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Pilar Bahíllo" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Carmen" "apellidos" => "González-Lamuño" "email" => array:1 [ 0 => "carmenglamuno@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Gonzalo" "apellidos" => "Díaz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Susana" "apellidos" => "García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Vanesa" "apellidos" => "Matías" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Cristina" "apellidos" => "Álvarez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 5 => array:3 [ "nombre" => "Mª. Pilar" "apellidos" => "Bahíllo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Pediatría, Hospital Clínico Universitario Valladolid, Valladolid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Endocrinología, Hospital Clínico Universitario Valladolid, Valladolid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Obstetricia y Ginecología, Hospital Clínico Universitario Valladolid, Valladolid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Complicaciones obstétricas y perinatales en la diabetes tipo 1: estudio retrospectivo unicéntrico" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Diabetes is the most common metabolic complication during pregnancy, and poses an increased risk of negative effects in relation to the obstetric and perinatal outcomes.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The prevalence of coexisting pregestational diabetes, mainly type 1 diabetes mellitus (DM1), during pregnancy is 1–2%.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A retrospective study was made of all women diagnosed with pregestational DM1 and their newborn infants during a 7-year period (2010–2017), following the creation of our pregestational diabetes clinic. Both the maternal and the newborn infant complications are described. We excluded patients diagnosed with type 2 diabetes mellitus (DM2), gestational diabetes, and those diagnosed with diabetes mellitus during pregnancy, as well as other types of diabetes.</p><p id="par0015" class="elsevierStylePara elsevierViewall">A total of 39 pregnant women with pregestational DM1 and 33 newborn infants (48.7% girls) were evaluated, since data on 6 infants could not be retrieved. No miscarriages were recorded. A total of 56.4% of the women had undergone preconception consultation, and metabolic control was considered to be adequate for pregnancy.</p><p id="par0020" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the main characteristics of the study sample.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Of note was the high proportion of patients receiving subcutaneous insulin infusion, as well as the proportion of patients with autoimmune thyroid disease (25% with Graves-Basedow’s disease, 75% with primary autoimmune hypothyroidism). The mean HbA1c levels exhibited a progressive and significant decrease from before pregnancy to the time before delivery (−1% on average; p < 0.001).</p><p id="par0030" class="elsevierStylePara elsevierViewall">No serious obstetric complications related to diabetes were recorded, though a percentage had diabetic nephropathy with positive microalbuminuria before pregnancy, with no worsening during gestation. There were no macrovascular complications.</p><p id="par0035" class="elsevierStylePara elsevierViewall">A high percentage of preterm deliveries were recorded, with full-term deliveries in 69.2% of the cases. Most deliveries were by caesarean section, versus 20.5% eutocic deliveries and 18% instrumented deliveries. The number of induced deliveries could not be established.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The mean (± standard deviation [SD]) birth weight was 3090.49 ± 747.29 g (range 1260–4290), with a high percentage of macrosomia (weight percentile >90). A positive and significant linear correlation was observed (r = 0.35), between HbA1c concentration and fetal weight during the third trimester (p < 0.05), i.e., the higher the HbA1c value, the greater the fetal weight.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In all, 56.41% of the newborn infants required hospital admission (43.6% in Neonatology, 12.8% in the Neonatal Intensive Care Unit [NICU]), with a mean stay of 10.5 ± 9.5 and 5 ± 5.09 days, respectively. A total of 42.4% presented hypoglycemia, and 85.7% required admission for treatment. In addition, 6.1% presented hypocalcemia, while 15.2% exhibited polyglobulia, and 60% required intravenous fluid therapy. Furthermore, a total of 36.4% presented neonatal jaundice, requiring phototherapy in 50% of the cases. One-third of the infants (33.3%) presented acute respiratory distress (respiratory support proving necessary in 72.7%). There was only one case of perinatal death due to panenterocolitis in the context of extreme prematurity. Echocardiography was performed in 48.6% of the newborn infants, with normal findings in only 6.1%. The most common finding was septal hypertrophy (12.1%).</p><p id="par0050" class="elsevierStylePara elsevierViewall">The objective of strict metabolic control in pregnant women with diabetes is to avoid maternal complications and fetal problems. In fact, observational studies show that the risk of fetal malformations is mainly related to poor glycemic control in the first weeks of pregnancy (i.e., the period of organogenesis); the optimization of control should therefore be started before conception. However, it is well known that a considerable percentage of patients do not plan pregnancy.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> Kernaghan et al.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> reported that women who plan pregnancy have a lower HbA1c concentration and therefore a lower obstetric complications rate than women who do not previously plan pregnancy. Wahabi et al.,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> in their meta-analysis, found that pregestational care reduces HbA1c in the first trimester by an average of 1.92%, and that effective pregestational control reduces congenital malformations and perinatal mortality. In our series, the high percentage of women treated with continuous subcutaneous insulin infusion (CSII) reflects attempts to secure the best possible metabolic control before and during pregnancy.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Johnstone et al.,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> in coincidence with our own findings, reported a positive correlation between HbA1c levels in the third trimester and birth weight. They also found this correlation to be negative during the first trimester of pregnancy, because higher HbA1c levels imply lesser placental development, which results in increased intrauterine growth restriction (IUGR) and prematurity. It should be noted that Yves et al.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> reported children of women with DM1 as having greater weight than the control group.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The delivery route depends on both the mother and on fetal monitoring. No specific modality is recommended. Although it has been reported that macrosomic fetuses are characterized by greater cephalic-pelvic disproportion, this does not entail any specific recommendation for caesarean section. Yves et al.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> reported a higher percentage of caesarean sections versus the global obstetric population studied. This was also seen in our series, where the percentage of caesarean sections in these women (61.5%) was much higher than the overall percentage of caesarean sections at the center (24.8%).