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          "es" => "<p id="spar0130" class="elsevierStyleSimplePara elsevierViewall">Protocolo de actuaci&#243;n en las primeras 6<span class="elsevierStyleHsp" style=""></span>h de vida y &#171;cadena de neuroprotecci&#243;n cerebral&#187;&#46;</p> <p id="spar0135" class="elsevierStyleSimplePara elsevierViewall">aEEG&#58; electroencefalograma integrado por amplitud&#59; BS&#58; patr&#243;n brote supresi&#243;n&#59; CBV&#58; patr&#243;n continuo de bajo voltaje&#59; DB&#58; d&#233;ficit de bases&#59; EG&#58; edad gestacional&#59; EHI&#58; encefalopat&#237;a hip&#243;xico-isqu&#233;mica&#59; FC&#58; frecuencia cardiaca&#59; FiO<span class="elsevierStyleInf">2</span>&#58; fracci&#243;n inspirada de ox&#237;geno&#59; FR&#58; frecuencia respiratoria&#59; g&#58; gramos&#59; hdv&#58; horas de vida&#59; hipoCa<span class="elsevierStyleSup">&#43;&#43;</span>&#58; hipocalcemia&#59; hipoMg<span class="elsevierStyleSup">&#43;&#43;</span>&#58; hipomagnesemia&#59; min&#58; minutos&#59; P&#58; patr&#243;n plano&#59; PaO<span class="elsevierStyleInf">2</span>&#58; presi&#243;n parcial de ox&#237;geno en la sangre arterial&#59; PaCO<span class="elsevierStyleInf">2</span>&#58; presi&#243;n parcial de di&#243;xido de carbono en la sangre arterial&#59; rScO<span class="elsevierStyleInf">2</span>&#58; saturaci&#243;n regional de ox&#237;geno cerebral&#59; REA&#58; reanimaci&#243;n&#59; RN&#58; reci&#233;n nacido&#59; SatO<span class="elsevierStyleInf">2</span>&#58; saturaci&#243;n arterial de ox&#237;geno&#59; T<span class="elsevierStyleSup">a</span>&#58; temperatura&#59; TA&#58; tensi&#243;n arterial&#46;</p>"
        ]
      ]
    ]
    "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">Las importantes implicaciones m&#233;dicas&#44; familiares&#44; sociales y legales que asocia la encefalopat&#237;a hip&#243;xico-isqu&#233;mica &#40;EHI&#41; perinatal en el reci&#233;n nacido &#40;RN&#41; a t&#233;rmino o pret&#233;rmino tard&#237;o hacen que constituya un problema sociosanitario relevante<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">En nuestro pa&#237;s&#44; en el a&#241;o 2011 la Sociedad Espa&#241;ola de Neonatolog&#237;a public&#243; una gu&#237;a de est&#225;ndares para la aplicaci&#243;n cl&#237;nica de la hipotermia terap&#233;utica &#40;HT&#41;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">2</span></a>&#44; y en el a&#241;o 2014&#44; un grupo de expertos elabor&#243; una gu&#237;a de pr&#225;ctica cl&#237;nica basada en la evidencia sobre el manejo integral del neonato con EHI<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">3</span></a>&#46; Cuando se ha analizado la efectividad de la HT en la pr&#225;ctica cl&#237;nica habitual&#44; los resultados parecen ser mejores que los obtenidos en los primeros ensayos cl&#237;nicos<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">4</span></a>&#46; Entre los factores que contribuir&#237;an a esta brecha entre eficacia y efectividad&#44; destacan aquellos que acontecen en las primeras horas de vida&#58; adecuada reanimaci&#243;n en paritorio&#44; comienzo precoz de la HT&#44; y control de factores potencialmente agravantes de la agresi&#243;n hip&#243;xico-isqu&#233;mica&#44; antes y durante la HT&#46; Sin embargo&#44; apenas existen recomendaciones sobre el proceso asistencial desde el nacimiento hasta el inicio de la HT&#44; periodo crucial en el que podemos actuar sobre los factores mencionados y as&#237; mejorar la efectividad neuroprotectora de la hipotermia<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">5&#8211;8</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Los objetivos de este trabajo de &#225;mbito nacional fueron&#58; 1&#41; conocer el manejo del RN con asfixia perinatal durante las primeras 6<span class="elsevierStyleHsp" style=""></span>h de vida en unidades de neonatolog&#237;a de nivel <span class="elsevierStyleSmallCaps">iii</span>&#44; y 2&#41; examinar si existen diferencias entre aquellas unidades que ofrecen HT y aquellas que transfieren los RN asf&#237;cticos a centros de referencia para recibir este tratamiento&#44; as&#237; como entre los diferentes niveles asistenciales tipo <span class="elsevierStyleSmallCaps">iii</span>&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Metodolog&#237;a</span><p id="par0020" class="elsevierStylePara elsevierViewall">Estudio transversal&#44; multic&#233;ntrico dirigido a examinar el proceso asistencial durante las primeras 6<span class="elsevierStyleHsp" style=""></span>h de vida del RN<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>35 semanas de edad gestacional con asfixia perinatal mediante un cuestionario on-line&#46; El estudio fue realizado en 2015 e incluy&#243; todos los hospitales terciarios &#40;p&#250;blicos y privados&#41;&#44; con unidades neonatales de nivel <span class="elsevierStyleSmallCaps">iii</span> de nuestro pa&#237;s<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">9</span></a>&#46; Se solicit&#243; que el responsable de cada centro con mayor experiencia en el manejo de la EHI respondiese al cuestionario&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">En las <a class="elsevierStyleCrossRefs" href="#tbl0005">tablas 1 y 2</a> se recogen las 23 preguntas de la encuesta referentes a la asistencia del RN con criterios de asfixia durante las primeras horas de vida&#46; Esta se defini&#243; por la presencia de al menos uno de los siguientes&#58; 1&#41; pH cord&#243;n o a la hora de vida<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>7 o d&#233;ficit de bases<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>16&#59; 2&#41; Apgar a los 5<span class="elsevierStyleHsp" style=""></span>min<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>5&#59; 3&#41; necesidad de reanimaci&#243;n avanzada &#40;intubaci&#243;n y&#47;o masaje cardiaco y&#47;o administraci&#243;n de f&#225;rmacos&#41;&#46; En la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> se recogen las 8 preguntas referidas a la disponibilidad de profesionales con experiencia en la asistencia del RN con EHI de cada uno de los hospitales que realizaban HT en el momento del cierre de la encuesta &#40;junio 2015&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Para clasificar la calidad de la asistencia ofrecida por cada hospital&#44; se asign&#243; una puntuaci&#243;n a cada pregunta&#58; 4 puntos si la pr&#225;ctica realizada respond&#237;a &#171;casi siempre&#187; al est&#225;ndar asistencial recomendado en las gu&#237;as de pr&#225;ctica cl&#237;nica&#44; 3 puntos si dicha pr&#225;ctica era realizada &#171;con frecuencia&#187; o 1 punto cuando la respuesta fue &#171;raramente o nunca&#187;&#46; Se asign&#243; a cada hospital una categor&#237;a de &#171;asistencia &#243;ptima&#187; si obtuvo 4 puntos en todas las preguntas&#44; &#171;asistencia aceptable&#187; si alguna pregunta obtuvo 3 puntos pero ninguna 1 punto&#44; y &#171;asistencia mejorable&#187; si alguna pregunta obtuvo 1 punto&#46; Se excluyeron de la puntuaci&#243;n las preguntas m&#225;s controvertidas &#40;preguntas 11&#44; 15&#44; 16&#44; 18&#44; 19&#44; 20&#44; 23 y 31&#41;&#46; Las que hac&#237;an referencia al mismo contenido se agruparon&#58; 1-2&#44; 3-4&#44; 24a-24b&#44; 26a-26d&#44; 26b-26c&#46; En las 3 preguntas con respuestas de elecci&#243;n m&#250;ltiple &#40;20&#44; 21 y 22&#41;&#44; se dio 1 punto si se contest&#243; &#171;ninguna&#187; y 4 puntos al resto de las opciones &#40;<a class="elsevierStyleCrossRefs" href="#tbl0005">tablas 1&#8211;3</a>&#41;&#46; El estudio fue aprobado por el comit&#233; de investigaci&#243;n del hospital coordinador&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">An&#225;lisis estad&#237;stico</span><p id="par0040" class="elsevierStylePara elsevierViewall">Los datos descriptivos se expresaron como n&#250;mero y porcentaje&#46; Para examinar diferencias&#44; se utiliz&#243; la prueba de Chi-cuadrado &#40;Fisher&#41; y U de Mann-Whitney&#47;Kruskal-Wallis para variables cualitativas y cuantitativas&#44; respectivamente&#46; Un valor de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 se consider&#243; estad&#237;sticamente significativo&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Resultados</span><p id="par0045" class="elsevierStylePara elsevierViewall">De la totalidad de los 90 servicios de Neonatolog&#237;a nivel <span class="elsevierStyleSmallCaps">iii</span> de nuestro pa&#237;s&#44; 89 aportaron la informaci&#243;n solicitada&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Respecto <span class="elsevierStyleItalic">al manejo al nacimiento</span> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#44; la mayor&#237;a de los hospitales &#40;98&#37;&#41; indicaron que ante un parto complicado acud&#237;a un neonat&#243;logo junto con una matrona y&#44; en ocasiones&#44; una enfermera