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profundo ou misto&#46; Em termos de extens&#227;o&#44; podem ser focal&#44; segmentar ou multifocal&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">1&#8211;3&#44;6</span></a> O subtipo focal &#233; o mais comum&#44; enquanto os segmentares &#8211; que ocupam uma subunidade do corpo &#8211; s&#227;o frequentemente associados a complica&#231;&#245;es&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">3&#44;9&#8211;11</span></a> Pacientes com les&#227;o segmentar na face ou cervical podem apresentar s&#237;ndrome PHACES&#44; que representa espectro de anomalias associadas &#40;malforma&#231;&#227;o da fossa posterior do c&#233;rebro&#44; hemangioma&#44; anomalias arteriais&#44; card&#237;acas&#44; oculares e esternais&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">10</span></a> Denomina&#8208;se hemangioma cyrano aqueles hemangiomas localizados na ponta nasal&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Os HIs ocorrem mais frequentemente em beb&#234;s prematuros&#44; sexo feminino e com baixo peso ao nascer&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">9&#44;10</span></a> Outros fatores de risco associados a maior incid&#234;ncia de HI s&#227;o&#58; idade materna avan&#231;ada&#44; etnia caucasiana&#44; gesta&#231;&#227;o m&#250;ltipla&#44; placenta pr&#233;via e pr&#233;&#8208;ecl&#226;mpsia&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">3</span></a> Embora sejam geralmente espor&#225;dicos&#44; a hist&#243;ria familiar de HI aumenta o risco de hemangioma&#44; sugerindo que uma predisposi&#231;&#227;o gen&#233;tica pode estar implicada em sua patog&#234;nese&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Em rela&#231;&#227;o &#224; hist&#243;ria natural&#44; em geral &#233; dividida em fases&#58; &#40;1&#41; surgimento ao nascimento ou logo ap&#243;s&#59; &#40;2&#41; prolifera&#231;&#227;o precoce&#59; &#40;3&#41; prolifera&#231;&#227;o tardia&#59; &#40;4&#41; estabiliza&#231;&#227;o &#40;plat&#244;&#41;&#59; &#40;5&#41; involu&#231;&#227;o&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">1&#8211;3</span></a> A maioria dos HIs n&#227;o est&#225; presente ao nascimento&#44; mas aparece tipicamente nas primeiras semanas de vida&#44; enquanto alguns pacientes t&#234;m les&#227;o precursora ao nascimento&#58; pequena p&#225;pula vermelha&#44; telangiectasia&#44; m&#225;cula hipocr&#244;mica &#40;que corresponde a um nevo an&#234;mico&#41; ou pseudoequimoses&#46; Os tumores crescem rapidamente por 6 a 10&#160;meses &#40;fase proliferativa&#41;&#59; a maioria atinge seu tamanho m&#225;ximo entre 3 e 5 meses de idade e lentamente regridem por&#160;7 a 10&#160;anos &#40;fase involutiva&#41;&#46; A regress&#227;o completa &#233; vista em&#160;90&#37;&#160;dos casos aos 4 anos de idade&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Analisamos pacientes diagnosticados com HI em acompanhamento em hospital universit&#225;rio do Sul do Brasil para entender o perfil epidemiol&#243;gico&#44; aspectos cl&#237;nicos e terap&#234;uticos desses pacientes e identificar as condi&#231;&#245;es associadas com complica&#231;&#245;es&#44; recidivas e sequela inest&#233;tica&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="par0030" class="elsevierStylePara elsevierViewall">Trata&#8208;se de coorte retrospectiva envolvendo pacientes com HI atendidos no Departamento de Dermatologia Pedi&#225;trica da Universidade Federal de Ci&#234;ncias da Sa&#250;de de Porto Alegre entre 2006 e 2018&#46; Este estudo est&#225; de acordo com os princ&#237;pios da Declara&#231;&#227;o de Helsinki e foi aprovado pelo Comit&#234; de &#201;tica em Pesquisa sob o n&#250;mero&#160;1&#46;973&#44;303&#46; Termo de Consentimento Livre e Esclarecido foi obtido em todos os casos&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">O diagn&#243;stico de HI foi cl&#237;nico na maioria dos casos&#44; exceto nos HIs profundos&#44; que requereram exame complementar como ecografia com Doppler&#44; tomografia computadorizada &#40;TC&#41; ou resson&#226;ncia nuclear magn&#233;tica &#40;RNM&#41;&#46; Para s&#237;ndrome SACRAL &#40;disrafismo espinal&#44; anomalias anogenital&#44; cut&#226;nea&#44; renal e urol&#243;gica associado com HI em localiza&#231;&#227;o lombossacra&#41;&#44; RNM de coluna e pelve foi realizada no contexto diagn&#243;stico&#44; enquanto pacientes com s&#237;ndrome PHACE realizaram TC e&#47;ou RNM de cr&#226;nio&#46; O diagn&#243;stico de s&#237;ndrome PHACES foi realizado conforme os crit&#233;rios diagn&#243;sticos publicado por Metry et al&#46; em 2009&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">12</span></a> Pacientes