array:23 [
  "pii" => "S1695403301775947"
  "issn" => "16954033"
  "doi" => "10.1016/S1695-4033(01)77594-7"
  "estado" => "S300"
  "fechaPublicacion" => "2001-06-01"
  "aid" => "77594"
  "copyright" => "Asociación Española de Pediatría"
  "copyrightAnyo" => "2001"
  "documento" => "article"
  "crossmark" => 0
  "subdocumento" => "fla"
  "cita" => "An Pediatr (Barc). 2001;54:559-66"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 3038
    "formatos" => array:3 [
      "EPUB" => 73
      "HTML" => 2383
      "PDF" => 582
    ]
  ]
  "itemSiguiente" => array:18 [
    "pii" => "S1695403301775959"
    "issn" => "16954033"
    "doi" => "10.1016/S1695-4033(01)77595-9"
    "estado" => "S300"
    "fechaPublicacion" => "2001-06-01"
    "aid" => "77595"
    "copyright" => "Asociación Española de Pediatría"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "sco"
    "cita" => "An Pediatr (Barc). 2001;54:567-72"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 4508
      "formatos" => array:3 [
        "EPUB" => 55
        "HTML" => 3816
        "PDF" => 637
      ]
    ]
    "es" => array:10 [
      "idiomaDefecto" => true
      "titulo" => "Asma y enfermedades crónicas de la vía respiratoria superior"
      "tienePdf" => "es"
      "tieneTextoCompleto" => 0
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "567"
          "paginaFinal" => "572"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Asthma and chronic diseases of the upper respiratory airway"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "L. García-Marcos Álvarez, M. Götz"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "L."
              "apellidos" => "García-Marcos Álvarez"
            ]
            1 => array:2 [
              "nombre" => "M."
              "apellidos" => "Götz"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403301775959?idApp=UINPBA00005H"
    "url" => "/16954033/0000005400000006/v1_201307051558/S1695403301775959/v1_201307051558/es/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S1695403301775935"
    "issn" => "16954033"
    "doi" => "10.1016/S1695-4033(01)77593-5"
    "estado" => "S300"
    "fechaPublicacion" => "2001-06-01"
    "aid" => "77593"
    "copyright" => "Asociación Española de Pediatría"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "fla"
    "cita" => "An Pediatr (Barc). 2001;54:555-8"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 6049
      "formatos" => array:3 [
        "EPUB" => 70
        "HTML" => 4977
        "PDF" => 1002
      ]
    ]
    "es" => array:10 [
      "idiomaDefecto" => true
      "titulo" => "Hipercalcemia por inmovilización en el niño críticamente enfermo: tratamiento con calcitonina"
      "tienePdf" => "es"
      "tieneTextoCompleto" => 0
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "555"
          "paginaFinal" => "558"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Hypercalcemia due to immobilization in critically ill children: calcitonin treatment"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M. Urán Moreno, R. Alonso Riofrío, C. Moliner Robredo, S. Pons Morales, J. López-Herce Cid"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "M."
              "apellidos" => "Urán Moreno"
            ]
            1 => array:2 [
              "nombre" => "R."
              "apellidos" => "Alonso Riofrío"
            ]
            2 => array:2 [
              "nombre" => "C."
              "apellidos" => "Moliner Robredo"
            ]
            3 => array:2 [
              "nombre" => "S."
              "apellidos" => "Pons Morales"
            ]
            4 => array:2 [
              "nombre" => "J."
              "apellidos" => "López-Herce Cid"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403301775935?idApp=UINPBA00005H"
    "url" => "/16954033/0000005400000006/v1_201307051558/S1695403301775935/v1_201307051558/es/main.assets"
  ]
  "es" => array:14 [
    "idiomaDefecto" => true
    "titulo" => "Relación entre el subtipo del virus respiratorio sincitial y la gravedad clínica en la bronquiolitis"
    "tieneTextoCompleto" => 0
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "559"
        "paginaFinal" => "566"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "J.L. Neves Barreira, C. Fonseca, M.J. Cardoso, A. Azevedo, A. Bonito Vítor"
        "autores" => array:5 [
          0 => array:4 [
            "nombre" => "J.L."
            "apellidos" => "Neves Barreira"
            "email" => array:1 [
              0 => "joaobarreira@mail.telepac.pt"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "C&#46;"
            "apellidos" => "Fonseca"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "M&#46;J&#46;"
            "apellidos" => "Cardoso"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "A&#46;"
            "apellidos" => "Azevedo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "A&#46;"
            "apellidos" => "Bonito V&#237;tor"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Departamento de Pediatr&#237;a"
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Microbiolog&#237;a y Serolog&#237;a&#46; Hospital de San Jo&#227;o"
            "etiqueta" => "<span class="elsevierStyleSup">b</span>"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Servicio de Higiene y Epidemiolog&#237;a&#46; Facultad de Medicina de Oporto&#46; Portugal"
            "etiqueta" => "<span class="elsevierStyleSup">c</span>"
            "identificador" => "aff0015"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#42;"
            "correspondencia" => "Correspondencia&#58; Departamento de Pediatr&#237;a&#46; Hospital de San Jo&#227;o&#46; Alameda Prof&#46; Hernani Monteiro&#46;4202-451 Oporto&#46; Portugal&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "en" => array:1 [
        "titulo" => "Relationship between respiratory syncytial virus subtype and clinical severity in bronchiolitis"
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2001-01-31"
    "fechaAceptado" => "2001-02-28"
    "PalabrasClave" => array:2 [
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec186692"
          "palabras" => array:4 [
            0 => "Bronquiolitis"
            1 => "Virus respiratorio sincitial &#40;VRS&#41;"
            2 => "Subtipos del VRS"
            3 => "Indicadores de gravedad cl&#237;nica"
          ]
        ]
      ]
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Key words"
          "identificador" => "xpalclavsec186693"
          "palabras" => array:4 [
            0 => "Bronchiolitis"
            1 => "Respiratory syncytial virus"
            2 => "Respiratory syncytial virus subtypes"
            3 => "Clinical severity index"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "es" => array:1 [
