Austria y Suiza<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">17&#44;18</span></a>&#44; y Suecia<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">19</span></a>&#46; Hasta donde conocemos&#44; en Espa&#241;a no existen actualmente datos sobre c&#243;mo se maneja la S&#47;A en reci&#233;n nacidos que permitan un an&#225;lisis cr&#237;tico y que constituyan un primer paso para la elaboraci&#243;n de gu&#237;as de pr&#225;ctica cl&#237;nica&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">En el marco del proyecto multic&#233;ntrico internacional Europain &#40;<a href="http://www.europainsurvey.eu/">www&#46;europainsurvey&#46;eu</a>&#41; se dise&#241;&#243; un estudio espec&#237;fico de la muestra espa&#241;ola con el objetivo de determinar las pr&#225;cticas cl&#237;nicas actuales y reales en relaci&#243;n con el uso de f&#225;rmacos sedantes y analg&#233;sicos en UCI neonatales en Espa&#241;a y los factores asociados a su uso&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material y m&#233;todos</span><p id="par0020" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8211;</span><p id="par0025" class="elsevierStylePara elsevierViewall">Dise&#241;o&#58; el estudio Europain-Espa&#241;a es de tipo observacional&#44; longitudinal y prospectivo&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8211;</span><p id="par0030" class="elsevierStylePara elsevierViewall">Selecci&#243;n de las unidades&#58; se solicit&#243; a la Sociedad Espa&#241;ola de Neonatolog&#237;a en el a&#241;o 2012 un listado de las UCI neonatales de la red sanitaria p&#250;blica espa&#241;ola&#46; Se invit&#243; a participar v&#237;a correo electr&#243;nico a 34 unidades que prestaban asistencia intensiva integral&#44; que inclu&#237;a todos los modos de ventilaci&#243;n mec&#225;nica invasiva&#46; Dos unidades declinaron la invitaci&#243;n&#44; no se obtuvo respuesta de una y otra abandon&#243; el estudio una vez comenzado&#46; Finalmente&#44; participaron 30 unidades neonatales distribuidas por todo el pa&#237;s &#40;<a class="elsevierStyleCrossRef" href="#sec0060">anexo 1</a>&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8211;</span><p id="par0035" class="elsevierStylePara elsevierViewall">Criterios de inclusi&#243;n&#58; en cada una de las unidades participantes se incluy&#243; a todos los reci&#233;n nacidos que ingresaron durante un mes &#40;noviembre del 2012&#41; hasta una edad corregida de 44 semanas y cuyos tutor&#47;es legal&#47;es firmaron el consentimiento informado para participar en el estudio&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8211;</span><p id="par0040" class="elsevierStylePara elsevierViewall">Recogida de datos&#58; de cada neonato se recogieron datos demogr&#225;ficos&#44; de los modos de asistencia respiratoria&#44; uso de sedantes&#44; analg&#233;sicos o relajantes musculares y manejo de la abstinencia de drogas&#46; La duraci&#243;n de la recogida de datos para cada reci&#233;n nacido incluido fue de 28 d&#237;as o hasta su alta&#44; traslado a otro hospital o defunci&#243;n&#46; Los coordinadores de las unidades proporcionaron adem&#225;s datos de los protocolos locales sobre S&#47;A y de las estad&#237;sticas generales de la unidad&#46; El control de calidad se realiz&#243; como una autoauditor&#237;a en cada hospital participante por una persona distinta de la que hab&#237;a introducido los datos&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8211;</span><p id="par0050" class="elsevierStylePara elsevierViewall">Aspectos &#233;ticos&#58; se obtuvo la aprobaci&#243;n de la Agencia Espa&#241;ola de Medicamentos y Productos Sanitarios y del comit&#233; de &#233;tica de investigaci&#243;n cl&#237;nica de referencia&#44; adem&#225;s de los comit&#233;s locales que as&#237; lo requirieron&#46; Se obtuvo el consentimiento informado de los padres y&#47;o tutores legales de todos los neonatos incluidos&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8211;</span><p id="par0055" class="elsevierStylePara elsevierViewall">An&#225;lisis de datos&#58; se realiz&#243; un an&#225;lisis descriptivo de las caracter&#237;sticas tanto de las unidades participantes como de los pacientes incluidos y su manejo&#44; indicando estimaciones por intervalo de los hallazgos principales&#46; Se analizaron las variables asociadas al uso de S&#47;A&#44; utilizando el test de la chi al cuadrado o el test exacto de Fisher y el test de Mann-Whitney&#44; calculando los valores de odds ratio y su intervalo de confianza del 95&#37;&#46; Para determinar las variables asociadas de forma independiente al uso de S&#47;A&#44; se ajust&#243; un modelo multivariante de regresi&#243;n log&#237;stica&#46; Dado que cada unidad incluy&#243; un n&#250;mero variable de neonatos&#44; se recurri&#243; para su ajuste a modelos de ecuaciones de estimaci&#243;n generalizada<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">20&#44;21</span></a>&#46; Este enfoque tiene en cuenta la dependencia que puede existir entre los datos de neonatos ingresados en una misma unidad y permite evitar los sesgos asociados a las t&#233;cnicas cl&#225;sicas cuando la hip&#243;tesis de independencia no se puede mantener&#46; Se sigui&#243; una estrategia de modelizaci&#243;n hacia delante&#44; introduciendo en el modelo todas aquellas variables que en el an&#225;lisis bivariado mostraron un valor de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;20&#46; Para el an&#225;lisis multivariante se clasificaron las unidades seg&#250;n n&#250;mero de ingresos anuales &#40;mayor o menor de 250&#41; y seg&#250;n el n&#250;mero de ingresos quir&#250;rgicos anuales &#40;mayor o menor de 25&#41;&#46; Se clasific&#243; igualmente a los pacientes seg&#250;n una puntuaci&#243;n de CRIB superior a 3 e inferior o igual a 3&#46; El an&#225;lisis estad&#237;stico se realiz&#243; con el programa SPSS 19&#46;0 para Windows&#46; Todas las pruebas se realizaron con un planteamiento bilateral&#46; Se consideraron significativos valores de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p></li></ul></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0075" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> se describen las caracter&#237;sticas de las 30 unidades participantes&#46; Se incluy&#243; a un total de 468 neonatos&#44; cuyas caracter&#237;sticas generales se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#46; Del total&#44; 202 neonatos &#40;43&#44;2&#37;&#44; IC del 95&#37;&#44; 38&#44;5-47&#44;7&#41; recibieron ventilaci&#243;n mec&#225;nica invasiva &#40;VM&#41;&#44; durante un tiempo medio &#177; DE de 126&#44;9 &#177; 173&#44;5 h&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Globalmente&#44; 198 neonatos &#40;42&#44;3&#37;&#44; IC del 95&#37;&#44; 37&#44;7-46&#44;8&#41; recibieron alg&#250;n tipo de medicaci&#243;n sedante o analg&#233;sica&#46; De estos&#44; 16 &#40;8&#37;&#41; la recibieron solo en perfusi&#243;n&#44; 85 &#40;42&#44;9&#37;&#41; solo en bolos y 97 &#40;48&#44;9&#37;&#41; en perfusi&#243;n y en bolos&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">De los 202 neonatos que recibieron VM invasiva&#44; 158 &#40;78&#44;2&#37;&#44; IC del 95&#37;&#44; 72&#44;2-84&#44;1&#41; recibieron alg&#250;n tipo de medicaci&#243;n sedante o analg&#233;sica&#46; En la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> se