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que ofrece cobertura a 105&#46;320 ni&#241;os de 0-14 a&#241;os&#44; con una media de 400 ingresos&#47;a&#241;o &#40;20&#37; patolog&#237;a neonatal&#44; 20&#37; pacientes cr&#237;ticos pedi&#225;tricos&#44; 28&#37; pacientes posquir&#250;rgicos y 32&#37; ingresos para realizaci&#243;n de t&#233;cnicas y procedimientos&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Se consider&#243; ITRI al cuadro cl&#237;nico caracterizado por tos&#44; taquipnea&#44; dificultad respiratoria con auscultaci&#243;n pulmonar patol&#243;gica precedido de s&#237;ntomas catarrales&#44; con o sin fiebre&#46; Se incluyeron solo los pacientes cuyo motivo de ingreso en UCIP fue un cuadro de IRA secundaria a ITRI&#44; cuyos diagn&#243;sticos fueron bronquiolitis aguda&#44; bronquitis v&#237;rica aguda&#44; estatus asm&#225;tico&#44; neumon&#237;a v&#237;rica o bacteriana y tosferina&#46; En lo que respecta a los pacientes con estatus asm&#225;tico&#44; se incluyeron &#250;nicamente aquellos con diagn&#243;stico de asma bronquial que presentaron cuadro cl&#237;nico sugerente de ITRI&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Se recogieron caracter&#237;sticas demogr&#225;ficas&#44; datos cl&#237;nicos y agente etiol&#243;gico&#46; El estudio ha sido aprobado por el Comit&#233; de &#201;tica de la Investigaci&#243;n con Medicamentos de nuestro centro&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Durante el per&#237;odo de estudio ingresaron en UCIP 1&#46;780 pacientes&#44; 363 &#40;20&#44;4&#37;&#41; por patolog&#237;a cr&#237;tica pedi&#225;trica&#44; de los cuales&#44; 182 fueron admisiones por causa respiratoria&#46; Se analizaron 161 ingresos por IRA secundaria a ITRI&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Observamos una reducci&#243;n significativa en la tasa de ingresos en UCIP por IRA secundaria a ITRI&#44; desde un 50&#37; &#40;149&#47;298&#41; en &#233;poca prepand&#233;mica hasta 18&#44;5&#37; &#40;12&#47;65&#41; durante la pandemia &#40;OR 0&#44;23 IC 95&#37; 0&#44;12-0&#44;44&#59; p <span class="elsevierStyleItalic">&#60;</span> 0&#44;001&#41;&#46; La tasa de ingresos ha sido calculada sobre el n&#250;mero de pacientes cr&#237;ticos pedi&#225;tricos&#44; excluyendo ingresos por patolog&#237;a neonatal&#44; posquir&#250;rgicos y para realizaci&#243;n de procedimientos&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Las medianas de edad y peso fueron mayores en el grupo de ni&#241;os ingresados durante la pandemia COVID-19&#44; en comparaci&#243;n con el grupo prepandemia&#46; Los diagn&#243;sticos principales en el per&#237;odo prepandemia fueron bronquiolitis &#40;39&#44;6&#37;&#41; y bronquitis v&#237;rica aguda &#40;32&#44;9&#37;&#41;&#44; mientras que durante la pandemia no se observaron ingresos por bronquiolitis&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Se realiz&#243; detecci&#243;n de agentes virales con t&#233;cnica de diagn&#243;stico molecular en muestras de lavado nasofar&#237;ngeo en todos los pacientes&#46; En la &#233;poca prepand&#233;mica&#44; el VRS fue el agente etiol&#243;gico m&#225;s frecuente &#40;50&#44;3&#37;&#41;&#44; seguido de entero&#47;rinovirus &#40;38&#44;3&#37;&#41;&#46; El VRS fue el causante del 89&#44;8&#37; de los casos de bronquiolitis aguda&#44; mientras que el entero&#47;rinovirus se detect&#243; con mayor frecuencia en bronquitis v&#237;rica aguda &#40;43&#37;&#41; y estatus asm&#225;tico &#40;53&#37;&#41;&#46; En siete pacientes &#40;4&#44;7&#37;&#41; no se detect&#243; agente etiol&#243;gico &#40;cinco con diagn&#243;stico de bronquitis aguda y dos con estatus asm&#225;tico&#41;&#46; Se observ&#243; coinfecci&#243;n por dos o m&#225;s virus en 36&#44;7&#37; de los casos&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Durante la pandemia por COVID-19&#44; los virus detectados fueron entero&#47;rinovirus &#40;50&#37;&#41; y metapneumovirus humano &#40;16&#44;7&#37;&#41;&#46; Presentaron estatus asm&#225;tico cinco pacientes&#44; en cuatro de ellos se aisl&#243; entero&#47;rinovirus y en uno metapneumovirus humano&#46; Se observaron dos casos de neumon&#237;a v&#237;rica &#40;por entero&#47;rinovirus y SARS-CoV-2&#41;&#44; y un caso de bronquitis v&#237;rica