        "resumen" => "<span class="elsevierStyleSectionTitle">Antecedentes</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El virus respiratorio sincitial &#40;VRS&#41; es el principal agente de la bronquiolitis y presenta dos subtipos distintos &#40;A y B&#41;&#46; Los trabajos acerca de la relaci&#243;n entre el subtipo de virus y la gravedad de la enfermedad obtienen resultados discordantes&#46;</p> <span class="elsevierStyleSectionTitle">Prop&#243;sito</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Analizar si el subtipo de este virus constituye una variable independiente en la gravedad cl&#237;nica de la enfermedad&#46;</p> <span class="elsevierStyleSectionTitle">Pacientes y m&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudio prospectivo que incluye ni&#241;os previamente sanos menores de 2 a&#241;os de edad&#44; hospitalizados por infecci&#243;n respiratoria por VRS durante un brote epid&#233;mico anual&#46; Se comparan la presentaci&#243;n y evoluci&#243;n cl&#237;nica&#44; las exploraciones complementarias y la radiograf&#237;a pulmonar en los pacientes infectados por los subtipos A y B de VRS&#46; Los indicadores cl&#237;nicos de gravedad incluyen el grado y duraci&#243;n del distr&#233;s respiratorio&#44; la necesidad de ox&#237;geno suplementario&#44; la admisi&#243;n en cuidados intensivos&#44; la ventilaci&#243;n mec&#225;nica y la duraci&#243;n del ingreso hospitalario&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">De los 85 enfermos incluidos &#40;35 mujeres&#44; 50 varones&#59; edad media&#44; 4&#44;8 6 4&#44;3 meses&#41;&#44; 59 casos pertenec&#237;an al subtipo A&#46; Ambos grupos no se diferenciaban en cuanto a sexo&#44; edad y antecedentes&#44; excepto en la lactancia materna que fue menos frecuente en el subtipo B&#46; La presentaci&#243;n cl&#237;nica&#44; anal&#237;tica y radiol&#243;gica fue semejante en los dos grupos&#46; Los indicadores cl&#237;nicos de gravedad no difirieron de forma significativa en los dos grupos&#46; La edad por debajo de los 3 meses se asoci&#243; a mayor duraci&#243;n del distr&#233;s respiratorio y de la estancia hospitalaria&#46;</p> <span class="elsevierStyleSectionTitle">Conclusi&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Los resultados no apoyan la hip&#243;tesis de que la infecci&#243;n por el subtipo A del VRS se asocie a mayor gravedad cl&#237;nica&#46;</p>"
      ]
      "en" => array:1 [
        "resumen" => "<span class="elsevierStyleSectionTitle">Background</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Respiratory syncytial virus &#40;RSV&#41; is the most frequently implicated agent in bronchiolitis&#46; The virus presents two antigenic subtypes &#40;A and B&#41;&#46; The results of studies on the relationship between viral subtype and clinical severity are conflicting&#46;</p> <span class="elsevierStyleSectionTitle">Purpose</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">To evaluate whether the subtype of this virus constitutes an independent variable in the severity of clinical expression of RSV infection&#46;</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">We prospectively studied previously healthy children aged less than 2 years admitted for RSV infection during an epidemic season&#46; Clinical presentation and evolution&#44; laboratory and radiological aspects were compared in subsets of children infected with RSV subtype A or B&#46; Clinical severity parameters included score and duration of respiratory distress&#44; oxygen requirements&#44; admission to the intensive care unit&#44; mechanical ventilation and length of hospital stay&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Eighty-five patients were enrolled in the study &#40;50 boys and 35 girls&#59; mean age 4&#46;8 6 4&#46;3 months&#41;&#46; Fifty-nine children were infected with RSV subtype A&#46; No differences were found in age&#44; sex or antecedents but children with subtype B were less likely to have been breast-fed&#46; Clinical presentation and laboratory and radiological findings were similar in both groups&#46; No statistically significant differences in clinical severity parameters were found between subsets A and B&#46; Age less than 3 months was associated with greater duration of respiratory distress and longer hospital stay&#46;</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The results do not support the hypothesis that subtype A infection is associated with more severe respiratory syncytial virus disease&#46;</p>"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliograf&#237;a"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:34 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bronchiolitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;R&#46; Welliver"
                            1 => "R&#46;C&#46; Welliver"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Rev"
                        "fecha" => "1993"
                        "volumen" => "14"
                        "paginaInicial" => "134"
                        "paginaFinal" => "139"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8516237"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bronchiolitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M&#46; Whol"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:5 [
                        "titulo" => "Kendig&#39;s Disorders of the Respiratory Tract in Children"
                        "paginaInicial" => "473"
                        "paginaFinal" => "484"
                        "edicion" => "6th"
                        "serieFecha" => "1998"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Respiratory Syncytial Virus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "C&#46;B&#46; Hall"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:5 [
                        "titulo" => "Textbook of Pediatric Infectious Diseases"
                        "paginaInicial" => "2084"
                        "paginaFinal" => "2111"
                        "edicion" => "4th"
                        "serieFecha" => "1997"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Respiratory syncytial virus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "T&#46; Darville"
                            1 => "T&#46; Yamauchi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Rev"
                        "fecha" => "1998"
                        "volumen" => "19"
                        "paginaInicial" => "55"
                        "paginaFinal" => "61"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9473944"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Outpatient assessment of infants with bronchiolitis &#91;see comments&#93;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "K&#46;N&#46; Shaw"
                            1 => "L&#46;M&#46; Bell"
                            2 => "N&#46;H&#46; Sherman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Dis Child"
                        "fecha" => "1991"
                        "volumen" => "145"
                        "paginaInicial" => "151"
                        "paginaFinal" => "155"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1994678"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk factors for respiratory syncytial virus-associated lower respiratory illnesses in the first year of life"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "C&#46;J&#46; Holberg"
                            1 => "A&#46;L&#46; Wright"
                            2 => "F&#46;D&#46; Martinez"
                            3 => "C&#46;G&#46; Ray"
                            4 => "L&#46;M&#46; Taussig"