muestra la proporci&#243;n de neonatos que recibieron alg&#250;n tipo de medicaci&#243;n sedante o analg&#233;sica y su modo de administraci&#243;n seg&#250;n la asistencia respiratoria m&#225;xima recibida durante el per&#237;odo de estudio&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">El f&#225;rmaco m&#225;s utilizado fue el fentanilo&#44; tanto en perfusi&#243;n como en bolos&#44; us&#225;ndose en 138&#47;468 neonatos &#40;29&#44;4&#37;&#41;&#46; La <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> muestra la utilizaci&#243;n de los f&#225;rmacos m&#225;s habituales y su modo de administraci&#243;n &#40;perfusi&#243;n o bolos&#41;&#46; En total&#44; se usaron durante el per&#237;odo de estudio 19 f&#225;rmacos distintos&#46; Solo fentanilo&#44; midazolam&#44; morfina y paracetamol se usaron al menos en un 20&#37; de los neonatos que recibieron S&#47;A&#46; La <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a> recoge la proporci&#243;n de pacientes que reciben cada f&#225;rmaco en cada unidad participante y muestra gr&#225;ficamente la variabilidad entre centros en el uso de estos f&#225;rmacos&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">En los 113 neonatos que recibieron alg&#250;n f&#225;rmaco sedante o analg&#233;sico en perfusi&#243;n continua hubo 14 pautas distintas&#44; siendo la m&#225;s frecuente la infusi&#243;n de fentanilo &#40;46 neonatos&#44; 40&#44;7&#37;&#41; y la combinaci&#243;n de fentanilo y midazolam &#40;26 neonatos&#44; 23&#37;&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">De los 202 neonatos que recibieron VM invasiva&#44; 45 &#40;22&#44;2&#37;&#44; IC del 95&#37;&#44; 16&#44;2-28&#44;2&#41; recibieron alg&#250;n tipo de relajante muscular&#46; Diez neonatos lo recibieron en perfusi&#243;n continua &#40;9 vecuronio&#44; uno cisatracurio&#41; y 41 en bolos &#40;33 vecuronio&#44; 7 succinilcolina&#44; uno cisatracurio&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Un total de 180 neonatos &#40;38&#44;4&#37;&#44; IC del 95&#37;&#44; 33&#44;9-42&#44;9&#41; recibieron alg&#250;n tipo de soluci&#243;n dulce oral&#44; siendo la m&#225;s frecuente la sacarosa &#40;174 neonatos&#41;&#44; seguida de la glucosa &#40;6 neonatos&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Se diagnostic&#243; un s&#237;ndrome de abstinencia en 25 de los 165 neonatos que hab&#237;an recibido alg&#250;n opi&#225;ceo o benzodiacepina &#40;15&#44;2&#37;&#41;&#46; En 33 neonatos se us&#243; una escala cl&#237;nica para evaluar la abstinencia&#44; siendo la m&#225;s utilizada la escala de Finnegan &#40;27 neonatos&#44; 81&#44;8&#37;&#41;&#44; seguida de la escala de Lipstiz &#40;5 neonatos&#44; 15&#44;1&#37;&#41;&#46; Un total de 28 neonatos recibieron alguna medicaci&#243;n para tratar o prevenir espec&#237;ficamente los s&#237;ntomas de la abstinencia&#46; La medicaci&#243;n m&#225;s usada fue la morfina &#40;14 neonatos&#44; 50&#37;&#41;&#44; seguida de la clonidina &#40;9 neonatos&#44; 32&#44;1&#37;&#41; y la metadona &#40;8 neonatos&#44; 28&#44;5&#37;&#41;&#46;</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Factores asociados a recibir sedaci&#243;n y&#47;o analgesia</span><p id="par0115" class="elsevierStylePara elsevierViewall">Finalmente&#44; se analizaron aquellas variables relativas a los neonatos o a las unidades asociadas al hecho de utilizar S&#47;A &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46; Tras el an&#225;lisis multivariante&#44; las variables asociadas fueron el haber recibido VM invasiva &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>23&#44;79&#41;&#44; un score de CRIB<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>3 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;023&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;26&#41;&#44; la existencia en la unidad de gu&#237;as locales de evaluaci&#243;n del dolor &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;82&#41; y la existencia de un l&#237;der de dolor m&#233;dico en la unidad &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;034&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;35&#41;&#46; Por el contrario&#44; una edad gestacional inferior a 33 semanas se asoci&#243; de forma significativa a una menor probabilidad de recibir S&#47;A&#46; Ni el uso de herramientas de evaluaci&#243;n del dolor ni el tama&#241;o de la unidad &#40;seg&#250;n el n&#250;mero de ingresos o ingresos quir&#250;rgicos anuales&#41; se asociaron a la utilizaci&#243;n de S&#47;A &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discusi&#243;n</span><p id="par0120" class="elsevierStylePara elsevierViewall">Hasta donde conocemos&#44; este estudio es el primer estudio multic&#233;ntrico prospectivo sobre el manejo de la S&#47;A en una muestra de neonatos ingresados en unidades neonatales espa&#241;olas&#46; En este estudio&#44; un 42&#44;3&#37; de los neonatos recibieron alg&#250;n tipo de medicaci&#243;n sedante o analg&#233;sica&#44; una proporci&#243;n que alcanz&#243; el 78&#44;2&#37; en aquellos que recibieron VM invasiva&#46; Sobre el total de neonatos&#44; un 31&#44;8&#37; recibi&#243; un opi&#225;ceo y un 17&#44;9&#37; recibi&#243; midazolam&#46; El opi&#225;ceo m&#225;s utilizado fue el fentanilo&#44; que se administr&#243; a un 29&#44;4&#37; del total de neonatos&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Casi la mitad de los neonatos recibieron alg&#250;n tipo de f&#225;rmaco sedante o analg&#233;sico en este estudio&#46; A nivel internacional&#44; en el a&#241;o 2003&#44; el 60&#44;3&#37; de una muestra de 151 neonatos holandeses recibi&#243; alg&#250;n tipo de analgesia farmacol&#243;gica<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">3</span></a>&#44; pero este porcentaje se redujo significativamente&#44; al 36&#44;6&#37;&#44; en las mismas unidades 8 a&#241;os despu&#233;s tras la intensificaci&#243;n de medidas no farmacol&#243;gicas&#44; la aplicaci&#243;n de los cuidados NIDCAP y el desarrollo de un protocolo de tratamiento basado en la valoraci&#243;n cl&#237;nica del dolor<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">22</span></a>&#46; En el grupo de neonatos con VM invasiva el porcentaje de S&#47;A ascendi&#243; a un 78&#44;2&#37;&#46; El f&#225;rmaco m&#225;s usado fue el fentanilo&#44; seguido del midazolam&#44; el paracetamol y la morfina&#44; hallazgos similares a una encuesta previa italiana<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">15</span></a>&#46; La VM es una t&#233;cnica estresante y potencialmente dolorosa&#44; adem&#225;s la inadaptaci&#243;n o &#171;lucha&#187; con el respirador puede dificultar una adecuada ventilaci&#243;n y tener efectos perjudiciales<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">23</span></a>&#46; Se han publicado recomendaciones internacionales promoviendo el uso de opi&#225;ceos en neonatos ventilados<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">7</span></a> y su uso ha sido evaluado en 2 estudios de buena calidad metodol&#243;gica<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">24&#44;25</span></a>&#44; y en un metaan&#225;lisis<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">26</span></a>&#46; Los resultados merecen una evaluaci&#243;n prudente&#46; Se ha observado un modesto efecto de la morfina sobre las escalas de valoraci&#243;n del dolor