aguda con coinfecci&#243;n por dos virus &#40;entero&#47;rinovirus y metapneumovirus&#41;&#46; No se aisl&#243; agente etiol&#243;gico en dos pacientes &#40;16&#44;7&#37;&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Respecto a las ITRI de etiolog&#237;a bacteriana&#44; 13 pacientes &#40;8&#44;7&#37;&#41; ingresaron por neumon&#237;a bacteriana en &#233;poca prepand&#233;mica y uno &#40;8&#44;3&#37;&#41; durante la pandemia por COVID-19&#46; Adem&#225;s&#44; se observ&#243; un caso de tosferina durante la pandemia&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> muestra el n&#250;mero de ingresos mensuales en UCIP por IRA secundaria a ITRI y la frecuencia de detecci&#243;n de virus respiratorios&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">La utilizaci&#243;n del soporte respiratorio fue similar en los dos per&#237;odos&#46; Durante la &#233;poca prepand&#233;mica&#44; 73&#37; requirieron ventilaci&#243;n no invasiva &#40;VNI&#41; y 10&#44;1&#37; ventilaci&#243;n mec&#225;nica invasiva&#44; mientras que durante la pandemia se utiliz&#243; VNI en el 75&#37; y dos pacientes &#40;16&#44;7&#37;&#41; fueron intubados&#44; uno de ellos con neumon&#237;a por COVID-19&#46; La <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> muestra las caracter&#237;sticas demogr&#225;ficas y cl&#237;nicas de los pacientes durante los dos per&#237;odos estudiados&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Este estudio demuestra una importante disminuci&#243;n en la tasa de ingresos en UCIP por IRA secundaria a ITRI durante la pandemia por COVID-19&#46; Las medidas aplicadas para reducir la transmisi&#243;n de SARS-CoV-2&#44; como higiene de manos&#44; uso de mascarilla y distanciamiento social&#44; probablemente han contribuido a reducir la transmisi&#243;n de otros virus respiratorios&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">El VRS est&#225; relacionado con aproximadamente el 30-40&#37; de todos los episodios de ITRI y las epidemias estacionales de gripe afectan cada a&#241;o al 10-20&#37; de la poblaci&#243;n&#44; de la cual&#44; el 20-40&#37; son ni&#241;os<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1&#44;5</span></a>&#46; Durante la temporada 2020-2021 en nuestra cohorte no se detect&#243; VRS ni influenza&#46; Este hallazgo se repite en el resto de Espa&#241;a y en otros pa&#237;ses<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">3&#44;6&#44;7</span></a>&#46; El Sistema de Vigilancia de Gripe y otros virus respiratorios en Espa&#241;a en la semana 6&#47;2021 ha notificado &#250;nicamente seis detecciones de VRS entre 3&#46;732 muestras analizadas &#40;0&#44;16&#37;&#41; y siete detecciones de influenza desde el inicio de la temporada 2020-2021&#46; La vacunaci&#243;n antigripal adelantada a octubre del 2020 podr&#237;a haber contribuido a la disminuci&#243;n de transmisi&#243;n del virus de influenza&#46; Aunque se est&#225;n realizando pruebas de detecci&#243;n de forma continuada&#44; la incidencia de virus respiratorios diferentes a SARS-CoV-2 durante la temporada epid&#233;mica 2020-2021 permanece muy baja<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">La baja incidencia de virus respiratorios&#44; especialmente VRS&#44; explica la ausencia de bronquiolitis durante la temporada oto&#241;o-invierno 2020-2021 en nuestra cohorte&#44; lo que justifica el mayor peso y edad de los pacientes respecto a la &#233;poca prepand&#233;mica&#46; Estos hallazgos concuerdan con los datos publicados en el hemisferio sur durante los meses epid&#233;micos de bronquiolitis &#40;abril-junio&#41;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">3&#44;8&#44;9</span></a>&#46; En Australia&#44; la media de hospitalizaci&#243;n por bronquiolitis en el a&#241;o 2020 fue 85&#44;9&#37; menor que la esperada&#44; con una reducci&#243;n del 89&#44;1&#37; de ingresos en UCIP<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a>&#46; En el estudio realizado por la Red Colaborativa Pedi&#225;trica de Latinoam&#233;rica&#44; se observ&#243; una reducci&#243;n del 83&#37; en los ingresos en UCIP por ITRI entre enero y agosto del 2020&#44; en comparaci&#243;n con los a&#241;os 2018-2019<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Durante la pandemia