                            5 => "M&#46;D&#46; Lebowitz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Epidemiol"
                        "fecha" => "1991"
                        "volumen" => "133"
                        "paginaInicial" => "1135"
                        "paginaFinal" => "1151"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2035517"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Respiratory syncytial virus immunoglobulin and monoclonal antibodies in the prevention and treatment of respiratory sincytial virus infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46;C&#46; Welliver"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Semin Perinatol"
                        "fecha" => "1998"
                        "volumen" => "22"
                        "paginaInicial" => "87"
                        "paginaFinal" => "95"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9523402"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Concurrent circulation of antigenically distinct strains of respiratory syncytial virus during community outbreaks"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "R&#46;M&#46; Hendry"
                            1 => "A&#46;L&#46; Talis"
                            2 => "E&#46; Godfrey"
                            3 => "L&#46;J&#46; Anderson"
                            4 => "B&#46;F&#46; Fernie"
                            5 => "K&#46; McIntosh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Infect Dis"
                        "fecha" => "1986"
                        "volumen" => "153"
                        "paginaInicial" => "291"
                        "paginaFinal" => "297"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2418126"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Respiratory syncytial virus epidemics&#58; variable dominance of subgroups A and B strains among children&#44; 1981-1986"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46;A&#46; Mufson"
                            1 => "R&#46;B&#46; Belshe"
                            2 => "C&#46; Orvell"
                            3 => "E&#46; Norrby"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Infect Dis"
                        "fecha" => "1988"
                        "volumen" => "157"
                        "paginaInicial" => "143"
                        "paginaFinal" => "148"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3335796"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Occurrence of groups A and B of respiratory syncytial virus over 15 years&#58; associated epidemiologic and clinical characteristics in hospitalized and ambulatory children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "C&#46;B&#46; Hall"
                            1 => "E&#46;E&#46; Walsh"
                            2 => "K&#46;C&#46; Schnabel"
                            3 => "C&#46;E&#46; Long"
                            4 => "K&#46;M&#46; McConnochie"
                            5 => "S&#46;W&#46; Hildreth"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Infect Dis"
                        "fecha" => "1990"
                        "volumen" => "162"
                        "paginaInicial" => "1283"
                        "paginaFinal" => "1290"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2230258"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Subgroup characteristics of respiratory sincytial virus strains recovered from children with two consecutive infections"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46;A&#46; Mufson"
                            1 => "R&#46;B&#46; Belshe"
                            2 => "C&#46; Orvell"
                            3 => "E&#46; Norrby"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Microbiol"
                        "fecha" => "1987"
                        "volumen" => "25"
                        "paginaInicial" => "1535"
                        "paginaFinal" => "1539"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3305568"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Group specific serum antibody responses in children with primary and recurrent respiratory syncytial virus infections"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "P&#46;M&#46; Muelenaer"
                            1 => "F&#46;W&#46; Henderson"
                            2 => "V&#46;G&#46; Hemming"
                            3 => "E&#46;E&#46; Walsh"
                            4 => "L&#46;J&#46; Anderson"
                            5 => "G&#46;A&#46; Prince"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Infect Dis"
                        "fecha" => "1991"
                        "volumen" => "164"
                        "paginaInicial" => "15"
                        "paginaFinal" => "21"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2056202"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Respiratory syncytial virus in a community population&#58; circulation of subgroups A and B since 1965"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46;S&#46; Monto"
                            1 => "S&#46; Ohmit"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Infect Dis"
                        "fecha" => "1990"
                        "volumen" => "161"
                        "paginaInicial" => "781"
                        "paginaFinal" => "783"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2319169"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Variation in severity of respiratory syncytial virus infections with subtype"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "K&#46;M&#46; McConnochie"
                            1 => "C&#46;B&#46; Hall"
                            2 => "E&#46;E&#46; Walsh"
                            3 => "K&#46;J&#46; Roghmann"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr"
                        "fecha" => "1990"
                        "volumen" => "117"
                        "paginaInicial" => "52"
                        "paginaFinal" => "62"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2115082"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Occurrence of respiratory syncytial virus subtypes in hospitalized children in Cleveland&#44; Ohio from 1985 to 1988"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;M&#46; Stark"
                            1 => "S&#46;H&#46; Fatemi"
                            2 => "S&#46;B&#46; Amini"
                            3 => "Y&#46;T&#46; Huang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Pulmonol"
                        "fecha" => "1991"
                        "volumen" => "11"
                        "paginaInicial" => "98"
                        "paginaFinal" => "102"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1758737"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Multicenter study of strains of respiratory syncytial virus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "L&#46;J&#46; Anderson"
                            1 => "R&#46;M&#46; Hendry"
                            2 => "L&#46;T&#46; Pierik"
                            3 => "C&#46; Tsou"