durante los procedimientos dolorosos&#44; y una ausencia de efecto sobre la prevenci&#243;n de lesiones neurol&#243;gicas o muerte<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">24&#44;25</span></a>&#46; Adem&#225;s&#44; la utilizaci&#243;n de morfina se ha asociado a un mayor tiempo para alcanzar la alimentaci&#243;n enteral completa en neonatos prematuros&#46; Sin embargo&#44; hay que resaltar el hecho que los opi&#225;ceos sint&#233;ticos como el fentanilo no han sido evaluados en esos aspectos y sobre todo que la utilizaci&#243;n de analg&#233;sicos para aliviar el dolor y el sufrimiento de los neonatos constituye en s&#237; una raz&#243;n suficiente para su utilizaci&#243;n incluso en ausencia de efecto sobre alg&#250;n resultado cl&#237;nico&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">En Espa&#241;a existen varios opi&#225;ceos disponibles&#44; pero en las unidades neonatales su uso pr&#225;cticamente se restringe al fentanilo y a la morfina&#44; sin poder recomendarse en este momento un opi&#225;ceo con respecto a otro&#46; Una explicaci&#243;n al elevado uso de fentanilo en las unidades espa&#241;olas es que este f&#225;rmaco puede tener algunas ventajas te&#243;ricas &#40;potente&#44; efecto r&#225;pido&#44; corta duraci&#243;n&#41; con un efecto analg&#233;sico similar a morfina<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">27</span></a>&#44; si bien existen muy pocos estudios aleatorizados al respecto y todos con un reducido n&#250;mero de pacientes<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">28&#44;29</span></a>&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">En cuanto a los f&#225;rmacos con acci&#243;n fundamentalmente sedante&#44; las benzodiacepinas son los f&#225;rmacos m&#225;s utilizados&#46; El midazolam se usa muy frecuentemente &#40;42&#44;4&#37; de los neonatos que recibieron alg&#250;n tipo de S&#47;A&#41; a pesar de la ausencia de beneficios demostrados&#44; de la preocupaci&#243;n sobre su influencia en el neurodesarrollo tanto en experimentaci&#243;n animal<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">30</span></a> como a nivel cl&#237;nico<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">6</span></a>&#44; y de recientes revisiones desaconsejando su uso rutinario<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">31</span></a>&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Como en otros estudios previos&#44; nuestros resultados indican una gran variabilidad en las pautas de S&#47;A entre las 30 unidades participantes<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">2</span></a>&#46; Los 19 f&#225;rmacos distintos utilizados&#44; las 14 combinaciones distintas de f&#225;rmacos en perfusi&#243;n y la dispersi&#243;n de los porcentajes de utilizaci&#243;n de los distintos f&#225;rmacos expresadas en la <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a> son reflejo de la carencia de pautas de consenso comunes a las unidades espa&#241;olas&#46; Esta gran variabilidad ha podido ser detectada gracias a una recogida de datos en la cabecera del paciente&#59; es muy probable que el uso de estas medicaciones no pudiese ser detectado en estudios tipo encuesta&#46; De forma similar&#44; Jenkins et al&#46;&#44; en un estudio prospectivo de 338 pacientes pedi&#225;tricos &#40;incluyendo 39 neonatos&#41; de 20 unidades en Reino Unido&#44; reportan 24 f&#225;rmacos sedantes o analg&#233;sicos distintos<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">32</span></a>&#46; Es f&#225;cil concluir que estas diferencias entre unidades dificultan la comparaci&#243;n de resultados y el estudio de la S&#47;A en nuestro pa&#237;s&#46;</p><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Soluciones dulces orales</span><p id="par0145" class="elsevierStylePara elsevierViewall">El uso de soluciones dulces orales durante procedimientos potencialmente dolorosos ha sido ampliamente recomendado<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">33&#44;34</span></a>&#46; Sin embargo&#44; en nuestro estudio solo el 38&#44;4&#37; de los neonatos recibieron alguna soluci&#243;n dulce oral &#40;sacarosa o glucosa&#41;&#46; Es posible que el registro de la administraci&#243;n de soluciones dulces orales fuese m&#225;s laxo que para los f&#225;rmacos&#44; aunque el car&#225;cter prospectivo del estudio deber&#237;a haber minimizado este posible error&#46; Otra posibilidad es que todav&#237;a existan reticencias a su uso debido al desconocimiento de su mecanismo de acci&#243;n exacto&#46; Es importante destacar el hecho de que 12 unidades utilizan soluciones dulces en m&#225;s de la mitad de sus pacientes y en cambio hubo 9 unidades que no las utilizaron en ninguno de los pacientes incluidos en el estudio&#46; Esta variabilidad&#44; aunque tambi&#233;n se observ&#243; con otros f&#225;rmacos&#44; es especialmente llamativa en el caso de las soluciones dulces orales&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Gu&#237;as locales de tratamiento y valoraci&#243;n del dolor</span><p id="par0150" class="elsevierStylePara elsevierViewall">A pesar de las recomendaciones internacionales al respecto de la conveniencia de establecer protocolos de manejo del dolor<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">35</span></a>&#44; un tercio de las unidades declararon no tener un protocolo por escrito&#44; porcentaje muy similar al observado en el estudio de Menc&#237;a et al&#46; en 36 UCI pedi&#225;tricas espa&#241;olas en el a&#241;o 2011&#44; en el cual un 64&#37; de las unidades declaraban tener un protocolo escrito de sedonalgesia<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">36</span></a>&#46; A nivel internacional&#44; la proporci&#243;n de unidades neonatales con protocolos por escrito var&#237;an desde un 15&#37;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">13</span></a> hasta un 88&#37;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">19</span></a>&#46; El porcentaje de nuestra muestra se sit&#250;a en valores similares a otros pa&#237;ses de nuestro entorno<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">9&#44;11&#44;14&#44;15&#44;17</span></a>&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Factores asociados a recibir sedaci&#243;n y&#47;o analgesia</span><p id="par0155" class="elsevierStylePara elsevierViewall">El an&#225;lisis multivariante mostr&#243; que las variables asociadas a un mayor uso de S&#47;A fueron la edad a t&#233;rmino&#44; la VM&#44; la gravedad al ingreso definida sobre la base de la puntuaci&#243;n de CRIB&#44; la existencia de gu&#237;as locales de evaluaci&#243;n del dolor y la existencia de un l&#237;der m&#233;dico del dolor&#46; El factor m&#225;s asociado al uso de S&#47;A fue la VM&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">En estudios previos&#44; se han descrito diferencias en el manejo del dolor asociadas al tama&#241;o de las unidades<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">17&#44;19</span></a>&#44; al nivel asistencial<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">11&#44;12</span></a> y a su car&#225;cter quir&#250;rgico<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">11</span></a>&#46; En nuestra muestra&#44; el n&#250;mero de ingresos anuales &#40;mayor o menor de 250&#41; y el n&#250;mero de ingresos quir&#250;rgicos