por COVID-19&#44; los &#250;nicos virus detectados en nuestra cohorte fueron metapneumovirus &#40;marzo del 2020&#41; y entero&#47;rinovirus &#40;oto&#241;o-invierno del 2020-2021&#41;&#46; No est&#225; claro por qu&#233; el entero&#47;rinovirus&#44; a diferencia de otros virus&#44; ha persistido durante la pandemia&#46; Britton et al&#46; plantean la hip&#243;tesis de que la falta de envoltura en este virus lo hace menos susceptible a la inactivaci&#243;n mediante lavado de manos&#44; haciendo m&#225;s f&#225;cil su transmisi&#243;n por contacto<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a>&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">&#218;nicamente hubo un ingreso de IRA causada por SARS-CoV-2&#46; Se conoce que en edad pedi&#225;trica&#44; la tasa de ingreso en UCIP por SARS-CoV-2 es menor que la de otros agentes infecciosos y que la de otros grupos de edad&#44; lo que coincide con la baja frecuencia de neumon&#237;a por COVID-19 observada en nuestro estudio&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Este es el primer estudio publicado en Espa&#241;a que informa sobre la baja incidencia de ingresos por IRA en UCIP durante la pandemia por COVID-19&#46; Es necesario realizar estudios multic&#233;ntricos que analicen la epidemiolog&#237;a de los virus respiratorios durante la pandemia&#44; con la finalidad de dise&#241;ar pautas de actuaci&#243;n orientadas a controlar los picos epid&#233;micos de los principales virus respiratorios en los pr&#243;ximos a&#241;os&#44; considerando el impacto que las medidas adoptadas durante la pandemia han tenido sobre la reducci&#243;n de ITRI&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicto de intereses</span><p id="par0100" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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          "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A&#58; N&#250;mero de ingresos mensuales en UCIP por insuficiencia respiratoria aguda secundaria a ITRI&#46; <span class="elsevierStyleBold">B&#58;</span> Frecuencia de detecci&#243;n de virus respiratorios en lavados nasofar&#237;ngeos durante el per&#237;odo de estudio&#46;</p>"
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          "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Las variables categ&#243;ricas est&#225;n expresadas en valor absoluto y porcentaje &#40;&#37;&#41; y las variables cuantitativas en mediana y rango intercuart&#237;lico &#91;RIQ&#93;&#46; Se ha empleado el test de Mann-Whitney-Wilcoxon para comparar las variables continuas y el test exacto de Fisher para comparar las variables cualititivas&#46; Nivel de significaci&#243;n &#8804; 0&#44;05&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">SDRA&#58; s&#237;ndrome de distr&#233;s respiratorio agudo&#59; OBF&#58; oxigenoterapia de bajo flujo&#59; OAF&#58; oxigenoterapia de alto flujo&#59; VNI&#58; ventilaci&#243;n no invasiva&#59; VMI&#58; ventilaci&#243;n mec&#225;nica invasiva&#46;</p>"
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Totaln &#61; 161 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Prepandemian &#61; 149 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9 &#91;4&#44;6-15&#44;3&#93;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">95 &#40;59&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">88 &#40;59&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7 &#40;58&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">33 &#40;20&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Diagn&#243;sticos de IRA por ITRI</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Bronquiolitis aguda&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">59 &#40;36&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">59 &#40;39&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Bronquitis v&#237;rica aguda&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">52 &#40;32&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">49 &#40;32&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estatus asm&#225;tico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">20 &#40;12&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;10&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5 &#40;41&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neumon&#237;a v&#237;rica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">15 &#40;9&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;8&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;16&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neumon&#237;a bacteriana&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">14 &#40;8&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">13 &#40;8&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;8&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tosferina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;0&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;8&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">SDRA</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2 &#40;16&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;111&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Etiolog&#237;a v&#237;rica</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>VRS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75 &#40;46&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">75 &#40;50&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Entero&#47;rinovirus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63 &#40;39&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">57 &#40;38&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;423&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Adenovirus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;10&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;11&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;367&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Influenza&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;9&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;10&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;606&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Coronavirus NL63&#44; OC43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;9&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">15 &#40;10&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;606&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Bocavirus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Coinfecciones virales</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Soporte respiratorio</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Estancia en UCIP &#40;d&#237;as&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;9 &#91;2&#44;3-6&#93;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;96 &#91;2&#44;3-6&#93;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;15 &#91;2-7&#44;9&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;824&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "es" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas demogr&#225;ficas y cl&#237;nicas de los pacientes durante los dos per&#237;odos de estudio</p>"
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      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliograf&#237;a"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:9 [
            0 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Global&#44; regional&#44; and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in young children in 2015&#58; a systematic review and modelling study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "T&#46; Shi"
                            1 => "D&#46;A&#46; McAllister"
                            2 => "K&#46;L&#46; O&#8217;Brien"
                            3 => "E&#46;A&#46;F&#46; Simoes"
                            4 => "S&#46;A&#46; Madhi"
                            5 => "B&#46;D&#46; Gessner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s0140-6736(17)30938-8"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet&#46;"
                        "fecha" => "2017"
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CARTA CIENTÍFICA
Impacto de la pandemia COVID-19 sobre la tasa de ingresos por infecciones respiratorias en Unidad de Cuidados Intensivos Pediátricos
Impact of the COVID-19 pandemic on admissions for respiratory infections in the Pediatric Intensive Care Unit
L. Bermúdez Barrezueta
Autor para correspondencia
bermudezlorena@hotmail.com

Autor para correspondencia.