neonatal&#46; Adem&#225;s&#44; pr&#225;cticamente todos los hospitales refirieron utilizar protocolos de reanimaci&#243;n&#44; apagar las fuentes ex&#243;genas de calor una vez estabilizado el RN&#44; y rara vez usar calcio o bicarbonato durante la reanimaci&#243;n&#46; Asimismo&#44; era com&#250;n trasladar al RN a la unidad neonatal&#44; incluso aunque se recuperase r&#225;pidamente&#44; si bien en esta circunstancia algunos hospitales &#40;25&#37;&#41; dejaban al RN con su madre&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> se muestran los resultados referentes a las <span class="elsevierStyleItalic">acciones durante las 6 primeras horas de vida</span>&#46; Mayoritariamente los centros dispon&#237;an de protocolos de actuaci&#243;n espec&#237;fica para este periodo&#44; realizaban controles de glucemia y gasometr&#237;a&#44; monitorizaban la temperatura con el objetivo de mantenerla por debajo de 36<span class="elsevierStyleHsp" style=""></span>&#176;<span class="elsevierStyleSmallCaps">C</span>&#44; y optaban por dejar al RN a dieta con sueroterapia&#46; En cuanto a la valoraci&#243;n de la EHI&#44; la mayor&#237;a &#40;92&#37;&#41; realizaban al menos 2 exploraciones en las primeras 6<span class="elsevierStyleHsp" style=""></span>h de vida&#44; utilizando las escalas de graduaci&#243;n de Garc&#237;a-Alix<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">10</span></a> y Sarnat<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">11</span></a> en el 94&#37; de los casos&#44; siendo el &#237;tem de la capacidad para despertar y mantener la alerta el m&#225;s relevante en el 90&#37; de los hospitales&#46; Respecto al uso del electroencefalograma integrado por amplitud &#40;aEEG&#41; en las primeras 6<span class="elsevierStyleHsp" style=""></span>h de vida&#44; 58 de los 89 hospitales &#40;65&#37;&#41; dispon&#237;an de aEEG&#58; 51 &#40;89&#37;&#41; de las 57 unidades que ofrec&#237;an HT y 7 &#40;22&#37;&#41; de las 32 que no &#40;p&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Entre los que dispon&#237;an de aEEG&#44; el 90&#37; de los hospitales refirieron utilizarlo siempre o con bastante frecuencia&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Informaci&#243;n sobre la <span class="elsevierStyleItalic">disponibilidad de profesionales con experiencia en el manejo del RN con EHI</span> en los hospitales que realizaban HT fue notificada de 53 de los 57 centros &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46; La mayor&#237;a de los centros dispon&#237;an siempre de personal con entrenamiento en la exploraci&#243;n neurol&#243;gica &#40;89&#37;&#41;&#44; en la ecograf&#237;a cerebral &#40;87&#37;&#41; e interpretaci&#243;n de la RM &#40;75&#37;&#41;&#44; y en la realizaci&#243;n de ecocardiograf&#237;a &#40;57&#37;&#41;&#46; Sin embargo&#44; en el 25&#37; de los hospitales no hab&#237;a siempre un neonat&#243;logo con experiencia en la realizaci&#243;n de examen neurol&#243;gico o en la interpretaci&#243;n del aEEG&#44; y en el 62&#37; tampoco lo hab&#237;a en la realizaci&#243;n de ecograf&#237;a cerebral&#46; La mayor&#237;a de los hospitales refirieron tener una relaci&#243;n de enfermeras por paciente adecuada&#44; aunque no exist&#237;an protocolos enfermeros espec&#237;ficos en el 28&#37; o experiencia en los cuidados de este grupo de pacientes en el 21&#37;&#46; Finamente&#44; m&#225;s del 50&#37; no dispon&#237;an de apoyo psicol&#243;gico especializado para los padres-familias de estos ni&#241;os&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">En cuanto a la puntuaci&#243;n obtenida en la asistencia en paritorio y en las 6 primeras horas de vida&#44; el 25&#37; de los 89 hospitales obtuvo una calificaci&#243;n de &#171;mejorable&#187;&#44; aunque con puntuaciones elevadas de 54&#44;5 &#40;46&#59;56&#41; puntos de mediana &#40;m&#237;n&#59;m&#225;x&#41; en los hospitales que no ofrec&#237;an HT frente a 56 &#40;49&#59;56&#41; puntos en el resto &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;052&#41;&#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46; Los hospitales con HT obtuvieron la calificaci&#243;n de manejo &#171;&#243;ptimo&#187; en m&#225;s casos que los que no dispon&#237;an de HT&#44; especialmente durante la reanimaci&#243;n &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;015&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; Atendiendo al nivel asistencial&#44; la calidad asistencial fue mejor cuanto mayor el nivel asistencial&#44; tanto de forma global&#44; como entre aquellos que realizaban HT &#40;<a class="elsevierStyleCrossRefs" href="#fig0010">figs&#46; 2 y 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discusi&#243;n</span><p id="par0070" class="elsevierStylePara elsevierViewall">En el RN con asfixia perinatal&#44; la asistencia en la primeras 6<span class="elsevierStyleHsp" style=""></span>h de vida constituye un periodo crucial que incluye diversas etapas asistenciales desde el nacimiento hasta el momento en que se inicia la HT&#58; 1&#41; reanimaci&#243;n y estabilizaci&#243;n del paciente&#44; 2&#41; control de factores com&#243;rbidos&#44; 3&#41; caracterizaci&#243;n precisa de la gravedad de la EHI&#44; y 4&#41; traslado urgente a centros de referencia que ofrecen una asistencia integral a estos RN incluyendo HT<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">2&#44;6&#8211;8&#44;12&#8211;14</span></a>&#46; Los resultados de este trabajo se&#241;alan que la asistencia del RN con asfixia perinatal&#44; analizando cada una de las etapas incluidas en las primeras 6<span class="elsevierStyleHsp" style=""></span>h de vida en los hospitales terciarios de nuestro pa&#237;s&#44; es globalmente satisfactoria aunque con diferencias seg&#250;n el nivel asistencial y si realizan o no HT&#46;</p><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Reanimaci&#243;n y estabilizaci&#243;n en paritorio</span><p id="par0075" class="elsevierStylePara elsevierViewall">En nuestro pa&#237;s todas las unidades de neonatolog&#237;a de centros terciarios aplican protocolos de actuaci&#243;n espec&#237;fica para la reanimaci&#243;n y estabilizaci&#243;n en el paritorio del RN con criterios de asfixia perinatal&#46; Coherentemente con las recomendaciones vigentes&#44; los hospitales disponen de personal entrenado en la reanimaci&#243;n neonatal y evitan la administraci&#243;n de calcio o bicarbonato<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">15&#44;16</span></a>&#46; Asimismo refieren apagar la cuna de reanimaci&#243;n una vez estabilizado el RN despu&#233;s de la reanimaci&#243;n&#46; A pesar de las recomendaciones actuales que indican evitar la hipertermia e iniciar HT en la EHI moderada-grave&#44; no se hace referencia a qu&#233; medidas iniciar durante la reanimaci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">16&#44;17</span></a>&#46; En cualquier caso&#44; dada la tendencia natural del RN con asfixia a disminuir la temperatura corporal&#44; es mandatorio monitorizar la temperatura central en paritorio m&#225;s a&#250;n si se retiran las fuentes de calor externa<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">18&#44;19</span></a>&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Tras la estabilizaci&#243;n inicial&#44; la monitorizaci&#243;n de diversas funciones fisiol&#243;gicas&#44; incluyendo frecuencia cardiaca&#44; tensi&#243;n arterial&#44; funci&#243;n respiratoria y temperatura&#44; son pr&#225;ctica est&#225;ndar en el cuidado de estos RN&#46; Un punto controvertido es si&#44; en caso de r&#225;pida recuperaci&#243;n del RN en paritorio&#44; este puede quedarse con su madre para favorecer el contacto piel con piel y el inicio de la lactancia materna&#59; o si por el contrario&#44; ser&#237;a conveniente un periodo de monitorizaci&#243;n en la unidad neonatal evitando adem&#225;s el inicio inmediato de la alimentaci&#243;n ante una potencial situaci&#243;n de hipoperfusi&#243;n intestinal&#46; En nuestro estudio&#44; la gran mayor&#237;a de los centros refirieron ingresar al RN con asfixia aunque el 25&#37; contemplaban la posibilidad de dejar al RN con su madre si la recuperaci&#243;n cl&#237;nica era r&#225;pida y adecuada&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Control de la temperatura</span><p id="par0085" class="elsevierStylePara elsevierViewall">Un aspecto fundamental en el RN con asfixia perinatal es el control de la temperatura desde los minutos siguientes al parto hasta la decisi&#243;n de indicar o no HT&#46; Por cada incremento de 1<span class="elsevierStyleHsp" style=""></span>&#176;C&#44; la odds ratio para muerte o discapacidad neurol&#243;gica moderada-grave se incrementa hasta 4 veces<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">20</span></a>&#46; Coherentemente con este conocimiento&#44; el 98&#37; de los centros refirieron trasladar al RN a la unidad