anuales &#40;mayor o menor de 25&#41; no se asociaron al hecho de recibir S&#47;A&#46; Existen pocos datos sobre la influencia de las gu&#237;as locales en el manejo del dolor en unidades neonatales&#46; Algunos estudios previos indican diferencias significativas entre las unidades que disponen de protocolos por escrito y las que no<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">17&#44;37</span></a>&#46; En nuestra muestra&#44; solo la existencia de gu&#237;as locales de valoraci&#243;n del dolor se asoci&#243; de forma independiente a un mayor uso de S&#47;A&#44; si bien la propia aplicaci&#243;n de las herramientas de valoraci&#243;n del dolor no se asoci&#243; de forma significativa&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Limitaciones</span><p id="par0165" class="elsevierStylePara elsevierViewall">Una preocupaci&#243;n habitual es la de la generabilidad de los resultados&#44; que aqu&#237; tiene potencial importancia&#46; En nuestro estudio han participado la gran mayor&#237;a de las unidades neonatales invitadas&#44; con representaci&#243;n de unidades de todo el pa&#237;s e inclusi&#243;n de un n&#250;mero elevado de pacientes consecutivos no seleccionados&#44; por lo que creemos que constituyen un reflejo fiel de la situaci&#243;n real de la S&#47;A en Espa&#241;a&#46; No se puede descartar que el hecho de participar en el estudio&#44; por saberse observado&#44; modifique las pr&#225;cticas &#40;efecto Hawthorne&#41;&#46; Este aspecto se intent&#243; minimizar con un tiempo relativamente largo de inclusi&#243;n &#40;un mes&#41; y de seguimiento &#40;28 d&#237;as&#41;&#44; que garantiza la rotaci&#243;n del personal&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Aunque el desarrollo inicial de la escala CRIB se llev&#243; a cabo en neonatos de menos de 32 semanas<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">38</span></a>&#44; se eligi&#243; utilizarla en este estudio como medidora de la gravedad principalmente por su sencillez y su amplia difusi&#243;n<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">39</span></a>&#44; pero tambi&#233;n porque la prematuridad fue el principal diagn&#243;stico al ingreso y por su uso previo en estudios de naturaleza similar al presente<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">No se evaluaron las dosis de los f&#225;rmacos utilizados ni se evaluaron las medidas no farmacol&#243;gicas para el manejo del dolor&#46; La decisi&#243;n de no recoger estos datos fue para facilitar la recogida de informaci&#243;n y hacer viable el estudio&#44; aspecto en el que tuvo &#233;xito&#44; pero limita la posibilidad de discusi&#243;n de aspectos de indudable inter&#233;s&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclusiones</span><p id="par0180" class="elsevierStylePara elsevierViewall">Nuestros resultados permiten conocer las pautas reales de S&#47;A utilizadas en Espa&#241;a y demuestran una importante variabilidad entre las distintas unidades&#46; Este &#171;estado del arte&#187; puede servir de base para la elaboraci&#243;n de gu&#237;as de pr&#225;ctica cl&#237;nica a nivel nacional<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">40</span></a>&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">A pesar de que el manejo de la S&#47;A es un campo en continuo cambio y que a&#250;n existen muchas &#225;reas en las que son necesarios m&#225;s estudios&#44; la creaci&#243;n de grupos de trabajo y la elaboraci&#243;n de gu&#237;as o protocolos consensuados entre las distintas unidades puede disminuir la variabilidad en la pr&#225;ctica cl&#237;nica y permitir una m&#225;s f&#225;cil evaluaci&#243;n de las pautas de S&#47;A en Espa&#241;a&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicto de intereses</span><p id="par0190" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El manejo del dolor y la sedaci&#243;n es una prioridad de los cuidados intensivos neonatales&#46; Se dise&#241;&#243; un estudio con el objetivo de determinar la pr&#225;ctica cl&#237;nica actual en relaci&#243;n con la sedaci&#243;n y la analgesia en unidades de cuidados intensivos neonatales en Espa&#241;a e identificar factores asociados al uso de f&#225;rmacos sedantes o analg&#233;sicos&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio multic&#233;ntrico&#44; observacional&#44; longitudinal y prospectivo&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Participaron 30 unidades neonatales y se reclut&#243; a 468 neonatos&#46; De estos&#44; 198 &#40;42&#44;3&#37;&#41; recibieron medicaci&#243;n sedante o analg&#233;sica&#46; En total&#44; se usaron durante el per&#237;odo de estudio 19 f&#225;rmacos distintos&#44; de los cuales el m&#225;s utilizado fue el fentanilo&#46; Solo fentanilo&#44; midazolam&#44; morfina y paracetamol se usaron al menos en un 20&#37; de los neonatos que recibieron sedaci&#243;n y&#47;o analgesia&#46; Se usaron 14 pautas distintas de f&#225;rmacos en perfusi&#243;n&#44; siendo las m&#225;s frecuentes la infusi&#243;n de fentanilo y la combinaci&#243;n de fentanilo y midazolam&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Las variables asociadas a recibir sedaci&#243;n y&#47;o analgesia fueron el haber precisado ventilaci&#243;n invasiva &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#60; 0&#44;001&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>23&#44;79&#41;&#44; un score de CRIB<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>3 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;023&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;26&#41;&#44; la existencia en la unidad de gu&#237;as de evaluaci&#243;n del dolor &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;82&#41; y de un l&#237;der de dolor &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;034&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;35&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Casi la mitad de los neonatos ingresados en cuidados intensivos recibe medicaci&#243;n sedante y&#47;o analg&#233;sica&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Existe una importante variabilidad entre las unidades neonatales espa&#241;olas en relaci&#243;n con las pautas de sedaci&#243;n y analgesia&#46; Nuestros resultados permiten conocer el &#171;estado del arte&#187; y pueden servir de base para la elaboraci&#243;n de gu&#237;as de pr&#225;ctica cl&#237;nica a nivel nacional&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Pain management and sedation is a priority in neonatal intensive care units&#46; A study was designed with the aim of determining current clinical practice as regards sedation and analgesia in neonatal intensive care units in Spain&#44; as well as to identify factors associated with the use of sedative and analgesic drugs&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Method</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A multicenter&#44; observational&#44; longitudinal and prospective study&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Thirty neonatal units participated and included 468 neonates&#46; Of these&#44; 198 &#40;42&#44;3&#37;&#41; received sedatives or analgesics&#46; A total of 19 different drugs were used during the study period&#44; and the most used was fentanyl&#46; Only fentanyl&#44; midazolam&#44; morphine and paracetamol were used in