                            4 => "K&#46; McIntosh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Infect Dis"
                        "fecha" => "1991"
                        "volumen" => "163"
                        "paginaInicial" => "687"
                        "paginaFinal" => "692"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2010623"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical severity of respiratory syncytial virus group A and B infection in Sydney&#44; Australia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "E&#46;D&#46; McIntosh"
                            1 => "S&#46;L&#46; De"
                            2 => "R&#46;K&#46; Oates"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Infect Dis J"
                        "fecha" => "1993"
                        "volumen" => "12"
                        "paginaInicial" => "815"
                        "paginaFinal" => "819"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8284117"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "&#91;Prevalence and clinical aspects of A and B subgroups of respiratory syncytial virus infection&#46; Observation of 8 consecutive epidemics between 1982 and 1990&#93;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46; Brouard"
                            1 => "F&#46; Freymuth"
                            2 => "S&#46; Constantini"
                            3 => "J&#46; Petitjean"
                            4 => "S&#46;G&#46; De"
                            5 => "J&#46;F&#46; Duhamel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Fr Pediatr"
                        "fecha" => "1993"
                        "volumen" => "50"
                        "paginaInicial" => "639"
                        "paginaFinal" => "643"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8002736"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pediatric Investigators Collaborative Network on Infections in Canada &#40;PICNIC&#41; prospective study of risk factors and outcomes in patients hospitalized with respiratory syncytial viral lower respiratory tract infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "E&#46;E&#46; Wang"
                            1 => "B&#46;J&#46; Law"
                            2 => "D&#46; Stephens"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr"
                        "fecha" => "1995"
                        "volumen" => "126"
                        "paginaInicial" => "212"
                        "paginaFinal" => "219"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7844667"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Relationship between clinical severity of respiratory syncytial virus infection and subtype"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46;C&#46; Kneyber"
                            1 => "A&#46;H&#46; Brandenburg"
                            2 => "P&#46;H&#46; Rothbarth"
                            3 => "G&#46;R&#46; De"
                            4 => "A&#46; Ott"
                            5 => "H&#46;A&#46; Van Steensel-Moll"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Dis Child"
                        "fecha" => "1996"
                        "volumen" => "75"
                        "paginaInicial" => "137"
                        "paginaFinal" => "140"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8869195"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Severity of respiratory syncytial virus infection is related to virus strain"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "E&#46;E&#46; Walsh"
                            1 => "K&#46;M&#46; McConnochie"
                            2 => "C&#46;E&#46; Long"
                            3 => "C&#46;B&#46; Hall"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Infect Dis"
                        "fecha" => "1997"
                        "volumen" => "175"
                        "paginaInicial" => "814"
                        "paginaFinal" => "820"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9086135"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "&#91;Severity of respiratory syncytial virus infection influenced by clinical riskfactors and subtype A and B in hospitalized children&#93;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "E&#46; Bergstrasser"
                            1 => "R&#46; Zbinden"
                            2 => "C&#46; Minder"
                            3 => "H&#46;E&#46; Gnehm"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1055/s-2008-1043915"
                      "Revista" => array:6 [
                        "tituloSerie" => "Klin Padiatr"
                        "fecha" => "1998"
                        "volumen" => "210"
                        "paginaInicial" => "418"
                        "paginaFinal" => "421"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9871899"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical and epidemiologic characteristics of respiratory syncytial virus subgroups A and B infections in Santa Fe&#44; Argentina"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46;S&#46; Imaz"
                            1 => "M&#46;D&#46; Sequeira"
                            2 => "C&#46; Videla"
                            3 => "I&#46; Veronessi"
                            4 => "R&#46; Cociglio"
                            5 => "E&#46; Zerbini"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Med Virol"
                        "fecha" => "2000"
                        "volumen" => "61"
                        "paginaInicial" => "76"
                        "paginaFinal" => "80"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10745236"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Respiratory syncytial virus infection in children with bronchopulmonary dysplasia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;R&#46; Groothuis"
                            1 => "K&#46;M&#46; Gutierrez"
                            2 => "B&#46;A&#46; Lauer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "1988"
                        "volumen" => "82"
                        "paginaInicial" => "199"
                        "paginaFinal" => "203"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3399292"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Does prematurity alter the course of respiratory syncytial virus infection&#945;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "K&#46; Meert"
                            1 => "S&#46; Heidemann"
                            2 => "B&#46; Abella"
                            3 => "A&#46; Sarnaik"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "1990"
                        "volumen" => "18"
                        "paginaInicial" => "1357"
                        "paginaFinal" => "1359"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2245609"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "26&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk factors for mechanical ventilation in respiratory syncytial virus infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "W&#46;J&#46; Tissing"