neonatal con la cuna de transporte apagada&#44; y monitorizar durante las primeras horas la temperatura rectal con el objetivo de evitar el sobreenfriamiento y sobre todo&#44; la hipertermia<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">21</span></a>&#46; Adem&#225;s&#44; la mayor&#237;a de los hospitales se&#241;alaron que habitualmente mantienen la temperatura por debajo de 36<span class="elsevierStyleHsp" style=""></span>&#176;C&#46; En el momento actual&#44; no existe evidencia respecto a los efectos beneficiosos o perjudiciales de disminuir la temperatura por debajo de la normotermia e incluso al rango de la HT &#40;33-34<span class="elsevierStyleHsp" style=""></span>&#176;C&#41; a un RN con asfixia perinatal sin esperar a establecer que padece una EHI moderada-grave&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Control de otros factores com&#243;rbidos</span><p id="par0090" class="elsevierStylePara elsevierViewall">Tras una agresi&#243;n hip&#243;xico-isqu&#233;mica&#44; el cerebro es particularmente vulnerable a factores com&#243;rbidos con capacidad potencial para da&#241;ar <span class="elsevierStyleItalic">per se</span> el SNC&#44; acortar la ventana terap&#233;utica y aumentar la gravedad del da&#241;o&#46; Entre estos factores se encuentran la hipoglucemia&#44; la hipocarbia y la hiper-&#47;hipoxia&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">La asfixia perinatal es una causa importante de hipoglucemia debido al metabolismo anaer&#243;bico de la glucosa&#46; Adem&#225;s&#44; la presencia concomitante de hipoxemia e isquemia podr&#237;a aumentar la vulnerabilidad del cerebro neonatal a la hipoglucemia&#46; La hipoglucemia por debajo de 40 o 46&#44;8<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; en las primeras horas de vida aumenta el riesgo de desarrollar EHI moderada-grave<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">22&#8211;25</span></a>&#44; as&#237; como de discapacidad o muerte ulterior<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">24&#44;25</span></a>&#46; Todos los centros realizaban al menos una medici&#243;n de glucemia e instauraban sueroterapia al ingreso&#46; No hay evidencia cient&#237;fica para establecer la recomendaci&#243;n universal de iniciar glucosa en perfusi&#243;n<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">16</span></a>&#44; frente a la opci&#243;n de monitorizar los valores de glucemia e iniciar la nutrici&#243;n enteral&#46; En este sentido&#44; es recomendable investigar la presencia acidosis o hiperlactatemia que podr&#237;an alertar de una potencial hipoperfusi&#243;n intestinal&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Otra pr&#225;ctica universal en todos los centros fue la realizaci&#243;n de una gasometr&#237;a en las primeras 6<span class="elsevierStyleHsp" style=""></span>h de vida&#46; Esta persigue detectar alteraciones como la hipocarbia grave &#40;pCO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>20<span class="elsevierStyleHsp" style=""></span>mmHg&#41; o la hipocarbia moderada sostenida &#40;pCO<span class="elsevierStyleInf">2</span> 20-25<span class="elsevierStyleHsp" style=""></span>mmHg&#41;&#44; que parecen aumentar el riesgo de muerte o discapacidad neurol&#243;gica moderada-grave en el RN con EHI<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">26&#8211;28</span></a>&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Identificaci&#243;n del reci&#233;n nacido con encefalopat&#237;a hip&#243;xico-isqu&#233;mica</span><p id="par0105" class="elsevierStylePara elsevierViewall">El aspecto clave&#44; junto con la monitorizaci&#243;n de las constantes vitales y de los factores com&#243;rbidos a trav&#233;s de la anal&#237;tica&#44; es establecer si el RN con asfixia perinatal presenta o no encefalopat&#237;a aguda&#46; Dado que esta tiene un car&#225;cter din&#225;mico&#44; y el diagn&#243;stico y graduaci&#243;n de la gravedad se establece mediante la evaluaci&#243;n cl&#237;nica&#44; es recomendable realizar varias exploraciones neurol&#243;gicas durante las 6 primeras horas de vida<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">2&#44;3&#44;7&#44;13</span></a>&#46; En esta l&#237;nea&#44; los hospitales contestaron que m&#225;s del 90&#37; realizaban habitualmente 2 o m&#225;s exploraciones&#46; De forma pr&#225;ctica&#44; las 3<span class="elsevierStyleHsp" style=""></span>h de vida podr&#237;a ser un momento adecuado para indicar el tratamiento con HT activa en un RN con asfixia al nacimiento y que presenta en ese momento una EHI moderada-grave<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">5</span></a>&#46; Si se tomase la decisi&#243;n de indicar HT inmediatamente al nacimiento en base del mayor beneficio&#44; estar&#237;amos ofreciendo HT a numerosos RN que se recuperar&#237;an en los minutos siguientes con un curso favorable sin el tratamiento&#46; Por el contrario&#44; si se retrasase el inicio de la HT hasta las 6<span class="elsevierStyleHsp" style=""></span>h de vida&#44; se puede perder la m&#225;xima eficacia del tratamiento&#44; que acontece cuanto antes se inicia tras la agresi&#243;n hip&#243;xico-isqu&#233;mica<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">29&#44;30</span></a>&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Todos los hospitales contestaron que utilizaban escalas para graduar la encefalopat&#237;a&#44; mayoritariamente la escala de Garc&#237;a-Alix<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">10</span></a>&#44; seguida por la escala de Sarnat<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">11</span></a>&#46; Las escalas ofrecen una aproximaci&#243;n estandarizada&#44; sistem&#225;tica y organizada&#44; y homogenizan la caracterizaci&#243;n de la gravedad&#44; por profesionales con diferente grado de entrenamiento neurol&#243;gico y permiten comparar la evoluci&#243;n de los pacientes en grupos homog&#233;neos&#46; Es recomendable que cada centro adquiera confianza y experiencia con la misma escala&#46; Debemos recordar&#44; a la espera de los resultados de un ensayo cl&#237;nico dirigido a aquellos RN con EHI leve&#44; que en el momento actual la indicaci&#243;n de HT es solo para aquellos con EHI moderada-grave&#44; a pesar de que hay series que refieren incluir en el tratamiento con hipotermia al 15-30&#37; de RN con EHI leve<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">31&#8211;33</span></a>&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">La alteraci&#243;n de la actividad electrocortical mediante el aEEG ha sido utilizada para incluir al RN con asfixia perinatal en HT<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">34&#44;35</span></a>&#44; y principalmente&#44; para monitorizar la funci&#243;n cerebral durante la fase aguda de la encefalopat&#237;a<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">36</span></a> y detectar convulsiones cl&#237;nicamente silentes&#46; Adem&#225;s&#44; la relativa simplicidad de la interpretaci&#243;n del registro junto con su valor predictivo ha dado lugar a que esta monitorizaci&#243;n sea extremadamente importante en los RN con enfermedad neurol&#243;gica&#44; particularmente en el RN con EHI<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">35&#44;36</span></a>&#46; Es de destacar que el 35&#37; de los centros no dispon&#237;a de aEEG a pesar de ser unidades terciarias de nivel <span class="elsevierStyleSmallCaps">iii</span>&#44; entre las que se inclu&#237;an varios centros que realizaban HT&#46; Estos datos traducen aspectos de mejora&#44; por cuanto no parece factible ofertar un cuidado &#243;ptimo del RN con HT sin la informaci&#243;n que aporta la monitorizaci&#243;n cerebral&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">A pesar de que los datos de la encuesta muestran un adecuado est&#225;ndar asistencial con puntuaciones similares entre los que realizan HT y los que no&#44; existe margen de mejora ya que solo el 50&#37; de los 89 hospitales terciarios obtuvieron una &#171;asistencia &#243;ptima&#187;&#46; Existen adem&#225;s diferencias atendiendo al nivel asistencial&#44; y a si realizan o no HT&#44; siendo la calidad mejor en las unidades que realizan hipotermia <span class="elsevierStyleSmallCaps">iii</span>c y <span class="elsevierStyleSmallCaps">iii</span>b frente a las <span class="elsevierStyleSmallCaps">iii</span>a en la atenci&#243;n del parto y 6 primeras horas de vida&#44; y en la disponibilidad de profesionales con experiencia en las unidades <span class="elsevierStyleSmallCaps">iii</span>c frente al resto&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Un aspecto clave para mejorar la respuesta en este estrecho marco temporal es la formaci&#243;n adecuada de los pediatras que atienden partos&#44; para as&#237; identificar r&#225;pidamente al RN candidato a HT y activar el &#171;c&#243;digo hipotermia&#187; de