</p><p id="par0065" class="elsevierStylePara elsevierViewall">Another complication of children of diabetic mothers is cardiac malformations. In this regard, it is important to perform a complete cardiological examination. Septal hypertrophy is the predominant finding, and is due to increased glycogen deposition in the myocardial cells. Passarella et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> reported septal hypertrophy in 35.4% of cases. This percentage is greater than in our study, perhaps because echocardiography was not performed in all patients, since echocardiography is not routinely performed in our center in infants born to diabetic mothers.</p><p id="par0070" class="elsevierStylePara elsevierViewall">In conclusion, despite the creation of specific gestational control units, the maternal-fetal complications rate remains high. New tools are needed to facilitate improved metabolic control in this subgroup of patients.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as: González-Lamuño C, Díaz G, García S, Matías V, Alvarez C, Bahíllo Mª.P. Complicaciones obstétricas y perinatales en la diabetes tipo 1: estudio retrospectivo unicéntrico. Endocrinol Diabetes Nutr. 2020;67:556–558.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">DM = diabetes mellitus; MDI = multiple dose insulin; CSII = continuous subcutaneous insulin infusion.</p>" "tablatextoimagen" => array:2 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean (standard deviation) \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 \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean age (years) \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">32.43 (5.26) \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">Mean duration of DM (years) \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">14.21 (8.09) \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">Mean HbA1c concentration before pregnancy (%) \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">7.30 (1.29) \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">Mean HbA1c concentration before delivery (%) \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">6.30 (0.65) \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">Gestational age at delivery (weeks)<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \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">36.93 (2.08) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2424705.png" ] ] 1 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Percentage \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 \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Thyroid disease (%) \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">41 \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">Nephropathy (%) \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">10 \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">Polyhydramnios (%) \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">2.6 \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">Pre-eclampsia (%) \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">20.5 \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">Intrauterine growth restriction (%) \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">10.3 \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">Threatened preterm labor (%) \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">7.7 \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">Genitourinary infections (%) \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">30.8 \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">CSII/MDI (%) \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">42.1/57.9 \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">Preterm deliveries (%) \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">30.8 \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">Caesarean sections (%) \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">61.5 \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">Macrosomia (%) \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">33.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2424706.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Range 29–39 weeks gestational age.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Principal characteristics of the study sample.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pregestational diabetes mellitus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "American College of Obstetricians and Gynecologists Committee on Practice Bulletin No. 201" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/AOG.0000000000002960" "Revista" => array:6 [ "tituloSerie" => "Obstet Gynecol" "fecha" => "2018" "volumen" => "132" "numero" => "6" "paginaInicial" => "228" "paginaFinal" => "248" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Asistencia a la gestante con diabetes. 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Guy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1155/2010/397623" "Revista" => array:3 [ "tituloSerie" => "Obstet Gynecol Int" "fecha" => "2010" "volumen" => "2010" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Disorders in glucidic metabolism and congenital heart diseases: detection and prevention" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "G. Passarella" 1 => "G. Trifirò" 2 => "M. Gasparetto" 3 => "G.S. Moreolo" 4 => "O. Milanesi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00246-012-0577-0" "Revista" => array:7 [ "tituloSerie" => "Pediatr Cardiol" "fecha" => "2013" "volumen" => "34" "numero" => "4" "paginaInicial" => "931" "paginaFinal" => "937" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23229289" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/25300180/0000006700000008/v1_202011131001/S2530018020301207/v1_202011131001/en/main.assets" "Apartado" => array:4 [ "identificador" => "72435" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letter" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/25300180/0000006700000008/v1_202011131001/S2530018020301207/v1_202011131001/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2530018020301207?idApp=UINPBA00004N" ]
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2024 November | 3 | 0 | 3 |
2024 October | 15 | 2 | 17 |
2024 September | 15 | 3 | 18 |
2024 August | 22 | 1 | 23 |
2024 July | 10 | 3 | 13 |
2024 June | 9 | 8 | 17 |
2024 May | 15 | 5 | 20 |
2024 April | 26 | 5 | 31 |
2024 March | 9 | 6 | 15 |
2024 February | 7 | 5 | 12 |
2024 January | 12 | 7 | 19 |
2023 December | 17 | 4 | 21 |
2023 November | 16 | 7 | 23 |
2023 October | 14 | 8 | 22 |
2023 September | 9 | 3 | 12 |
2023 August | 13 | 3 | 16 |
2023 July | 3 | 2 | 5 |
2023 June | 12 | 4 | 16 |
2023 May | 19 | 3 | 22 |
2023 April | 22 | 0 | 22 |
2023 March | 6 | 4 | 10 |
2023 February | 2 | 1 | 3 |
2023 January | 6 | 2 | 8 |
2022 December | 6 | 2 | 8 |
2022 November | 18 | 2 | 20 |
2022 October | 10 | 7 | 17 |
2022 September | 7 | 4 | 11 |
2022 August | 6 | 8 | 14 |
2022 July | 11 | 6 | 17 |
2022 June | 5 | 3 | 8 |
2022 May | 7 | 5 | 12 |
2022 April | 6 | 4 | 10 |
2022 March | 4 | 9 | 13 |
2022 February | 6 | 3 | 9 |
2022 January | 13 | 4 | 17 |
2021 December | 5 | 7 | 12 |
2021 November | 7 | 4 | 11 |
2021 October | 8 | 9 | 17 |
2021 September | 7 | 4 | 11 |
2021 August | 9 | 2 | 11 |
2021 July | 6 | 5 | 11 |
2021 June | 5 | 4 | 9 |
2021 May | 8 | 7 | 15 |
2021 April | 17 | 3 | 20 |
2021 March | 1 | 0 | 1 |