                            1 => "H&#46;A&#46; Van Steensel-Moll"
                            2 => "M&#46; Offringa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Pediatr"
                        "fecha" => "1993"
                        "volumen" => "152"
                        "paginaInicial" => "125"
                        "paginaFinal" => "127"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8444219"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk factors for respiratory syncytial virus associated apnoea"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46;C&#46; Kneyber"
                            1 => "A&#46;H&#46; Brandenburg"
                            2 => "G&#46;R&#46; De"
                            3 => "K&#46;F&#46; Joosten"
                            4 => "P&#46;H&#46; Rothbarth"
                            5 => "A&#46; Ott"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Pediatr"
                        "fecha" => "1998"
                        "volumen" => "157"
                        "paginaInicial" => "331"
                        "paginaFinal" => "335"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9578972"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "28&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Association of fever and severe clinical course in bronchiolitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46;S&#46; El-Radhi"
                            1 => "W&#46; Barry"
                            2 => "S&#46; Patel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Dis Child"
                        "fecha" => "1999"
                        "volumen" => "81"
                        "paginaInicial" => "231"
                        "paginaFinal" => "234"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10451396"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "29&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Respiratory syncytial virus&#58; changes in prevalence of subgroups A and B among Argentinian children&#44; 1990-1996"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "G&#46; Carballal"
                            1 => "C&#46; Videla"
                            2 => "M&#46;D&#46; Sequeira"
                            3 => "A&#46; Mistchenko"
                            4 => "P&#46;V&#46; Requeijo"
                            5 => "J&#46; Arbiza"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Med Virol"
                        "fecha" => "2000"
                        "volumen" => "61"
                        "paginaInicial" => "275"
                        "paginaFinal" => "279"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10797385"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "30&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of various respiratory viruses in the middle ear during acute otitis media"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "T&#46; Heikkinen"
                            1 => "M&#46; Thint"
                            2 => "T&#46; Chonmaitree"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM199901283400402"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1999"
                        "volumen" => "340"
                        "paginaInicial" => "260"
                        "paginaFinal" => "264"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9920949"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "31&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The clinical course of bronchiolitis associated with acute otitis media"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "G&#46; Shazberg"
                            1 => "S&#46; Revel-Vilk"
                            2 => "D&#46; Shoseyov"
                            3 => "A&#46; Ben-Ami"
                            4 => "A&#46; Klar"
                            5 => "H&#46; Hurvitz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Dis Child"
                        "fecha" => "2000"
                        "volumen" => "83"
                        "paginaInicial" => "317"
                        "paginaFinal" => "319"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10999866"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "32&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Systemic corticosteroids in infant bronchiolitis&#58; A meta-analysis &#91;In Process Citation&#93;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46;M&#46; Garrison"
                            1 => "D&#46;A&#46; Christakis"
                            2 => "E&#46; Harvey"
                            3 => "P&#46; Cummings"
                            4 => "R&#46;L&#46; Davis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2000"
                        "volumen" => "105"
                        "paginaInicial" => "44"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "33&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Antimicrobial use in febrile children diagnosed with respiratory tract illness in an emergency department"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "N&#46; Le Saux"
                            1 => "C&#46; Bjornson"
                            2 => "C&#46; Pitters"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Infect Dis J"
                        "fecha" => "1999"
                        "volumen" => "18"
                        "paginaInicial" => "1078"
                        "paginaFinal" => "1080"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10608628"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "34&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Differences in management of bronchiolitis between hospitals in The Netherlands&#46; Dutch Paediatric Respiratory Society"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "P&#46;L&#46; Brand"
                            1 => "A&#46;A&#46; Vaessen-Verberne"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Pediatr"
                        "fecha" => "2000"
                        "volumen" => "159"
                        "paginaInicial" => "343"
                        "paginaFinal" => "347"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10834519"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "es"
  "url" => "/16954033/0000005400000006/v1_201307051558/S1695403301775947/v1_201307051558/es/main.assets"
  "Apartado" => array:4 [
    "identificador" => "14282"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Originales"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/16954033/0000005400000006/v1_201307051558/S1695403301775947/v1_201307051558/es/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403301775947?idApp=UINPBA00005H"
]
Compartir
Información de la revista
Vol. 54. Núm. 6.
Páginas 559-566 (junio 2001)
Compartir
Compartir
Descargar PDF
Más opciones de artículo
Vol. 54. Núm. 6.
Páginas 559-566 (junio 2001)
Acceso a texto completo
Relación entre el subtipo del virus respiratorio sincitial y la gravedad clínica en la bronquiolitis
Relationship between respiratory syncytial virus subtype and clinical severity in bronchiolitis
Visitas
6744
J.L. Neves Barreiraa,
Autor para correspondencia
joaobarreira@mail.telepac.pt