manera muy precoz<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">37</span></a>&#46; En nuestro medio&#44; la incidencia de asfixia perinatal est&#225; en torno a 7 por mil RN<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">7</span></a> y si bien la mayor&#237;a de los ni&#241;os no necesitar&#225;n traslado&#44; la activaci&#243;n de este c&#243;digo y la puesta en marcha de una serie de acciones en secuencia que denominamos &#171;cadena de neuroprotecci&#243;n cerebral&#187; permiten poner en alerta al equipo de transporte y al centro de referencia&#44; as&#237; como vigilar de forma estrecha el estado neurol&#243;gico del RN&#44; controlar potenciales factores com&#243;rbidos y determinar la presencia de EHI en el marco de las 6<span class="elsevierStyleHsp" style=""></span>h de oro &#40;<a class="elsevierStyleCrossRef" href="#fig0020">fig&#46; 4</a>&#41;&#46; Nuestro estudio muestra &#225;reas de mejora&#44; como son la dotaci&#243;n tecnol&#243;gica y de personal entrenado&#59; al menos todos los centros que ofrecen HT deber&#237;an tener equipos de aEEG y neonat&#243;logos entrenados en las diferentes herramientas de evaluaci&#243;n neurol&#243;gica junto con experiencia en el manejo de las complicaciones asociadas a la EHI<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">12&#44;38</span></a>&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">La fortaleza de este trabajo es que pr&#225;cticamente todos los centros terciarios aportaron informaci&#243;n y gracias a ello disponemos de datos &#250;nicos&#44; no previamente conocidos que ofrecen un panorama global sobre la asistencia que se da al RN con asfixia perinatal y candidato a HT durante las primeras horas de vida en nuestro pa&#237;s&#46; Por otro lado este estudio presenta algunas limitaciones&#46; La metodolog&#237;a de una encuesta puede conllevar sesgos al incorporar al conjunto de datos informaci&#243;n incompleta o err&#243;nea&#46; Como no se dispone de criterios validados para establecer la calidad asistencial en el intervalo temporal de las 6 primeras horas en el contexto de la asfixia perinatal&#44; se sigui&#243; el criterio de puntuar la pr&#225;ctica cl&#237;nica de acuerdo con el est&#225;ndar recomendado en las gu&#237;as de pr&#225;ctica cl&#237;nica <a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">2&#44;3&#44;12&#8211;14</span></a>&#46; Asimismo&#44; se han eliminado las preguntas m&#225;s controvertidas y se ha optado por una escala asim&#233;trica que reforzase una actuaci&#243;n conforme al est&#225;ndar recomendado&#44; frente a una respuesta de &#171;raramente o nunca&#187;&#46; Finalmente&#44; es preciso resaltar que la encuesta eval&#250;a protocolos de actuaci&#243;n generales en cada hospital&#44; pero no es posible a trav&#233;s de ella conocer la calidad real asistencial de los pacientes&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">La informaci&#243;n aportada por este trabajo es relevante especialmente para dimensionar la pr&#225;ctica asistencial en nuestro pa&#237;s durante las horas de oro del RN asf&#237;ctico en riesgo de EHI y mostrar aspectos de posible mejora para poder dirigir adecuadamente los esfuerzos encaminados a ofertar una asistencia adecuada en este marco temporal&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflicto de intereses</span><p id="par0140" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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              "titulo" => "Control de la temperatura"
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              "titulo" => "Identificaci&#243;n del reci&#233;n nacido con encefalopat&#237;a hip&#243;xico-isqu&#233;mica"
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            1 => "Asfixia"
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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 proceso asistencial hasta el inicio de la hipotermia terap&#233;utica &#40;HT&#41; es crucial para mejorar su efectividad y prevenir el agravamiento del da&#241;o hip&#243;xico-isqu&#233;mico&#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 transversal nacional realizado en 2015 mediante cuestionario a todas las unidades nivel <span class="elsevierStyleSmallCaps">iii</span> sobre la asistencia al reci&#233;n nacido &#40;RN&#41; con asfixia perinatal en las primeras horas de vida&#46; Se compar&#243; la calidad asistencial entre los hospitales que realizaban o no HT y seg&#250;n el nivel asistencial&#44; de acuerdo a las gu&#237;as de pr&#225;ctica cl&#237;nica&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Participaron 89&#47;90 hospitales&#44; 57&#47;90 realizaban HT&#46; Todos utilizaban protocolos de reanimaci&#243;n y apagaban la cuna tras estabilizaci&#243;n&#46; Fue universal realizar medici&#243;n de glucemia y gasometr&#237;a&#44; monitorizar la temperatura&#44; dejar al RN a dieta y realizar al menos 2 exploraciones para el diagn&#243;stico de encefalopat&#237;a hip&#243;xico-isqu&#233;mica&#46; El 35&#37; no dispon&#237;a de electroencefalograma integrado por amplitud&#59; 6&#47;57 eran hospitales que realizaban HT&#46; La calidad asistencial entre los hospitales con&#47;sin HT fue similar&#44; siendo mejor la del parto en los que hac&#237;an HT&#44; y la de aquellos con mayor nivel asistencial&#46; El 25&#37; de aquellos que realizaban HT no ten&#237;an neonat&#243;logos con experiencia en la exploraci&#243;n neurol&#243;gica o en la interpretaci&#243;n del electroencefalograma integrado por amplitud&#59; ni en la realizaci&#243;n de ecograf&#237;a cerebral en el 62&#37;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Atendiendo a las recomendaciones del RN asf&#237;ctico&#44; existe un adecuado est&#225;ndar asistencial nacional&#44; con diferencias seg&#250;n el nivel asistencial y si realizan o no hipotermia&#46; Son necesarios m&#225;s equipos de electroencefalograma integrado por amplitud y formaci&#243;n de los neonat&#243;logos en las evaluaciones que requerir&#225; el RN con encefalopat&#237;a hip&#243;xico-isqu&#233;mica&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The process of care and assistance from birth to the starting of therapeutic hypothermia &#40;TH&#41; is crucial in order to improve its effectiveness and prevent the worsening of hypoxic-ischaemic injury&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A national cross-sectional study carried out in 2015 by use of a questionnaire sent to all level <span class="elsevierStyleSmallCaps">iii</span> units on the care of the newborn<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>35 weeks gestation within the first hours of life after a perinatal asphyxia event&#46; According to clinical practice guidelines&#44; the quality of care was compared between the hospitals that carried out or did not carry out TH&#44; and according to the level of care&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A total of 89&#47;90 hospitals participated&#44; of which 57&#47;90 performed TH&#46; They all used resuscitation protocols and turned off the radiant warmer after stabilisation&#46; All of them performed glucose and blood gas analysis&#44; monitored the central temperature&#44; put the newborn on a diet&#44; and performed at least two examinations for the diagnosis of hypoxic-ischaemic encephalopathy&#46; Greater than one-third &#40;35&#37;&#41; of hospitals did not have amplitude-integrated electroencephalogram&#44; and 6&#47;57 were TH-hospitals&#46; The quality of care among hospitals with and without TH was similar&#44; childbirth being better in those that performed TH&#44; and those with a higher level of care&#46; Level IIIc hospitals had higher scores than the others&#46; The TH-hospitals mentioned not always having neonatologists with experience in neurological assessment and interpretation of amplitude-integrated electroencephalogram &#40;25&#37;&#41;&#44; or in brain ultrasound &#40;62&#37;&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">In response to the recommendations of the asphyxiated newborn&#44; there is a proper national health care standard with differences according to the level of care and whether TH is offered&#46; More amplitude-integrated electroencephalogram devices are necessary&#44; as well as more neonatologists trained in the evaluations that will be require by the newborn with hypoxic-ischaemic encephalopathy&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0035">Los miembros del Grupo de Trabajo ESP-EHI se presentan en <a class="elsevierStyleCrossRef" href="#sec0055">anexo 1</a>&#46;</p>"
