Improving Antibiotic Use in Pediatric Hospitals in Argentina: A Quality Improvement Study

Autores
Jorro Baron, Facundo Ariel; Echave, Cecilia; Rodriguez, Viviana; Aguilar Fixman, Maria Jose; Balboa, Romina; Guglielmino, Marina; Garcia Causarano, Florencia; Del Negro, Veronica; Dondoglio, Patricia; Falcon, Esteban; Gibbons, Luz; Guerrero, Celeste; Juarez, Ximena; López, Analía; Matteucci, Erika; Paula Rodriguez, Ana; Vitar, Emilse Mabel; Roberti, Javier Eugenio; Garcia Elorrio, Ezequiel; Falaschi, Andrea
Año de publicación
2025
Idioma
inglés
Tipo de recurso
artículo
Estado
versión publicada
Descripción
OBJECTIVE: We aimed to achieve a 15% reduction in days of antibiotic therapy (DOT) and a 20% increase in access antibiotic group (narrower spectrum of the World Health Organization classification) units after 24 weeks of implementing an antibiotic stewardship program (ASP) in 2 pediatric hospitals. METHODS: We implemented a quality improvement (QI) initiative preceded by a formative phase to identify barriers and facilitators. The strategy included developing an antibiotic management program, establishing a data management and learning system, and fostering teamwork and effective communication. The intervention spanned 2 learning sessions, each with an action period, and was supported by coaching and QI training. Primary outcomes included DOT per 1000 hospital days and the access antibiotic group use percentage. We examined the implementation of change ideas and adherence to clinical pathways for process measures using mortality rates as a balancing measure. Run charts tracked follow-up outcomes, with control charts employed once sufficient data points were collected. RESULTS: We gathered data from 249 patients during the baseline period (BP) (Jan 2022 to June 2022) and from 588 patients during the implementation period (IP) (July 2022 to January 2023). The IP group included younger patients with higher rates of acute lower respiratory tract infections and more severe clinical conditions. Access antibiotic group consumption was 30.7% in BP and 37.9% in IP. Concerning antibiotic DOT, throughout time, we observed variable results with many points outside the control limits, with an average of 854 in BP and 1068 in IP. CONCLUSION: The QI initiative demonstrated that ASP implementation in pediatric hospitals was associated with antibiotic narrow-spectrum selection.
Fil: Jorro Baron, Facundo Ariel. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Echave, Cecilia. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); Argentina
Fil: Rodriguez, Viviana. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Aguilar Fixman, Maria Jose. Gobierno de la Provincia de Mendoza. Hospital Pediátrico Humberto Notti; Argentina
Fil: Balboa, Romina. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); Argentina
Fil: Guglielmino, Marina. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Garcia Causarano, Florencia. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); Argentina
Fil: Del Negro, Veronica. Gobierno de la Provincia de Mendoza. Hospital Pediátrico Humberto Notti; Argentina
Fil: Dondoglio, Patricia. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); Argentina
Fil: Falcon, Esteban. Hospital de Niños Dr Humberto Notti; Argentina
Fil: Gibbons, Luz. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Guerrero, Celeste. Gobierno de la Provincia de Mendoza. Hospital Pediátrico Humberto Notti; Argentina
Fil: Juarez, Ximena. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); Argentina
Fil: López, Analía. Gobierno de la Provincia de Mendoza. Hospital Pediátrico Humberto Notti; Argentina
Fil: Matteucci, Erika. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); Argentina
Fil: Paula Rodriguez, Ana. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Vitar, Emilse Mabel. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina
Fil: Roberti, Javier Eugenio. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina
Fil: Garcia Elorrio, Ezequiel. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina
Fil: Falaschi, Andrea. Gobierno de la Provincia de Mendoza. Hospital Pediátrico Humberto Notti; Argentina
Materia
ANTIBIOTIC RESISTANCE
PEDIATRICS
ANTIBIOTIC THERAPY
STEWARDSHIPS
Nivel de accesibilidad
acceso abierto
Condiciones de uso
https://creativecommons.org/licenses/by-nc-nd/2.5/ar/
Repositorio
CONICET Digital (CONICET)
Institución
Consejo Nacional de Investigaciones Científicas y Técnicas
OAI Identificador
oai:ri.conicet.gov.ar:11336/291287
Acceder
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oai_identifier_str oai:ri.conicet.gov.ar:11336/291287
network_acronym_str CONICETDig
repository_id_str 3498
network_name_str CONICET Digital (CONICET)
spelling Improving Antibiotic Use in Pediatric Hospitals in Argentina: A Quality Improvement StudyJorro Baron, Facundo ArielEchave, CeciliaRodriguez, VivianaAguilar Fixman, Maria JoseBalboa, RominaGuglielmino, MarinaGarcia Causarano, FlorenciaDel Negro, VeronicaDondoglio, PatriciaFalcon, EstebanGibbons, LuzGuerrero, CelesteJuarez, XimenaLópez, AnalíaMatteucci, ErikaPaula Rodriguez, AnaVitar, Emilse MabelRoberti, Javier EugenioGarcia Elorrio, EzequielFalaschi, AndreaANTIBIOTIC RESISTANCEPEDIATRICSANTIBIOTIC THERAPYSTEWARDSHIPShttps://purl.org/becyt/ford/3.2https://purl.org/becyt/ford/3OBJECTIVE: We aimed to achieve a 15% reduction in days of antibiotic therapy (DOT) and a 20% increase in access antibiotic group (narrower spectrum of the World Health Organization classification) units after 24 weeks of implementing an antibiotic stewardship program (ASP) in 2 pediatric hospitals. METHODS: We implemented a quality improvement (QI) initiative preceded by a formative phase to identify barriers and facilitators. The strategy included developing an antibiotic management program, establishing a data management and learning system, and fostering teamwork and effective communication. The intervention spanned 2 learning sessions, each with an action period, and was supported by coaching and QI training. Primary outcomes included DOT per 1000 hospital days and the access antibiotic group use percentage. We examined the implementation of change ideas and adherence to clinical pathways for process measures using mortality rates as a balancing measure. Run charts tracked follow-up outcomes, with control charts employed once sufficient data points were collected. RESULTS: We gathered data from 249 patients during the baseline period (BP) (Jan 2022 to June 2022) and from 588 patients during the implementation period (IP) (July 2022 to January 2023). The IP group included younger patients with higher rates of acute lower respiratory tract infections and more severe clinical conditions. Access antibiotic group consumption was 30.7% in BP and 37.9% in IP. Concerning antibiotic DOT, throughout time, we observed variable results with many points outside the control limits, with an average of 854 in BP and 1068 in IP. CONCLUSION: The QI initiative demonstrated that ASP implementation in pediatric hospitals was associated with antibiotic narrow-spectrum selection.Fil: Jorro Baron, Facundo Ariel. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Echave, Cecilia. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); ArgentinaFil: Rodriguez, Viviana. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Aguilar Fixman, Maria Jose. Gobierno de la Provincia de Mendoza. Hospital Pediátrico Humberto Notti; ArgentinaFil: Balboa, Romina. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); ArgentinaFil: Guglielmino, Marina. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Garcia Causarano, Florencia. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); ArgentinaFil: Del Negro, Veronica. Gobierno de la Provincia de Mendoza. Hospital Pediátrico Humberto Notti; ArgentinaFil: Dondoglio, Patricia. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); ArgentinaFil: Falcon, Esteban. Hospital de Niños Dr Humberto Notti; ArgentinaFil: Gibbons, Luz. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Guerrero, Celeste. Gobierno de la Provincia de Mendoza. Hospital Pediátrico Humberto Notti; ArgentinaFil: Juarez, Ximena. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); ArgentinaFil: López, Analía. Gobierno de la Provincia de Mendoza. Hospital Pediátrico Humberto Notti; ArgentinaFil: Matteucci, Erika. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); ArgentinaFil: Paula Rodriguez, Ana. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Vitar, Emilse Mabel. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Roberti, Javier Eugenio. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Garcia Elorrio, Ezequiel. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Falaschi, Andrea. Gobierno de la Provincia de Mendoza. Hospital Pediátrico Humberto Notti; ArgentinaAmerican Academy of Pediatrics2025-05info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttp://purl.org/coar/resource_type/c_6501info:ar-repo/semantics/articuloapplication/pdfapplication/pdfhttp://hdl.handle.net/11336/291287Jorro Baron, Facundo Ariel; Echave, Cecilia; Rodriguez, Viviana; Aguilar Fixman, Maria Jose; Balboa, Romina; et al.; Improving Antibiotic Use in Pediatric Hospitals in Argentina: A Quality Improvement Study; American Academy of Pediatrics; Hospital Pediatrics; 5-2025; 1-102154-16632154-1671CONICET DigitalCONICETenginfo:eu-repo/semantics/altIdentifier/url/https://publications.aap.org/hospitalpediatrics/article/doi/10.1542/hpeds.2024-008046/201782/Improving-Antibiotic-Use-in-Pediatric-Hospitals-ininfo:eu-repo/semantics/altIdentifier/doi/10.1542/hpeds.2024-008046info:eu-repo/semantics/openAccesshttps://creativecommons.org/licenses/by-nc-nd/2.5/ar/reponame:CONICET Digital (CONICET)instname:Consejo Nacional de Investigaciones Científicas y Técnicas2026-08-25T15:28:12Zoai:ri.conicet.gov.ar:11336/291287instacron:CONICETInstitucionalhttp://ri.conicet.gov.ar/Organismo científico-tecnológicoNo correspondehttp://ri.conicet.gov.ar/oai/requestdasensio@conicet.gov.ar; lcarlino@conicet.gov.arArgentinaNo correspondeNo correspondeNo correspondeopendoar:34982026-08-25 15:28:12.711CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicasfalse
dc.title.none.fl_str_mv Improving Antibiotic Use in Pediatric Hospitals in Argentina: A Quality Improvement Study
title Improving Antibiotic Use in Pediatric Hospitals in Argentina: A Quality Improvement Study
spellingShingle Improving Antibiotic Use in Pediatric Hospitals in Argentina: A Quality Improvement Study
Jorro Baron, Facundo Ariel
ANTIBIOTIC RESISTANCE
PEDIATRICS
ANTIBIOTIC THERAPY
STEWARDSHIPS
title_short Improving Antibiotic Use in Pediatric Hospitals in Argentina: A Quality Improvement Study
title_full Improving Antibiotic Use in Pediatric Hospitals in Argentina: A Quality Improvement Study
title_fullStr Improving Antibiotic Use in Pediatric Hospitals in Argentina: A Quality Improvement Study
title_full_unstemmed Improving Antibiotic Use in Pediatric Hospitals in Argentina: A Quality Improvement Study
title_sort Improving Antibiotic Use in Pediatric Hospitals in Argentina: A Quality Improvement Study
dc.creator.none.fl_str_mv Jorro Baron, Facundo Ariel
Echave, Cecilia
Rodriguez, Viviana
Aguilar Fixman, Maria Jose
Balboa, Romina
Guglielmino, Marina
Garcia Causarano, Florencia
Del Negro, Veronica
Dondoglio, Patricia
Falcon, Esteban
Gibbons, Luz
Guerrero, Celeste
Juarez, Ximena
López, Analía
Matteucci, Erika
Paula Rodriguez, Ana
Vitar, Emilse Mabel
Roberti, Javier Eugenio
Garcia Elorrio, Ezequiel
Falaschi, Andrea
author Jorro Baron, Facundo Ariel
author_facet Jorro Baron, Facundo Ariel
Echave, Cecilia
Rodriguez, Viviana
Aguilar Fixman, Maria Jose
Balboa, Romina
Guglielmino, Marina
Garcia Causarano, Florencia
Del Negro, Veronica
Dondoglio, Patricia
Falcon, Esteban
Gibbons, Luz
Guerrero, Celeste
Juarez, Ximena
López, Analía
Matteucci, Erika
Paula Rodriguez, Ana
Vitar, Emilse Mabel
Roberti, Javier Eugenio
Garcia Elorrio, Ezequiel
Falaschi, Andrea
author_role author
author2 Echave, Cecilia
Rodriguez, Viviana
Aguilar Fixman, Maria Jose
Balboa, Romina