Correspondencia: Departamento de Pediatría. Hospital de San João. Alameda Prof. Hernani Monteiro.4202-451 Oporto. Portugal.
, C. Fonsecaa, M.J. Cardosob, A. Azevedoc, A. Bonito Vítora
a Departamento de Pediatría
b Servicio de Microbiología y Serología. Hospital de San João
c Servicio de Higiene y Epidemiología. Facultad de Medicina de Oporto. Portugal
Este artículo ha recibido
Información del artículo
Resumen
Bibliografía
Descargar PDF
Estadísticas
Antecedentes

El virus respiratorio sincitial (VRS) es el principal agente de la bronquiolitis y presenta dos subtipos distintos (A y B). Los trabajos acerca de la relación entre el subtipo de virus y la gravedad de la enfermedad obtienen resultados discordantes.

Propósito

Analizar si el subtipo de este virus constituye una variable independiente en la gravedad clínica de la enfermedad.

Pacientes y métodos

Estudio prospectivo que incluye niños previamente sanos menores de 2 años de edad, hospitalizados por infección respiratoria por VRS durante un brote epidémico anual. Se comparan la presentación y evolución clínica, las exploraciones complementarias y la radiografía pulmonar en los pacientes infectados por los subtipos A y B de VRS. Los indicadores clínicos de gravedad incluyen el grado y duración del distrés respiratorio, la necesidad de oxígeno suplementario, la admisión en cuidados intensivos, la ventilación mecánica y la duración del ingreso hospitalario.

Resultados

De los 85 enfermos incluidos (35 mujeres, 50 varones; edad media, 4,8 6 4,3 meses), 59 casos pertenecían al subtipo A. Ambos grupos no se diferenciaban en cuanto a sexo, edad y antecedentes, excepto en la lactancia materna que fue menos frecuente en el subtipo B. La presentación clínica, analítica y radiológica fue semejante en los dos grupos. Los indicadores clínicos de gravedad no difirieron de forma significativa en los dos grupos. La edad por debajo de los 3 meses se asoció a mayor duración del distrés respiratorio y de la estancia hospitalaria.

Conclusión

Los resultados no apoyan la hipótesis de que la infección por el subtipo A del VRS se asocie a mayor gravedad clínica.

Palabras clave:
Bronquiolitis
Virus respiratorio sincitial (VRS)
Subtipos del VRS
Indicadores de gravedad clínica
Background

Respiratory syncytial virus (RSV) is the most frequently implicated agent in bronchiolitis. The virus presents two antigenic subtypes (A and B). The results of studies on the relationship between viral subtype and clinical severity are conflicting.

Purpose

To evaluate whether the subtype of this virus constitutes an independent variable in the severity of clinical expression of RSV infection.