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            "apendice" => "<p id="par0150" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Grupo de Trabajo ESP-EHI&#46; Unidades de Neonatolog&#237;a&#46; Hospitales terciarios&#44; Espa&#241;a</span></p> <p id="par0155" class="elsevierStylePara elsevierViewall">J&#46; Diez-Delgado &#40;Torrec&#225;rdenas&#44; Almer&#237;a&#41;&#44; <span class="elsevierStyleSmallCaps">I</span>&#46;Benavente &#40;Puerta del Mar&#44; C&#225;diz&#41;&#44; <span class="elsevierStyleSmallCaps">I</span>&#46; Tof&#233; &#40;Reina Sof&#237;a&#44; C&#243;rdoba&#41;&#44; A&#46;E&#46; Jerez &#40;S&#46; Cecilio&#44; Granada&#41;&#44; J&#46;A&#46; Hurtado &#40;Virgen de las Nieves&#44; Granada&#41;&#44; J&#46;M&#46; Ceballos &#40;J&#46;R&#46; Jim&#233;nez&#44; Huelva&#41;&#44; M&#46;L&#46; Mill&#225;n &#40;C&#46; Hospitalario&#44; Ja&#233;n&#41;&#44; M&#46;D&#46; Esquivel &#40;Materno-Infantil&#44; Jerez&#41;&#44; C&#46; Ruiz &#40;Costa del Sol&#44; Marbella&#41;&#44; M&#46; Baca &#40;Quir&#243;n&#44; M&#225;laga&#41;&#44; E&#46; Tapia &#40;G&#46; Universitario&#44; M&#225;laga&#41;&#44; M&#46; Losada &#40;Quir&#243;n S&#46; Coraz&#243;n&#44; Sevilla&#41;&#44; E&#46; Torres &#40;Valme&#44; Sevilla&#41;&#44; A&#46; Pav&#243;n &#40;Virgen del Roc&#237;o&#44; Sevilla&#41;&#44; P&#46;J&#46; Jim&#233;nez &#40;Virgen Macarena&#44; Sevilla&#41;&#44; F&#46; Jim&#233;nez &#40;S&#46; &#193;ngela de la Cruz&#44; Sevilla&#41;&#44; M&#46;P&#46; Ventura &#40;Lozano Blesa&#44; Zaragoza&#41;&#44; S&#46; Rite &#40;Miguel Servet&#44; Zaragoza&#41;&#44; T&#46; Gonz&#225;lez &#40;Cabue&#241;es&#44; Gij&#243;n&#41;&#44; R&#46;P&#46;Arias &#40;Central Asturias&#44; Oviedo&#41;&#44; P&#46;R&#46; Balliu &#40;Son Espases&#44; Mallorca&#41;&#44; J&#46;M&#46;Lloreda-Garc&#237;a &#40;S&#46; Luc&#237;a&#44; Cartagena&#41;&#44; J&#46;L&#46; Alcar&#225;z &#40;Virgen de la Arrixaca&#44; Murcia&#41;&#44; C&#46; Tapia &#40;General&#44; Alicante&#41;&#44; A&#46; de la Morena &#40;S&#46; Juan&#44; Alicante&#41;&#44; <span class="elsevierStyleSmallCaps">I</span>&#46;Centelles &#40;General&#44; 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Madrid&#41;&#44; G&#46; Romera &#40;Montepr&#237;ncipe&#44; Madrid&#41;&#44; A&#46; Cu&#241;arro &#40;Alcorc&#243;n&#41;&#44; C&#46; Mu&#241;&#243;z &#40;Puerta de Hierro&#95;Majadahonda&#44; Madrid&#41;&#44; F&#46; Caba&#241;as &#40;H&#46; U&#46; Quir&#243;n Madrid&#41;&#44; E&#46; Valverde &#40;La Paz&#44; Madrid&#41;&#44; R&#46; Montero &#40;Nisa&#95;Pardo de Aravaca&#44; Madrid&#41;&#44; J&#46;C&#46; Tejedor &#40;General&#44; M&#243;stoles&#41;&#44; C&#46; Santana &#40;Materno Insular&#44; Las Palmas&#41;&#44; B&#46; Reyes &#40;Universitario de Canarias&#44; Tenerife&#41;&#44; S&#46; Romero &#40;N&#46; S&#46; de Candelaria&#44; Tenerife&#41;&#44; A&#46; Orizaola &#40;Marqu&#233;s de Valdecilla&#44; Santander&#41;&#44; M&#46; Baquero &#40;General&#44; Albacete&#41;&#44; D&#46; Hern&#225;ndez &#40;General&#44; Ciudad Real&#41;&#44; A&#46; Pantoja &#40;Virgen de la Salud&#44; Toledo&#41;&#44; C&#46; Vega &#40;HUBU&#44; Burgos&#41;&#44; L&#46; Casta&#241;&#243;n &#40;CAULE&#44; Le&#243;n&#41;&#44; E&#46;P&#46; Guti&#233;rrez &#40;Universitario&#44; Salamanca&#41;&#44; M&#46; Benito &#40;Cl&#237;nico&#44; Valladolid&#41;&#44; S&#46; Caser&#237;o &#40;Rio Hortega&#44; Valladolid&#41;&#44; G&#46; Arca &#40;Cl&#237;nic&#44; Barcelona&#41;&#44; M&#46;J&#46; Garc&#237;a &#40;S&#46; Creu i S&#46; Pau&#44; Barcelona&#41;&#44; M&#46;A&#46; L&#243;pez-V&#237;lchez &#40;H&#46; del Mar&#44; Barcelona&#41;&#44; L&#46; Castells &#40;General de Catalunya&#44; Barcelona&#41;&#44; M&#46; Domingo &#40;Parc Taul&#237;&#44; Sabadell&#41;&#44; W&#46; Coroleu &#40;Germans Trias i Pujol&#44; Badalona&#41;&#44; H&#46; Boix &#40;Vall d¿Hebr&#243;n&#44; Barcelona&#41;&#44; R&#46; Porta &#40;<span class="elsevierStyleSmallCaps">I</span>&#46;Dexeus&#95;Quir&#243;n&#44; Barcelona&#41;&#44; A&#46; Garc&#237;a-Alix &#40;S&#46; Joan de D&#233;u&#44; Barcelona&#41;&#44; S&#46; Mart&#237;nez-Nadal &#40;SCIAS&#44; Barcelona&#41;&#44; E&#46; Jim&#233;nez &#40;Dr&#46; J&#46;Trueta&#44; Girona&#41;&#44; E&#46; Sole &#40;Arnau de Vilanova&#44; Lleida&#41;&#44; M&#46; Alb&#250;jar &#40;Joan <span class="elsevierStyleSmallCaps">XXIII</span>&#44; Tarragona&#41;&#44; E&#46;M&#46; Fern&#225;ndez &#40;Infanta Cristina&#44; Badajoz&#41;&#44; A&#46;R&#46; Barrio &#40;S&#46; Pedro de Alc&#225;ntara&#44; C&#225;ceres&#41;&#44; E&#46; Pi&#241;&#225;n &#40;M&#233;rida&#41;&#44; A&#46; Avila-Alvarez &#40;CHU A Coru&#241;a&#41;&#44; M&#46;E&#46; V&#225;zquez &#40;Lucus Augusti&#44; Lugo&#41;&#44; N&#46; Balado &#40;CHU&#44; Orense&#41;&#44; P&#46;A&#46; Crespo &#40;CHU&#44; Pontevedra&#41;&#44; M&#46;L&#46; Couce &#40;Cl&#237;nico&#44; Santiago de Compostela&#41;&#44; A&#46; Concheiro-Guis&#225;n &#40;Xeral&#44; Vigo&#41;&#44; <span class="elsevierStyleSmallCaps">I</span>&#46; Esteban &#40;S&#46; Pedro&#44; Logro&#241;o&#41;&#44; A&#46; Lavilla &#40;CH&#44; Navarra&#41;&#44; <span class="elsevierStyleSmallCaps">V</span>&#46; Alzina &#40;C&#46; Universidad de Navarra&#41;&#44; A&#46; Aguirre &#40;Basurto&#44; Bilbao&#41;&#44; B&#46; Loureiro &#40;Cruces&#44; Bilbao&#41;&#44; <span class="elsevierStyleSmallCaps">I</span>&#46; Ech&#225;niz &#40;Quir&#243;n&#44; Bilbao&#41;&#44; M&#46;D&#46; Elorza &#40;HU&#46; Donostia&#44; San Sebasti&#225;n&#41;&#44; A&#46; Euba &#40;HUA Txagorritxu&#44; Vitoria&#41;&#46;</p>"
            "etiqueta" => "Anexo 1"
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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Calidad de la asistencia de los hospitales que realizan hipotermia terap&#233;utica frente a los que no&#46;</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">HT&#58; hospital con hipotermia terap&#233;utica&#59; No-HT&#58; hospital sin hipotermia terap&#233;utica&#59; hdv&#58; horas de vida&#46;</p> <p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">&#40;a&#41; Se incluyen las preguntas 5-10&#44; y las agrupadas 1-2 y 3-4&#46;</p> <p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">&#40;b&#41; Se incluyen las preguntas 12-14&#44; 17&#44; 21&#44; 22&#46;</p> <p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">&#40;c&#41; Se incluyen las preguntas 20&#44; 25&#44; 27-30&#44; y las agrupadas 24a-24b&#44; 26a-26d y 26b-26c&#46;</p> <p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Todo<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#40;a&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&#40;b&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&#40;c&#41;&#46;</p> <p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">&#42; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;015 &#40;test de chi-cuadrado comparando &#8220;clasificaci&#243;n &#243;ptima&#8221; vs&#46; &#8220;clasificaci&#243;n aceptable &#43; mejorable&#8221;&#41;&#46;</p>"
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          "es" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Calidad de la asistencia de los hospitales nivel <span class="elsevierStyleSmallCaps">iii</span> que realizan hipotermia terap&#233;utica&#44; seg&#250;n el nivel asistencial&#46;</p> <p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">hdv&#58; horas de vida&#46;</p> <p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">&#40;a&#41; Se incluyen las preguntas 5-10&#44; y las agrupadas 1-2 y 3-4&#46;</p> <p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">&#40;b&#41; Se incluyen las preguntas 12-14&#44; 17&#44; 21&#44; 22&#46;</p> <p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">&#40;c&#41; Se incluyen las preguntas 20&#44; 25&#44; 27-30&#44; y las agrupadas 24a-24b&#44; 26a-26d y 26b-26c&#46;</p> <p id="spar1045" class="elsevierStyleSimplePara elsevierViewall">Todo<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#40;a&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&#40;b&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&#40;c&#41;&#46;</p> <p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">En las preguntas &#8220;Parto&#46;&#8221; &#8220;6hdv&#8221; y &#8220;Parto-6hdv&#8221; se incluyen las respuestas de los 89 hospitales&#46; En las preguntas &#8220;Profesionales&#8221; y &#8220;Todo&#8221; se incluyen los 53 hospitales con HT que responden a la encuesta &#40;4 IIIA&#44; 34 IIIB y 15 IIIC&#41;&#46;</p>"