at least 20&#37; of the neonates who received sedatives and&#47;or analgesics&#46; In infusions&#44; 14 different drug prescriptions were used&#44; with the most frequent being fentanyl and the combination of fentanyl and midazolam&#46;</p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The variables associated with receiving sedation and&#47;or analgesia were&#44; to have required invasive ventilation <span class="elsevierStyleItalic">&#40;P</span>&#60;&#46;001&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>23&#46;79&#41;&#44; a CRIB score &#62;3 <span class="elsevierStyleItalic">&#40;P</span>&#61;&#46;023&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;26&#41;&#44; the existence of pain evaluation guides in the unit &#40;P&#60;&#46;001&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#46;82&#41;&#44; and a pain leader <span class="elsevierStyleItalic">&#40;P</span>&#61;&#46;034&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;35&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Almost half of the neonates admitted to intensive care units receive sedatives or analgesics&#46;</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">There is significant variation between Spanish neonatal units as regards sedation and analgesia prescribing&#46; Our results provide evidence on the &#8220;state of the art&#8221;&#44; and could serve as the basis of preparing clinical practice guidelines at a national level&#46;</p></span>"
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        "etiqueta" => "&#9674;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Los miembros Grupo Espa&#241;ol del proyecto Europain se presentan en el <a class="elsevierStyleCrossRef" href="#sec0060">anexo 1</a>&#46;</p>"
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            "apendice" => "<p id="par0195" class="elsevierStylePara elsevierViewall">Helena Viana&#44; Paloma Lopez Ortego &#40;Hospital Infantil Universitario La Paz&#44; Madrid&#41;&#46; Pilar Saenz Gonzalez&#44; Raquel Escrig &#40;Hospital Universitari i Politecnic La Fe&#44; Valencia&#41;&#46; Eva Bargall&#243; Ailagas&#44; Concepcio Carles &#40;Hospital Universitari Josep Trueta&#44; Girona&#41;&#46; Laura San Feliciano&#44; Ana Bel&#233;n Mateo &#40;Hospital Universitario de Salamanca&#41;&#46; In&#233;s Esteban Di&#233;z&#44; Rosa Gonz&#225;lez Crespo &#40;Hospital San Pedro de Logro&#241;o&#41;&#46; Ersilia Gonz&#225;lez Carrasco&#44; Isabel de la Nogal Tagarro &#40;Hospital Universitario Severo Ochoa&#44; Legan&#233;s&#41;&#46; Mar&#237;a Dolores Elorza Fern&#225;ndez&#44; Nerea Benito Guerra &#40;Hospital Universitario de Donostia&#41;&#46; Salud Luna Lagares&#44; Pedro Jim&#233;nez Parrilla &#40;Hospital Virgen Macarena&#44; Sevilla&#41;&#46; Francesc Botet&#44; Anna Ciurana&#44; Rebeca Tarjuelo &#40;Hospital Clinic de Barcelona&#41;&#46; Mar&#237;a Jos&#233; Garc&#237;a Borau&#44; Nuria Ib&#225;&#241;ez &#40;Hospital de la Santa Creu i Sant Pau&#44; Barcelona&#41;&#46; Gloria Di&#225;&#241;ez Vega &#40;Hospital Universitario Puerta del Mar&#44; C&#225;diz&#41;&#46; Mar&#237;a Arriaga Redondo &#40;Hospital General Universitario Gregorio Mara&#241;&#243;n&#44; Madrid&#41;&#46; Gloria Herranz&#44; Virginia de la Fuente Iglesias &#40;Hospital Cl&#237;nico San Carlos&#44; Madrid&#41;&#46; Amaya P&#233;rez Oc&#243;n&#44; Sagrario Santiago Aguinaga &#40;Complejo Hospitalario de Navarra&#41;&#46; Bel&#233;n Mart&#237;n Parra&#44; Antonia Valero Cardona &#40;Hospital General de Castell&#243;n&#41;&#46; Mar&#237;a Dolores S&#225;nchez-Redondo&#44; Antonio Arroyos Plana &#40;Hospital Virgen de la Salud&#44; Toledo&#41;&#46; Zenaida Galve Pradel&#44; Nuria Clavero Monta&#241;&#233;s &#40;Hospital Universitario Miguel Servet&#44; Zaragoza&#41;&#46; Mar&#237;a Jes&#250;s Ripalda Crespo&#44; Raquel Nogales Ju&#225;rez &#40;Hospital Universitario Pr&#237;ncipe de Asturias&#44; Alcal&#225; de Henares&#41;&#46; Aintzane Euba Lopez&#44; Sonia Fern&#225;ndez de Retana &#40;Hospital Universitario de &#193;lava&#41;&#46; Mar Reyn&#233; Vergeli&#44; Raquel Vidal &#40;Hospital Sant Joan de D&#233;u&#44; Barcelona&#41;&#46; Jose Luis Fernandez-Trisac&#44; Mar&#237;a Taboada &#40;Complexo Hospitalario Universitario de A Coru&#241;a&#41;&#46; Aurora Montoro Exp&#243;sito&#44; F&#225;tima Camba Longueira &#40;Hospital Vall d¿Hebron&#44; Barcelona&#41;&#46; Gonzalo Sol&#237;s S&#225;nchez &#40;Hospital Universitario Central de Asturias&#44; Oviedo&#41;&#46; Mar&#237;a Purificaci&#243;n Ventura Faci&#44; Marivi Mallen &#40;Hospital Cl&#237;nico Universitario Lozano Blesa&#44; Zaragoza&#41;&#46; Pilar Crespo Su&#225;rez&#44; Elvira de Sola &#40;Complexo Hospitalario de Pontevedra&#41;&#46; Caridad Tapia Collados &#40;Hospital General de Alicante&#41;&#46; Isabel de las Cuevas&#44; Beatriz Mart&#237;n &#40;Hospital Universitario Marqu&#233;s de Valdecilla&#44; Santander&#41;&#46; Mar&#237;a Luz Couce Pico&#44; Alejandro P&#233;rez Mu&#241;uzuri&#44; Salom&#233; Quint&#225;ns &#40;Complexo Hospitalario Universitario de Santiago&#41;&#46; Ana Melgar Bonis&#44; Eugenia Bodas &#40;Hospital Universitario 12 de Octubre&#44; Madrid&#41;&#46; Ana Concheiro Guisan&#44; Bego&#241;a P&#233;rez Costas &#40;Complexo Hospitalario Universitario de Vigo&#41;&#46;</p>"
            "etiqueta" => "Anexo 1"
            "titulo" => "Grupo espa&#241;ol del estudio Europain"
            "identificador" => "sec0060"
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          "es" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Proporci&#243;n de neonatos &#40;&#37;&#41; que recibieron alg&#250;n tipo de medicaci&#243;n sedante o analg&#233;sica y su modo de administraci&#243;n seg&#250;n la asistencia respiratoria m&#225;xima recibida durante el per&#237;odo de estudio&#46;</p> <p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">VM&#58; ventilaci&#243;n mec&#225;nica invasiva&#59; VNI&#58; ventilaci&#243;n no invasiva&#46;</p>"
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          "es" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Representaci&#243;n gr&#225;fica del uso de los f&#225;rmacos m&#225;s habituales en cada una de las 30 unidades participantes&#46; La l&#237;nea horizontal se&#241;ala el porcentaje de cada variable en la muestra total&#46; Los puntos representan el porcentaje de pacientes que reciben cada f&#225;rmaco en cada una de las unidades participantes&#46;</p>"
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          "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">CRIB es una medida de la gravedad validada en neonatos pret&#233;rmino compuesto por 6 &#237;tems recogidos en las primeras 12 h de vida&#44; Su valor va de 0 a 23&#44; en donde valores mayores indican mayor gravedad&#44;</p><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">DE&#58; desviaci&#243;n est&#225;ndar&#59; IQ&#58; rango intercuart&#237;lico&#59; NA&#58; no aplicable&#46;</p>"