, M. Brezmes Raposo, I. Sanz Fernández, P. López Casillas, C. Villa Francisco, A. Pino Vázquez
Unidad de Cuidados Intensivos Pediátricos y Neonatales. Servicio de Pediatría, Hospital Clínico Universitario de Valladolid, Valladolid, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Las infecciones del tracto respiratorio inferior &#40;ITRI&#41; son una causa com&#250;n de insuficiencia respiratoria aguda &#40;IRA&#41; en ni&#241;os y un motivo de ingreso frecuente en la Unidad de Cuidados Intensivos Pedi&#225;tricos &#40;UCIP&#41;&#46; El virus respiratorio sincitial &#40;VRS&#41;&#44; agente etiol&#243;gico principal de la bronquiolitis aguda y neumon&#237;a en ni&#241;os menores de dos a&#241;os&#44; tiene un patr&#243;n epidemiol&#243;gico estacional muy caracter&#237;stico&#44; con picos de m&#225;xima incidencia durante los meses de noviembre y febrero<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a>&#46; Aunque las ITRI tienen una evoluci&#243;n habitualmente benigna&#44; en ocasiones pueden cursar de forma m&#225;s grave&#44; precisando ingreso en UCIP un 10-20&#37; de ni&#241;os hospitalizados por ITRI<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La enfermedad por SARS-CoV-2 &#40;COVID-19&#41;&#44; declarada pandemia mundial en marzo del 2020&#44; es causante de IRA grave en adultos&#44; sin embargo&#44; afecta en menor proporci&#243;n a ni&#241;os&#44; provocando generalmente cuadros m&#225;s leves&#46; La pandemia COVID-19 ha generado gran presi&#243;n asistencial y ha modificado la epidemiolog&#237;a de otras causas de hospitalizaci&#243;n en ni&#241;os y adultos<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">3&#44;4</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Presentamos un estudio observacional&#44; retrospectivo&#44; donde analizamos la epidemiolog&#237;a de los ingresos por IRA secundaria a ITRI en una UCIP durante la pandemia por COVID-19 &#40;1 marzo del 2020 a 15 febrero del 2021&#41;&#44; en comparaci&#243;n con cuatro temporadas epid&#233;micas anteriores &#40;1 septiembre del 2016 a 29 febrero del 2020&#41;&#44; per&#237;odo prepandemia&#46; Se trata de una UCIP mixta&#44; pedi&#225;trica y neonatal&#44; que ofrece cobertura a 105&#46;320 ni&#241;os de 0-14 a&#241;os&#44; con una media de 400 ingresos&#47;a&#241;o &#40;20&#37; patolog&#237;a neonatal&#44; 20&#37; pacientes cr&#237;ticos pedi&#225;tricos&#44; 28&#37; pacientes posquir&#250;rgicos y 32&#37; ingresos para realizaci&#243;n de t&#233;cnicas y procedimientos&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Se consider&#243; ITRI al cuadro cl&#237;nico caracterizado por tos&#44; taquipnea&#44; dificultad respiratoria con auscultaci&#243;n pulmonar patol&#243;gica precedido de s&#237;ntomas catarrales&#44; con o sin fiebre&#46; Se incluyeron solo los pacientes cuyo motivo de ingreso en UCIP fue un cuadro de IRA secundaria a ITRI&#44; cuyos diagn&#243;sticos fueron bronquiolitis aguda&#44; bronquitis v&#237;rica aguda&#44; estatus asm&#225;tico&#44; neumon&#237;a v&#237;rica o bacteriana y tosferina&#46; En lo que respecta a los pacientes con estatus asm&#225;tico&#44; se incluyeron &#250;nicamente aquellos con diagn&#243;stico de asma bronquial que presentaron cuadro cl&#237;nico sugerente de ITRI&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Se recogieron caracter&#237;sticas demogr&#225;ficas&#44; datos cl&#237;nicos y agente etiol&#243;gico&#46; El estudio ha sido aprobado por el Comit&#233; de &#201;tica de la Investigaci&#243;n con Medicamentos de nuestro centro&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Durante el per&#237;odo de estudio ingresaron en UCIP 1&#46;780 pacientes&#44; 363 &#40;20&#44;4&#37;&#41; por patolog&#237;a cr&#237;tica pedi&#225;trica&#44; de los cuales&#44; 182 fueron admisiones por causa respiratoria&#46; Se analizaron 161 ingresos por IRA secundaria a ITRI&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Observamos una reducci&#243;n significativa en la tasa de ingresos en UCIP por IRA secundaria a ITRI&#44; desde un 50&#37; &#40;149&#47;298&#41; en &#233;poca prepand&#233;mica hasta 18&#44;5&#37; &#40;12&#47;65&#41; durante la pandemia &#40;OR 0&#44;23 IC 95&#37; 0&#44;12-0&#44;44&#59; p <span class="elsevierStyleItalic">&#60;</span> 0&#44;001&#41;&#46; La tasa de ingresos ha sido calculada sobre el n&#250;mero de pacientes cr&#237;ticos pedi&#225;tricos&#44; excluyendo ingresos por patolog&#237;a neonatal&#44; posquir&#250;rgicos y para realizaci&#243;n de procedimientos&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Las medianas de edad y peso fueron mayores en el grupo de ni&#241;os ingresados durante la pandemia COVID-19&#44; en comparaci&#243;n con el grupo prepandemia&#46; Los