Guglielmino, Marina
Garcia Causarano, Florencia
Del Negro, Veronica
Dondoglio, Patricia
Falcon, Esteban
Gibbons, Luz
Guerrero, Celeste
Juarez, Ximena
López, Analía
Matteucci, Erika
Paula Rodriguez, Ana
Vitar, Emilse Mabel
Roberti, Javier Eugenio
Garcia Elorrio, Ezequiel
Falaschi, Andrea
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv ANTIBIOTIC RESISTANCE
PEDIATRICS
ANTIBIOTIC THERAPY
STEWARDSHIPS
topic ANTIBIOTIC RESISTANCE
PEDIATRICS
ANTIBIOTIC THERAPY
STEWARDSHIPS
purl_subject.fl_str_mv https://purl.org/becyt/ford/3.2
https://purl.org/becyt/ford/3
dc.description.none.fl_txt_mv OBJECTIVE: We aimed to achieve a 15% reduction in days of antibiotic therapy (DOT) and a 20% increase in access antibiotic group (narrower spectrum of the World Health Organization classification) units after 24 weeks of implementing an antibiotic stewardship program (ASP) in 2 pediatric hospitals. METHODS: We implemented a quality improvement (QI) initiative preceded by a formative phase to identify barriers and facilitators. The strategy included developing an antibiotic management program, establishing a data management and learning system, and fostering teamwork and effective communication. The intervention spanned 2 learning sessions, each with an action period, and was supported by coaching and QI training. Primary outcomes included DOT per 1000 hospital days and the access antibiotic group use percentage. We examined the implementation of change ideas and adherence to clinical pathways for process measures using mortality rates as a balancing measure. Run charts tracked follow-up outcomes, with control charts employed once sufficient data points were collected. RESULTS: We gathered data from 249 patients during the baseline period (BP) (Jan 2022 to June 2022) and from 588 patients during the implementation period (IP) (July 2022 to January 2023). The IP group included younger patients with higher rates of acute lower respiratory tract infections and more severe clinical conditions. Access antibiotic group consumption was 30.7% in BP and 37.9% in IP. Concerning antibiotic DOT, throughout time, we observed variable results with many points outside the control limits, with an average of 854 in BP and 1068 in IP. CONCLUSION: The QI initiative demonstrated that ASP implementation in pediatric hospitals was associated with antibiotic narrow-spectrum selection.
Fil: Jorro Baron, Facundo Ariel. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Echave, Cecilia. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); Argentina
Fil: Rodriguez, Viviana. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Aguilar Fixman, Maria Jose. Gobierno de la Provincia de Mendoza. Hospital Pediátrico Humberto Notti; Argentina
Fil: Balboa, Romina. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); Argentina
Fil: Guglielmino, Marina. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Garcia Causarano, Florencia. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); Argentina
Fil: Del Negro, Veronica. Gobierno de la Provincia de Mendoza. Hospital Pediátrico Humberto Notti; Argentina
Fil: Dondoglio, Patricia. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); Argentina
Fil: Falcon, Esteban. Hospital de Niños Dr Humberto Notti; Argentina
Fil: Gibbons, Luz. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Guerrero, Celeste. Gobierno de la Provincia de Mendoza. Hospital Pediátrico Humberto Notti; Argentina
Fil: Juarez, Ximena. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); Argentina
Fil: López, Analía. Gobierno de la Provincia de Mendoza. Hospital Pediátrico Humberto Notti; Argentina
Fil: Matteucci, Erika. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); Argentina
Fil: Paula Rodriguez, Ana. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Vitar, Emilse Mabel. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina
Fil: Roberti, Javier Eugenio. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina
Fil: Garcia Elorrio, Ezequiel. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina
Fil: Falaschi, Andrea. Gobierno de la Provincia de Mendoza. Hospital Pediátrico Humberto Notti; Argentina
description OBJECTIVE: We aimed to achieve a 15% reduction in days of antibiotic therapy (DOT) and a 20% increase in access antibiotic group (narrower spectrum of the World Health Organization classification) units after 24 weeks of implementing an antibiotic stewardship program (ASP) in 2 pediatric hospitals. METHODS: We implemented a quality improvement (QI) initiative preceded by a formative phase to identify barriers and facilitators. The strategy included developing an antibiotic management program, establishing a data management and learning system, and fostering teamwork and effective communication. The intervention spanned 2 learning sessions, each with an action period, and was supported by coaching and QI training. Primary outcomes included DOT per 1000 hospital days and the access antibiotic group use percentage. We examined the implementation of change ideas and adherence to clinical pathways for process measures using mortality rates as a balancing measure. Run charts tracked follow-up outcomes, with control charts employed once sufficient data points were collected. RESULTS: We gathered data from 249 patients during the baseline period (BP) (Jan 2022 to June 2022) and from 588 patients during the implementation period (IP) (July 2022 to January 2023). The IP group included younger patients with higher rates of acute lower respiratory tract infections and more severe clinical conditions. Access antibiotic group consumption was 30.7% in BP and 37.9% in IP. Concerning antibiotic DOT, throughout time, we observed variable results with many points outside the control limits, with an average of 854 in BP and 1068 in IP. CONCLUSION: The QI initiative demonstrated that ASP implementation in pediatric hospitals was associated with antibiotic narrow-spectrum selection.
publishDate 2025
dc.date.none.fl_str_mv 2025-05
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
http://purl.org/coar/resource_type/c_6501
info:ar-repo/semantics/articulo
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/11336/291287
Jorro Baron, Facundo Ariel; Echave, Cecilia; Rodriguez, Viviana; Aguilar Fixman, Maria Jose; Balboa, Romina; et al.; Improving Antibiotic Use in Pediatric Hospitals in Argentina: A Quality Improvement Study; American Academy of Pediatrics; Hospital Pediatrics; 5-2025; 1-10
2154-1663
2154-1671
CONICET Digital
CONICET
url http://hdl.handle.net/11336/291287
identifier_str_mv Jorro Baron, Facundo Ariel; Echave, Cecilia; Rodriguez, Viviana; Aguilar Fixman, Maria Jose; Balboa, Romina; et al.; Improving Antibiotic Use in Pediatric Hospitals in Argentina: A Quality Improvement Study; American Academy of Pediatrics; Hospital Pediatrics; 5-2025; 1-10
2154-1663
2154-1671
CONICET Digital
CONICET
dc.language.none.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv info:eu-repo/semantics/altIdentifier/url/https://publications.aap.org/hospitalpediatrics/article/doi/10.1542/hpeds.2024-008046/201782/Improving-Antibiotic-Use-in-Pediatric-Hospitals-in
info:eu-repo/semantics/altIdentifier/doi/10.1542/hpeds.2024-008046
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
https://creativecommons.org/licenses/by-nc-nd/2.5/ar/
eu_rights_str_mv openAccess
rights_invalid_str_mv https://creativecommons.org/licenses/by-nc-nd/2.5/ar/
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv American Academy of Pediatrics
publisher.none.fl_str_mv American Academy of Pediatrics
dc.source.none.fl_str_mv reponame:CONICET Digital (CONICET)
instname:Consejo Nacional de Investigaciones Científicas y Técnicas
reponame_str CONICET Digital (CONICET)
collection CONICET Digital (CONICET)
instname_str Consejo Nacional de Investigaciones Científicas y Técnicas
repository.name.fl_str_mv CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicas
repository.mail.fl_str_mv dasensio@conicet.gov.ar; lcarlino@conicet.gov.ar
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