Patients and methods

We prospectively studied previously healthy children aged less than 2 years admitted for RSV infection during an epidemic season. Clinical presentation and evolution, laboratory and radiological aspects were compared in subsets of children infected with RSV subtype A or B. Clinical severity parameters included score and duration of respiratory distress, oxygen requirements, admission to the intensive care unit, mechanical ventilation and length of hospital stay.

Results

Eighty-five patients were enrolled in the study (50 boys and 35 girls; mean age 4.8 6 4.3 months). Fifty-nine children were infected with RSV subtype A. No differences were found in age, sex or antecedents but children with subtype B were less likely to have been breast-fed. Clinical presentation and laboratory and radiological findings were similar in both groups. No statistically significant differences in clinical severity parameters were found between subsets A and B. Age less than 3 months was associated with greater duration of respiratory distress and longer hospital stay.

Conclusion

The results do not support the hypothesis that subtype A infection is associated with more severe respiratory syncytial virus disease.

Key words:
Bronchiolitis
Respiratory syncytial virus
Respiratory syncytial virus subtypes
Clinical severity index
El Texto completo está disponible en PDF
Bibliografía
[1.]
J.R. Welliver, R.C. Welliver.
Bronchiolitis.
Pediatr Rev, 14 (1993), pp. 134-139
[2.]
M. Whol.
Bronchiolitis.
Kendig's Disorders of the Respiratory Tract in Children, 6th, pp. 473-484
[3.]
C.B. Hall.
Respiratory Syncytial Virus.
Textbook of Pediatric Infectious Diseases, 4th, pp. 2084-2111
[4.]
T. Darville, T. Yamauchi.
Respiratory syncytial virus.
Pediatr Rev, 19 (1998), pp. 55-61
[5.]
K.N. Shaw, L.M. Bell, N.H. Sherman.
Outpatient assessment of infants with bronchiolitis [see comments].
Am J Dis Child, 145 (1991), pp. 151-155
[6.]
C.J. Holberg, A.L. Wright, F.D. Martinez, C.G. Ray, L.M. Taussig, M.D. Lebowitz.
Risk factors for respiratory syncytial virus-associated lower respiratory illnesses in the first year of life.
Am J Epidemiol, 133 (1991), pp. 1135-1151
[7.]
R.C. Welliver.
Respiratory syncytial virus immunoglobulin and monoclonal antibodies in the prevention and treatment of respiratory sincytial virus infection.
Semin Perinatol, 22 (1998), pp. 87-95
[8.]
R.M. Hendry, A.L. Talis, E. Godfrey, L.J. Anderson, B.F. Fernie, K. McIntosh.
Concurrent circulation of antigenically distinct strains of respiratory syncytial virus during community outbreaks.
J Infect Dis, 153 (1986), pp. 291-297
[9.]
M.A. Mufson, R.B. Belshe, C. Orvell, E. Norrby.
Respiratory syncytial virus epidemics: variable dominance of subgroups A and B strains among children, 1981-1986.
J Infect Dis, 157 (1988), pp. 143-148
[10.]
C.B. Hall, E.E. Walsh, K.C. Schnabel, C.E. Long, K.M. McConnochie, S.W. Hildreth.
Occurrence of groups A and B of respiratory syncytial virus over 15 years: associated epidemiologic and clinical characteristics in hospitalized and ambulatory children.
J Infect Dis, 162 (1990), pp. 1283-1290
[11.]
M.A. Mufson, R.B. Belshe, C. Orvell, E. Norrby.
Subgroup characteristics of respiratory sincytial virus strains recovered from children with two consecutive infections.
J Clin Microbiol, 25 (1987), pp. 1535-1539
[12.]
P.M. Muelenaer, F.W. Henderson, V.G. Hemming, E.E. Walsh, L.J. Anderson, G.A. Prince.
Group specific serum antibody responses in children with primary and recurrent respiratory syncytial virus infections.
J Infect Dis, 164 (1991), pp. 15-21
[13.]
A.S. Monto, S. Ohmit.
Respiratory syncytial virus in a community population: circulation of subgroups A and B since 1965.
J Infect Dis, 161 (1990), pp. 781-783
[14.]
K.M. McConnochie, C.B. Hall, E.E. Walsh, K.J. Roghmann.
Variation in severity of respiratory syncytial virus infections with subtype.
J Pediatr, 117 (1990), pp. 52-62
[15.]
J.M. Stark, S.H. Fatemi, S.B. Amini, Y.T. Huang.
Occurrence of respiratory syncytial virus subtypes in hospitalized children in Cleveland, Ohio from 1985 to 1988.