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          "es" => "<p id="spar0130" class="elsevierStyleSimplePara elsevierViewall">Protocolo de actuaci&#243;n en las primeras 6<span class="elsevierStyleHsp" style=""></span>h de vida y &#171;cadena de neuroprotecci&#243;n cerebral&#187;&#46;</p> <p id="spar0135" class="elsevierStyleSimplePara elsevierViewall">aEEG&#58; electroencefalograma integrado por amplitud&#59; BS&#58; patr&#243;n brote supresi&#243;n&#59; CBV&#58; patr&#243;n continuo de bajo voltaje&#59; DB&#58; d&#233;ficit de bases&#59; EG&#58; edad gestacional&#59; EHI&#58; encefalopat&#237;a hip&#243;xico-isqu&#233;mica&#59; FC&#58; frecuencia cardiaca&#59; FiO<span class="elsevierStyleInf">2</span>&#58; fracci&#243;n inspirada de ox&#237;geno&#59; FR&#58; frecuencia respiratoria&#59; g&#58; gramos&#59; hdv&#58; horas de vida&#59; hipoCa<span class="elsevierStyleSup">&#43;&#43;</span>&#58; hipocalcemia&#59; hipoMg<span class="elsevierStyleSup">&#43;&#43;</span>&#58; hipomagnesemia&#59; min&#58; minutos&#59; P&#58; patr&#243;n plano&#59; PaO<span class="elsevierStyleInf">2</span>&#58; presi&#243;n parcial de ox&#237;geno en la sangre arterial&#59; PaCO<span class="elsevierStyleInf">2</span>&#58; presi&#243;n parcial de di&#243;xido de carbono en la sangre arterial&#59; rScO<span class="elsevierStyleInf">2</span>&#58; saturaci&#243;n regional de ox&#237;geno cerebral&#59; REA&#58; reanimaci&#243;n&#59; RN&#58; reci&#233;n nacido&#59; SatO<span class="elsevierStyleInf">2</span>&#58; saturaci&#243;n arterial de ox&#237;geno&#59; T<span class="elsevierStyleSup">a</span>&#58; temperatura&#59; TA&#58; tensi&#243;n arterial&#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="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Hospitales que no realizan HT</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Hospitales que realizan HT</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">Casi siempre&nbsp;\t\t\t\t\t\t\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">Casi siempre&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">Con frecuencia&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">Rara vez o nunca&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  " colspan="7" align="left" valign="top"><span class="elsevierStyleBold">En paritorio&#44; en un parto complicado est&#225; presente</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">1&#46; Un pediatra</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32 &#40;100&#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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">55 &#40;96&#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&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;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">2&#46; Un pediatra neonat&#243;logo</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22 &#40;69&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;31&#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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">43 &#40;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;21&#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;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">3&#46; Una enfermera - matrona</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31 &#40;97&#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&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;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">2 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">4&#46; Una enfermera de la Unidad Neonatal</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;25&#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;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 &#40;47&#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;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33 &#40;58&#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  " colspan="7" 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="7" align="left" valign="top"><span class="elsevierStyleBold">Si al nacimiento el RN presenta datos de asfixia perinatal</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">5&#46; Tiene un protocolo de actuaci&#243;n espec&#237;fico en paritorio</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30 &#40;94&#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;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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">53 &#40;93&#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;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">1 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">6&#46; Aunque el pH sea &#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">7&#44;00&#44; evita poner bicarbonato</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26 &#40;81&#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;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">4 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">51 &#40;89&#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;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">4 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">7&#46; Evita administrar calcio a&#250;n si precisa reanimaci&#243;n avanzada</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><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="left" valign="top">26 &#40;81&#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;13&#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;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">55 &#40;96&#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&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;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">8&#46; Apaga las fuentes de calor una vez recupere la frecuencia cardiaca</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26 &#40;81&#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;13&#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;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">55 &#40;96&#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;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">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">9&#46; Traslada al RN con la cuna de transporte apagada</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29 &#40;91&#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;3&#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;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">56 &#40;98&#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;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">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">10&#46; Se ingresa al RN para observaci&#243;n en la Unidad</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31 &#40;97&#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;3&#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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54 &#40;95&#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;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">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">11&#46; Si se recupera r&#225;pidamente&#44; se deja al RN con su madre</span>&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;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">7 &#40;22&#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;72&#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;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">12 &#40;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">43 &#40;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0155" class="elsevierStyleSimplePara elsevierViewall">aEEG&#58; electroencefalograma integrado por amplitud&#59; EHI&#58; encefalopat&#237;a hip&#243;xico-isqu&#233;mica&#59; hdv&#58; horas de vida&#59; HT&#58; hipotermia terap&#233;utica&#59; RN&#58; reci&#233;n nacido&#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="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Hospitales que no realizan HT</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Hospitales que realizan HT</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">Casi siempre&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">Con frecuencia&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">Rara vez o nunca&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">Casi siempre&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">Con frecuencia&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">Rara vez o nunca&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  " colspan="7" align="left" valign="top"><span class="elsevierStyleBold">Durante las primeras 6 hdv en el RN con asfixia perinatal</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">12&#46; Aplica un protocolo de actuaci&#243;n espec&#237;fico</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26 &#40;81&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;16&#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;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">52 &#40;91&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;9&#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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">13&#46; Realiza gasometr&#237;a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32 &#40;100&#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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57 &#40;100&#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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">14&#46; Realiza