diagn&#243;sticos principales en el per&#237;odo prepandemia fueron bronquiolitis &#40;39&#44;6&#37;&#41; y bronquitis v&#237;rica aguda &#40;32&#44;9&#37;&#41;&#44; mientras que durante la pandemia no se observaron ingresos por bronquiolitis&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Se realiz&#243; detecci&#243;n de agentes virales con t&#233;cnica de diagn&#243;stico molecular en muestras de lavado nasofar&#237;ngeo en todos los pacientes&#46; En la &#233;poca prepand&#233;mica&#44; el VRS fue el agente etiol&#243;gico m&#225;s frecuente &#40;50&#44;3&#37;&#41;&#44; seguido de entero&#47;rinovirus &#40;38&#44;3&#37;&#41;&#46; El VRS fue el causante del 89&#44;8&#37; de los casos de bronquiolitis aguda&#44; mientras que el entero&#47;rinovirus se detect&#243; con mayor frecuencia en bronquitis v&#237;rica aguda &#40;43&#37;&#41; y estatus asm&#225;tico &#40;53&#37;&#41;&#46; En siete pacientes &#40;4&#44;7&#37;&#41; no se detect&#243; agente etiol&#243;gico &#40;cinco con diagn&#243;stico de bronquitis aguda y dos con estatus asm&#225;tico&#41;&#46; Se observ&#243; coinfecci&#243;n por dos o m&#225;s virus en 36&#44;7&#37; de los casos&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Durante la pandemia por COVID-19&#44; los virus detectados fueron entero&#47;rinovirus &#40;50&#37;&#41; y metapneumovirus humano &#40;16&#44;7&#37;&#41;&#46; Presentaron estatus asm&#225;tico cinco pacientes&#44; en cuatro de ellos se aisl&#243; entero&#47;rinovirus y en uno metapneumovirus humano&#46; Se observaron dos casos de neumon&#237;a v&#237;rica &#40;por entero&#47;rinovirus y SARS-CoV-2&#41;&#44; y un caso de bronquitis v&#237;rica aguda con coinfecci&#243;n por dos virus &#40;entero&#47;rinovirus y metapneumovirus&#41;&#46; No se aisl&#243; agente etiol&#243;gico en dos pacientes &#40;16&#44;7&#37;&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Respecto a las ITRI de etiolog&#237;a bacteriana&#44; 13 pacientes &#40;8&#44;7&#37;&#41; ingresaron por neumon&#237;a bacteriana en &#233;poca prepand&#233;mica y uno &#40;8&#44;3&#37;&#41; durante la pandemia por COVID-19&#46; Adem&#225;s&#44; se observ&#243; un caso de tosferina durante la pandemia&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> muestra el n&#250;mero de ingresos mensuales en UCIP por IRA secundaria a ITRI y la frecuencia de detecci&#243;n de virus respiratorios&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">La utilizaci&#243;n del soporte respiratorio fue similar en los dos per&#237;odos&#46; Durante la &#233;poca prepand&#233;mica&#44; 73&#37; requirieron ventilaci&#243;n no invasiva &#40;VNI&#41; y 10&#44;1&#37; ventilaci&#243;n mec&#225;nica invasiva&#44; mientras que durante la pandemia se utiliz&#243; VNI en el 75&#37; y dos pacientes &#40;16&#44;7&#37;&#41; fueron intubados&#44; uno de ellos con neumon&#237;a por COVID-19&#46; La <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> muestra las caracter&#237;sticas demogr&#225;ficas y cl&#237;nicas de los pacientes durante los dos per&#237;odos estudiados&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Este estudio demuestra una importante disminuci&#243;n en la tasa de ingresos en UCIP por IRA secundaria a ITRI durante la pandemia por COVID-19&#46; Las medidas aplicadas para reducir la transmisi&#243;n de SARS-CoV-2&#44; como higiene de manos&#44; uso de mascarilla y distanciamiento social&#44; probablemente han contribuido a reducir la transmisi&#243;n de otros virus respiratorios&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">El VRS est&#225; relacionado con aproximadamente el 30-40&#37; de todos los episodios de ITRI y las epidemias estacionales de gripe afectan cada a&#241;o al 10-20&#37; de la poblaci&#243;n&#44; de la cual&#44; el 20-40&#37; son ni&#241;os<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1&#44;5</span></a>&#46; Durante la temporada 2020-2021 en nuestra cohorte no se detect&#243; VRS ni influenza&#46; Este hallazgo se repite en el resto de Espa&#241;a y en otros pa&#237;ses<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">3&#44;6&#44;7</span></a>&#46; El Sistema de Vigilancia de Gripe y otros virus respiratorios en Espa&#241;a en la semana 6&#47;2021 ha notificado &#250;nicamente seis detecciones de VRS entre 3&#46;732 muestras analizadas &#40;0&#44;16&#37;&#41; y siete detecciones de influenza desde el inicio de la temporada 2020-2021&#46; La vacunaci&#243;n antigripal adelantada a octubre del 2020 podr&#237;a haber contribuido a la disminuci&#243;n de transmisi&#243;n del virus de influenza&#46; Aunque se est&#225;n realizando pruebas de detecci&#243;n de forma continuada&#44; la incidencia de virus respiratorios diferentes a SARS-CoV-2 durante