Pediatr Pulmonol, 11 (1991), pp. 98-102
[16.]
L.J. Anderson, R.M. Hendry, L.T. Pierik, C. Tsou, K. McIntosh.
Multicenter study of strains of respiratory syncytial virus.
J Infect Dis, 163 (1991), pp. 687-692
[17.]
E.D. McIntosh, S.L. De, R.K. Oates.
Clinical severity of respiratory syncytial virus group A and B infection in Sydney, Australia.
Pediatr Infect Dis J, 12 (1993), pp. 815-819
[18.]
J. Brouard, F. Freymuth, S. Constantini, J. Petitjean, S.G. De, J.F. Duhamel.
[Prevalence and clinical aspects of A and B subgroups of respiratory syncytial virus infection. Observation of 8 consecutive epidemics between 1982 and 1990].
Arch Fr Pediatr, 50 (1993), pp. 639-643
[19.]
E.E. Wang, B.J. Law, D. Stephens.
Pediatric Investigators Collaborative Network on Infections in Canada (PICNIC) prospective study of risk factors and outcomes in patients hospitalized with respiratory syncytial viral lower respiratory tract infection.
J Pediatr, 126 (1995), pp. 212-219
[20.]
M.C. Kneyber, A.H. Brandenburg, P.H. Rothbarth, G.R. De, A. Ott, H.A. Van Steensel-Moll.
Relationship between clinical severity of respiratory syncytial virus infection and subtype.
Arch Dis Child, 75 (1996), pp. 137-140
[21.]
E.E. Walsh, K.M. McConnochie, C.E. Long, C.B. Hall.
Severity of respiratory syncytial virus infection is related to virus strain.
J Infect Dis, 175 (1997), pp. 814-820
[22.]
E. Bergstrasser, R. Zbinden, C. Minder, H.E. Gnehm.
[Severity of respiratory syncytial virus infection influenced by clinical riskfactors and subtype A and B in hospitalized children].
Klin Padiatr, 210 (1998), pp. 418-421
[23.]
M.S. Imaz, M.D. Sequeira, C. Videla, I. Veronessi, R. Cociglio, E. Zerbini.
Clinical and epidemiologic characteristics of respiratory syncytial virus subgroups A and B infections in Santa Fe, Argentina.
J Med Virol, 61 (2000), pp. 76-80
[24.]
J.R. Groothuis, K.M. Gutierrez, B.A. Lauer.
Respiratory syncytial virus infection in children with bronchopulmonary dysplasia.
Pediatrics, 82 (1988), pp. 199-203
[25.]
K. Meert, S. Heidemann, B. Abella, A. Sarnaik.
Does prematurity alter the course of respiratory syncytial virus infectionα.
Crit Care Med, 18 (1990), pp. 1357-1359
[26.]
W.J. Tissing, H.A. Van Steensel-Moll, M. Offringa.
Risk factors for mechanical ventilation in respiratory syncytial virus infection.
Eur J Pediatr, 152 (1993), pp. 125-127
[27.]
M.C. Kneyber, A.H. Brandenburg, G.R. De, K.F. Joosten, P.H. Rothbarth, A. Ott.
Risk factors for respiratory syncytial virus associated apnoea.
Eur J Pediatr, 157 (1998), pp. 331-335
[28.]
A.S. El-Radhi, W. Barry, S. Patel.
Association of fever and severe clinical course in bronchiolitis.
Arch Dis Child, 81 (1999), pp. 231-234
[29.]
G. Carballal, C. Videla, M.D. Sequeira, A. Mistchenko, P.V. Requeijo, J. Arbiza.
Respiratory syncytial virus: changes in prevalence of subgroups A and B among Argentinian children, 1990-1996.
J Med Virol, 61 (2000), pp. 275-279
[30.]
T. Heikkinen, M. Thint, T. Chonmaitree.
Prevalence of various respiratory viruses in the middle ear during acute otitis media.
N Engl J Med, 340 (1999), pp. 260-264
[31.]
G. Shazberg, S. Revel-Vilk, D. Shoseyov, A. Ben-Ami, A. Klar, H. Hurvitz.
The clinical course of bronchiolitis associated with acute otitis media.
Arch Dis Child, 83 (2000), pp. 317-319
[32.]
M.M. Garrison, D.A. Christakis, E. Harvey, P. Cummings, R.L. Davis.
Systemic corticosteroids in infant bronchiolitis: A meta-analysis [In Process Citation].
Pediatrics, 105 (2000), pp. 44
[33.]
N. Le Saux, C. Bjornson, C. Pitters.
Antimicrobial use in febrile children diagnosed with respiratory tract illness in an emergency department.
Pediatr Infect Dis J, 18 (1999), pp. 1078-1080
[34.]
P.L. Brand, A.A. Vaessen-Verberne.
Differences in management of bronchiolitis between hospitals in The Netherlands. Dutch Paediatric Respiratory Society.
Eur J Pediatr, 159 (2000), pp. 343-347
Copyright © 2001. Asociación Española de Pediatría
Descargar PDF
Idiomas
Anales de Pediatría
Opciones de artículo
Herramientas
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?