glucemia</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32 &#40;100&#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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57 &#40;100&#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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">15&#46; Le deja a dieta absoluta</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32 &#40;100&#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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">56 &#40;98&#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;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">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">16&#46; Le deja a dieta absoluta con sueroterapia</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32 &#40;100&#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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48 &#40;84&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;14&#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;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">17&#46; Monitoriza la temperatura central continua o intermitente&#47;30</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">min</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22 &#40;69&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;31&#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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42 &#40;74&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;21&#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;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">18&#46; Mantiene la temperatura central por debajo de 36</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#176;C</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27 &#40;84&#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;9&#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;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">40 &#40;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">19&#46; Si dispone de aEEG&#44; monitoriza la funci&#243;n cerebral</span><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="left" valign="top">5 &#40;16&#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;3&#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;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38 &#40;67&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;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  " colspan="7" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">20&#46; N&#46;</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">o</span></span><span class="elsevierStyleItalic">de aparatos de aEEG</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&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="left" valign="top">12 &#40;21&#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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Uno&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;22&#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><td class="td" title="table-entry  " align="left" valign="top">39 &#40;68&#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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Ninguno&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25 &#40;78&#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><td class="td" title="table-entry  " align="left" valign="top">6 &#40;11&#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  " colspan="7" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">21&#46; &#191;Cu&#225;ntas exploraciones realiza para graduar la EHI&#63;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29 &#40;91&#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><td class="td" title="table-entry  " align="left" valign="top">53 &#40;93&#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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Una&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;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="" 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">4 &#40;7&#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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Ninguna&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&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="left" valign="top">0&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="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">22&#46; &#191;Qu&#233; escala utiliza para graduar la EHI&#63;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Garc&#237;a-Alix&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20 &#40;63&#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><td class="td" title="table-entry  " align="left" valign="top">39 &#40;68&#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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Sarnat&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;38&#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><td class="td" title="table-entry  " align="left" valign="top">13 &#40;23&#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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Otra&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&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="left" valign="top">5 &#40;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="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Ninguna&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&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="left" valign="top">0&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="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">23&#46; En la escala que utiliza&#44; da prioridad al &#237;tem</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Despertar y mantener la alerta&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30 &#40;94&#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><td class="td" title="table-entry  " align="left" valign="top">50 &#40;88&#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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Tono muscular&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;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><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="left" valign="top">6 &#40;10&#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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Movimientos&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;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><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="left" valign="top">1 &#40;2&#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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Otros&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&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="left" valign="top">0&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></tbody></table>
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          "es" => "<p id="spar0150" class="elsevierStyleSimplePara elsevierViewall">Preguntas formuladas respecto a la asistencia del reci&#233;n nacido con asfixia perinatal durante las 6 primeras horas de vida</p>"
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          "leyenda" => "<p id="spar0165" class="elsevierStyleSimplePara elsevierViewall">Cincuenta y tres del total de 57 hospitales que realizaban hipotermia contestaron a las preguntas&#46;</p><p id="spar0170" class="elsevierStyleSimplePara elsevierViewall">aEEG&#58; electroencefalograma integrado por amplitud&#59; EHI&#58; encefalopat&#237;a hip&#243;xico-isqu&#233;mica&#59; RM&#58; resonancia magn&#233;tica cerebral&#46;</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" 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">Casi siempre&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">Con frecuencia&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">Rara vez o nunca&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  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">24&#46; Profesionales entrenados en la exploraci&#243;n neurol&#243;gica neonatal</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>a&#46; Neonat&#243;logo&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;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;23&#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;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>b&#46; Neur&#243;logo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28 &#40;53&#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;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">25&#46; Neonat&#243;logos entrenados en la interpretaci&#243;n del aEEG</span>&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;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;10&#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  " colspan="4" 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="4" align="left" valign="top"><span class="elsevierStyleItalic">26&#46; Profesionales entrenados en la neuroimagen cerebral</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>a&#46; Neonat&#243;logo entrenado en la interpretaci&#243;n de la RM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20 &#40;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26 &#40;49&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>b&#46; Neonat&#243;logo entrenado en ecograf&#237;a y doppler&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20 &#40;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 &#40;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18 &#40;34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>c&#46; Radi&#243;logo entrenado en ecograf&#237;a y doppler&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34 &#40;64&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>d&#46; Radi&#243;logo entrenado en la interpretaci&#243;n de la RM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39 &#40;74&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;23&#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;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">27&#46; Neonat&#243;logo entrenado en ecocardio&#47;cardi&#243;logo infantil</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30 &#40;57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">28&#46; Equipo de enfermer&#237;a con formaci&#243;n espec&#237;fica en EHI</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42 &#40;79&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;15&#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;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">29&#46; Plan de cuidados espec&#237;fico dise&#241;ado por enfermer&#237;a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38 &#40;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;11&#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;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">30&#46; Ratio de enfermeras igual al de otro paciente grave</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">43 &#40;81&#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;17&#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;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">31&#46; Psic&#243;logo de apoyo a los padres en este tipo de situaci&#243;n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 &#40;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27 &#40;51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1862590.png"
              ]
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          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0160" class="elsevierStyleSimplePara elsevierViewall">Preguntas dirigidas a los hospitales que realizaban hipotermia sobre la disponibilidad de profesionales con experiencia en el manejo del reci&#233;n nacido con encefalopat&#237;a hip&#243;xico-isqu&#233;mica</p>"
        ]
      ]
      7 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Tabla 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at4"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0180" class="elsevierStyleSimplePara elsevierViewall">HT&#58; hipotermia terap&#233;utica&#46;</p><p id="spar0185" class="elsevierStyleSimplePara elsevierViewall">Datos en mediana &#40;m&#237;n&#59;m&#225;x&#41;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="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  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Realizaci&#243;n si&#47;no HT</th><th class="td" title="table-head  " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Seg&#250;n el nivel asistencial</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Preguntas referidas 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">No-HT &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>32&#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">S&#237;-HT &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>57&#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">Valor de 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">IIIA &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>25&#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">IIIB &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>47&#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">IIIC &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>17&#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">Valor de p&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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">La asistencia durante el parto<a class="elsevierStyleCrossRef" href="#tblfn0015"><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="left" valign="top">31&#44;5 &#40;25&#59;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32 &#40;26&#59;32&#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;007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31 &#40;25&#59;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32 &#40;25&#59;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32 &#40;26&#59;32&#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;034&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">La asistencia durante las 6 primeras horas<a class="elsevierStyleCrossRef" href="#tblfn0020"><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="left" valign="top">24 &#40;20&#59;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 &#40;20&#59;24&#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;426&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 &#40;21&#59;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 &#40;20&#59;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 &#40;20&#59;24&#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;827&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">La asistencia durante el parto y las 6 primeras horas de vida<a class="elsevierStyleCrossRefs" href="#tblfn0015"><span class="elsevierStyleSup">a&#44;b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54&#44;5 &#40;46&#59;56&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">56 &#40;49&#59;56&#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;052&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">55 &#40;48&#59;56&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">56 &#40;47&#59;56&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">56 &#40;46&#59;56&#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;105&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">La disponibilidad de profesionales con experiencia<a class="elsevierStyleCrossRefs" href="#tblfn0025"><span class="elsevierStyleSup">c&#44;d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" 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">34 &#40;21&#59;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" 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">31&#44;5 &#40;27&#59;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33 &#40;24&#59;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35 &#40;21&#59;36&#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;129&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Todas<a class="elsevierStyleCrossRefs" href="#tblfn0015"><span class="elsevierStyleSup">a&#44;b&#44;c&#44;d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" 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">89 &#40;72&#59;92&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" 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">84 &#40;81&#59;90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">88&#44;5 &#40;77&#59;92&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">91 &#40;72&#59;92&#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;027&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1862589.png"
              ]
            ]
          ]
          "notaPie" => array:4 [
            0 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Se incluyen las preguntas 5-10&#44; y las agrupadas 1-2 y 3-4&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0020"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Se incluyen las preguntas 12-14&#44; 17&#44; 21&#44; 22&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0025"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Se incluyen las preguntas 20&#44; 25&#44; 27-30&#44; y las agrupadas 24a-24b&#44; 26a-26d y 26b-26c&#46;</p>"
            ]
            3 => array:3 [
              "identificador" => "tblfn0030"
              "etiqueta" => "d"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Solo se incluyen 53 de los 57 hospitales con hipotermia que contestaron a la encuesta &#40;4 IIIA&#44; 34 IIIB y 15 IIIC&#41;&#46;</p>"
            ]
          ]
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