la temporada epid&#233;mica 2020-2021 permanece muy baja<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">La baja incidencia de virus respiratorios&#44; especialmente VRS&#44; explica la ausencia de bronquiolitis durante la temporada oto&#241;o-invierno 2020-2021 en nuestra cohorte&#44; lo que justifica el mayor peso y edad de los pacientes respecto a la &#233;poca prepand&#233;mica&#46; Estos hallazgos concuerdan con los datos publicados en el hemisferio sur durante los meses epid&#233;micos de bronquiolitis &#40;abril-junio&#41;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">3&#44;8&#44;9</span></a>&#46; En Australia&#44; la media de hospitalizaci&#243;n por bronquiolitis en el a&#241;o 2020 fue 85&#44;9&#37; menor que la esperada&#44; con una reducci&#243;n del 89&#44;1&#37; de ingresos en UCIP<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a>&#46; En el estudio realizado por la Red Colaborativa Pedi&#225;trica de Latinoam&#233;rica&#44; se observ&#243; una reducci&#243;n del 83&#37; en los ingresos en UCIP por ITRI entre enero y agosto del 2020&#44; en comparaci&#243;n con los a&#241;os 2018-2019<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Durante la pandemia por COVID-19&#44; los &#250;nicos virus detectados en nuestra cohorte fueron metapneumovirus &#40;marzo del 2020&#41; y entero&#47;rinovirus &#40;oto&#241;o-invierno del 2020-2021&#41;&#46; No est&#225; claro por qu&#233; el entero&#47;rinovirus&#44; a diferencia de otros virus&#44; ha persistido durante la pandemia&#46; Britton et al&#46; plantean la hip&#243;tesis de que la falta de envoltura en este virus lo hace menos susceptible a la inactivaci&#243;n mediante lavado de manos&#44; haciendo m&#225;s f&#225;cil su transmisi&#243;n por contacto<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a>&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">&#218;nicamente hubo un ingreso de IRA causada por SARS-CoV-2&#46; Se conoce que en edad pedi&#225;trica&#44; la tasa de ingreso en UCIP por SARS-CoV-2 es menor que la de otros agentes infecciosos y que la de otros grupos de edad&#44; lo que coincide con la baja frecuencia de neumon&#237;a por COVID-19 observada en nuestro estudio&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Este es el primer estudio publicado en Espa&#241;a que informa sobre la baja incidencia de ingresos por IRA en UCIP durante la pandemia por COVID-19&#46; Es necesario realizar estudios multic&#233;ntricos que analicen la epidemiolog&#237;a de los virus respiratorios durante la pandemia&#44; con la finalidad de dise&#241;ar pautas de actuaci&#243;n orientadas a controlar los picos epid&#233;micos de los principales virus respiratorios en los pr&#243;ximos a&#241;os&#44; 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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Totaln &#61; 161 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Prepandemian &#61; 149 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Pandemia COVID-19n &#61; 12 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Valor p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Edad &#40;meses&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">13&#44;2 &#91;1&#44;8-40&#44;8&#93;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12&#44;8 &#91;1&#44;8-39&#93;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">40&#44;3 &#91;4&#44;2-78&#44;5&#93;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;14&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Peso &#40;kg&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9 &#91;4&#44;6-15&#44;3&#93;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8&#44;7 &#91;4&#44;6-15&#93;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13&#44;8 &#91;4-28&#44;5&#93;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sexo masculino</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">95 &#40;59&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">88 &#40;59&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7 &#40;58&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;96&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Comorbilidad</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">33 &#40;20&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">30 &#40;20&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Diagn&#243;sticos de IRA por ITRI</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Bronquiolitis aguda&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">59 &#40;36&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">59 &#40;39&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Bronquitis v&#237;rica aguda&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52 &#40;32&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">49 &#40;32&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estatus asm&#225;tico&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">20 &#40;12&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">15 &#40;10&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5 &#40;41&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neumon&#237;a v&#237;rica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">15 &#40;9&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">13 &#40;8&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2 &#40;16&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neumon&#237;a bacteriana&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">14 &#40;8&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">13 &#40;8&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1 &#40;8&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tosferina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;0&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;8&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">SDRA</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;16&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;111&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Etiolog&#237;a v&#237;rica</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>VRS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">75 &#40;46&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">75 &#40;50&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Entero&#47;rinovirus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">63 &#40;39&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">57 &#40;38&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;423&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Adenovirus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">17 &#40;10&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">17 &#40;11&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;367&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Influenza&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">15 &#40;9&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15 &#40;10&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;606&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Coronavirus NL63&#44; OC43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">15 &#40;9&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">15 &#40;10&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;606&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Bocavirus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">13 &#40;8&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">13 &#40;8&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;606&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Metapneumovirus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">13 &#40;8&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">11 &#40;7&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2 &#40;16&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;250&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Parainfluenza&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7 &#40;4&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">7 &#40;4&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>SARS-CoV-2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;0&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;075&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Agente etiol&#243;gico no encontrado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7 &#40;4&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2 &#40;16&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;137&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Coinfecciones virales</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">55 &#40;34&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">54 &#40;36&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;8&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;098&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Soporte respiratorio</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;761&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>OBF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8 &#40;5&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>OAF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">17 &#40;10&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">16 &#40;10&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1 &#40;8&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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ISSN: 02105691
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