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                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Edad gestacional &#40;semanas&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Media<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DE&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mediana &#40;IQ&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34&#44;3 &#40;30&#44;2-38&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#44;9 &#40;29&#44;1-38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#44;1 &#40;30&#44;2-35&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&#44;4 &#40;33&#44;9-39&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>24-29&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">107 &#40;22&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70 &#40;34&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34 &#40;22&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;2&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>30-32&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">76 &#40;16&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24 &#40;11&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37 &#40;24&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;12&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>33-36&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">115 &#40;24&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38 &#40;18&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45 &#40;30&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32 &#40;27&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>37-42&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">170 &#40;36&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70 &#40;34&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33 &#40;22&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">67 &#40;57&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Peso al nacer &#40;g&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Media<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;182&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>976&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;051<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;985<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>849&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;663<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>919&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mediana &#40;IQ&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;081 &#40;1&#46;390-3&#46;025&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;050 &#40;1&#46;089-2&#46;905&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;880 &#40;1&#46;350-2&#46;425&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;720 &#40;1&#46;805-3&#46;310&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Hombre&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">256 &#40;54&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">113 &#40;55&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75 &#40;50&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68 &#40;58&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;228&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Nacido en el propio hospital&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">377 &#40;80&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">143 &#40;70&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">138 &#40;92&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">96 &#40;82&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Edad al ingreso &#40;h&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Media<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">64&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>237&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>309&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>152&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>171&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;114&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mediana &#40;IQ&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;5 &#40;0&#44;23-6&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;5 &#40;0&#44;3-7&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;3 &#40;0&#44;2-1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;5 &#40;0&#44;2-48&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">CRIB score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Media<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mediana &#40;IQ&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;0&#44;0-3&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;1-6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0-1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0-1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Apgar a los 5</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">min &#40;n</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">467&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Media<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#44;8&#177; 1&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mediana &#40;IQ&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 &#40;8-10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;6-9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;8-10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;9-10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Ya intubado al ingreso&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">112 &#40;23&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">112 &#40;55&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Defunci&#243;n durante el per&#237;odo de estudio&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21 &#40;3&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21 &#40;10&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Duraci&#243;n de la hospitalizaci&#243;n &#40;d&#237;as&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Media<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mediana &#40;IQ&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14 &#40;6-28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;7-28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17 &#40;8-28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;4-14&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">La recogida de datos se realiz&#243; hasta el 28&#176; d&#237;a de hospitalizaci&#243;n&#46;</p>"
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        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas de los neonatos incluidos en el estudio&#44; en la muestra total y sobre la base de la asistencia respiratoria m&#225;xima recibida durante el per&#237;odo de estudio</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="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Modo de administraci&#243;n</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>468&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">En bolos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">En perfusi&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Fentanilo&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">138 &#40;29&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">111 &#40;23&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">97 &#40;20&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Midazolam&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84 &#40;17&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75 &#40;16&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40 &#40;8&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Paracetamol&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66 &#40;14&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66 &#40;14&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Morfina&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40 &#40;8&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30 &#40;6&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23 &#40;4&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Metamizol&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;3&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;3&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;0&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Fenobarbital&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;2&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;2&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Clonidina&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;2&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;1&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Propofol&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;2&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;2&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Ketamina&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Remifentanilo&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;1&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;0&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Meperidina&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Diazepam&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Penthotal&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;0&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;0&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Fenito&#237;na&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;0&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;0&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Bupivaca&#237;na&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;0&#44;4&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;0&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Lorazepam&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Hidrato de cloral&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Levomepromazina&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Sevoflurano&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#44;2&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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              "identificador" => "tblfn0010"
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">V&#237;a epidural&#46;</p>"
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            1 => array:3 [
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">V&#237;a inhalatoria&#46;</p>"
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        "descripcion" => array:1 [
          "es" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Proporci&#243;n de pacientes tratados con los diferentes f&#225;rmacos sedantes o analg&#233;sicos durante el per&#237;odo de estudio y modo de administraci&#243;n&#46; Se muestran los porcentajes del total de pacientes &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>468&#41; que reciben cada f&#225;rmaco</p>"
        ]
      ]
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        "mostrarFloat" => true
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        "tabla" => array:3 [
          "leyenda" => "<p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">CRIB es una medida de la gravedad validada en neonatos pret&#233;rmino compuesto por 6 &#237;tems recogidos en las primeras 12 h de vida&#46; Su valor va de 0 a 23&#44; en donde valores mayores indican mayor gravedad&#46;</p><p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">DE&#58; desviaci&#243;n est&#225;ndar&#59; OR&#58; odds ratio&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Recibir alguna medicaci&#243;n sedante&#47;analgesia</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">S&#237;n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Non &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR &#40;IC del 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Edad gestacional</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>24-29 semanas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51 &#40;47&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56 &#40;52&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;9 &#40;0&#44;5-1&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>30-32 semanas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23 &#40;30&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53 &#40;69&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;4 &#40;0&#44;2-0&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>33-36 semanas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39 &#40;33&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76 &#40;66&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;5 &#40;0&#44;3-0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>37-42 semanas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85 &#40;50&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85 &#40;50&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Prematuridad &#40;&#8804; 36 semanas&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">113 &#40;37&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">185 &#40;62&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;6 &#40;0&#44;4-0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85 &#40;50&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85 &#40;50&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Ventilaci&#243;n mec&#225;nica invasiva</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">158 &#40;78&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44 &#40;21&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#44;2 &#40;12&#44;6-32&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40 &#40;15&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">226 &#40;85&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Uso de herramientas de evaluaci&#243;n del dolor</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46 &#40;58&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32 &#40;41&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;2 &#40;1&#44;3-3&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">152 &#40;38&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">238 &#40;61&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Gu&#237;as locales de tratamiento del dolor</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;553&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">140 &#40;43&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">184 &#40;56&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;1 &#40;0&#44;7-1&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58 &#40;40&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">86 &#40;59&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Gu&#237;as locales de evaluaci&#243;n del dolor</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">113 &#40;58&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80 &#40;41&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;1 &#40;2&#44;1-4&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85 &#40;30&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">190 &#40;70&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">L&#237;der de dolor m&#233;dico en la unidad</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;088&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43 &#40;50&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42 &#40;49&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;5 &#40;0&#44;9-2&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">155 &#40;40&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">228 &#40;59&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">L&#237;der de dolor enfermer&#237;a en la unidad</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;291&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26 &#40;49&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27 &#40;51&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;3 &#40;0&#44;7-2&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">172 &#40;41&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">243 &#40;58&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Equipo del dolor en la unidad</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;524&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">95 &#40;40&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">141 &#40;59&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;8 &#40;0&#44;6-1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">98 &#40;43&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">129 &#40;56&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Visitas de los padres permitidas 24 h</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;268&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">184 &#40;43&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">243 &#40;57&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;6 &#40;0&#44;7-3&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;34&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27 &#40;65&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">Media<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">Media<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">OR &#40;IC del 95&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0020"><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" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Gravedad &#40;CRIB score&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;5 &#40;1&#44;3-1&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">N&#250;mero de camas en la unidad</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;03 &#40;1&#44;01-1&#44;06&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">N&#250;mero de ingresos anuales</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">329&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>138&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">296&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>130&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;01 &#40;1&#44;00-1&#44;01&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">N&#250;mero de ingresos quir&#250;rgicos anuales</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>66&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>57&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;01 &#40;1&#44;00-1&#44;01&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0130" class="elsevierStyleSimplePara elsevierViewall">CRIB es una medida de la gravedad validada en neonatos pret&#233;rmino compuesto por 6 &#237;tems recogidos en las primeras 12 h de vida&#46; Su valor va de 0 a 23&#44; en donde valores mayores indican mayor gravedad&#46;</p><p id="spar0135" class="elsevierStyleSimplePara elsevierViewall">B&#58; coeficiente de regresi&#243;n&#59; EE&#58; error est&#225;ndar&#59; IC&#58; intervalo de confianza&#59; OR&#58; odds ratio&#46;</p>"
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">EE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">IC del 95&#37; &#40;OR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Intersecci&#243;n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#44;138&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;5806&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Edad gestacional &#40;semanas&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>24-29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;1&#44;563&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;5439&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;210&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;072&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;609&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>30-32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;1&#44;126&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;4221&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;324&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;142&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;742&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>33-36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;0&#44;663&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;3537&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;061&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;515&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;258&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;031&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>37-42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#40;ref&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Ventilaci&#243;n mec&#225;nica invasiva</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;183&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;3147&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#44;116&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#44;016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44&#44;682&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Gravedad &#40;CRIB score&#41;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#62;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">3</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;786&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;3466&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;023&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;195&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;113&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#44;330&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Gu&#237;as locales de evaluaci&#243;n del dolor</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;1&#44;401&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;3151&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#44;058&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;189&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#44;526&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">L&#237;der de dolor m&#233;dico en la unidad</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;0&#44;809&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;245&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;015&nbsp;\t\t\t\t\t\t\n
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Información del artículo
ISSN: 16954033
Idioma original: Español
DOI:10.1016/j.anpedi.2015.03.017
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