com HI multifocal realizaram ecografia abdominal total a fim de descartar envolvimento hep&#225;tico&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">As sequelas inest&#233;ticas inclu&#237;das foram anetodermia&#44; pele redundante&#44; tecido fibroadiposo&#44; cicatriz atr&#243;fica e telangiectasias&#44; enquanto as complica&#231;&#245;es inclu&#237;das foram ulcera&#231;&#227;o e altera&#231;&#227;o funcional&#46; Consideramos como recidiva recente as que ocorreram entre 11 meses de idade e 2 anos e 11 meses de vida&#44; e como recidiva tardia as que ocorreram a partir dos 3 anos de idade&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Procedemos com a revis&#227;o de prontu&#225;rios m&#233;dico dos pacientes selecionados e com an&#225;lise fotogr&#225;fica&#46; Qualquer vari&#225;vel n&#227;o encontrada em prontu&#225;rio m&#233;dico foi questionada durante a consulta m&#233;dica de rotina ou por contato telef&#244;nico&#46; Exclu&#237;mos do trabalho pacientes cujos pais&#47;respons&#225;veis n&#227;o assinaram o Termo de Consentimento Livre e Esclarecido&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Vari&#225;veis demogr&#225;ficas e pr&#233;&#8208;natais dos pacientes selecionados foram perguntadas na primeira consulta no servi&#231;o de Dermatologia da Universidade Federal de Ci&#234;ncias da Sa&#250;de de Porto Alegre&#46; As vari&#225;veis cl&#237;nicas&#44; terap&#234;uticas e de resposta ao tratamento foram analisadas durante as consultas de rotina e por meio de an&#225;lise fotogr&#225;fica&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">As compara&#231;&#245;es dos grupos foram feitas usando os testes <span class="elsevierStyleItalic">t</span> de Student e Qui&#8208;Quadrado de Pearson ou os testes de Wilcoxon&#8208;Mann&#8208;Whitney e exato de Fisher&#44; quando apropriado&#46; A associa&#231;&#227;o entre o tempo de tratamento com propranolol e vari&#225;veis cl&#237;nicas foi testada por meio de modelagem utilizando Generalized Estimating Equation &#40;GEE&#41;&#46; Para essa an&#225;lise&#44; foi escolhida uma distribui&#231;&#227;o gama com fun&#231;&#227;o logar&#237;tmica&#46; Estimador robusto e m&#233;todo independente foram selecionados para as matrizes de covari&#226;ncia e correla&#231;&#227;o&#44; respectivamente&#46; Alpha foi estabelecido em 5&#37;&#44; e os dados foram analisados usando SPSS&#160;18&#46;0 &#40;SPSS Inc&#46; Chicago&#44; IL&#44; EUA&#41;&#46; Para avalia&#231;&#227;o de correla&#231;&#227;o&#44; utilizou&#8208;se a corre&#231;&#227;o de continuidade de Yates&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="par0060" class="elsevierStylePara elsevierViewall">Entre&#160;2006&#160;e&#160;2018&#44;&#160;inclu&#237;mos 190&#160;pacientes &#40;72&#44;6&#37;&#160;feminino&#41; diagnosticados com HI&#46; A m&#233;dia de idade ao diagn&#243;stico de HI foi&#44; em geral&#44; 14&#160;dias de vida&#44; embora&#160;63&#37;&#160;os casos apresentassem les&#227;o precursora ao nascimento&#46; A m&#233;dia de idade ao diagn&#243;stico de HIs superficiais foi de&#160;11&#44;9&#160;dias&#44; 14&#160;dias para os HIs mistos e 34&#160;dias para os HIs profundos &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0192&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">HI focal foi o subtipo mais prevalente&#44; com ocorr&#234;ncia em&#160;133&#160;pacientes&#160;&#40;71&#44;8&#37;&#41;&#46; Em rela&#231;&#227;o ao subtipo morfol&#243;gico&#44; a maioria&#160;&#40;62&#44;5&#37;&#41; apresentava componente misto&#59; 74&#44;8&#37;&#160;localizavam&#8208;se em cabe&#231;a&#47;pesco&#231;o&#46; Dos pacientes com HI multifocal&#44; 25&#37;&#160;apresentavam hemangioma visceral &#8211; o f&#237;gado foi o local mais comum&#44; com ocorr&#234;ncia em 75&#37; dos indiv&#237;duos &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Trinta e seis pacientes&#160;&#40;19&#44;4&#37;&#41; apresentava HI segmentar e 4&#44;8&#37;&#160;tinham s&#237;ndrome PHACES&#44; de acordo com os crit&#233;rios diagn&#243;sticos propostos por Metry et al&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">12</span></a> Um paciente apresentou s&#237;ndrome SACRAL&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Quarenta crian&#231;as &#40;27&#44;5&#37;&#59; 40&#47;145&#41; foram prematuras &#40;idade gestacional&#160;&#60;<span class="elsevierStyleHsp" style=""></span>37&#160;semanas&#41;&#46; Baixo peso ao nascer &#40;&#60; 2500<span class="elsevierStyleHsp" style=""></span>g&#41; foi evidenciado em 18&#37; dos indiv&#237;duos&#59; a m&#233;dia de peso ao nascer foi de&#160;2980<span class="elsevierStyleHsp" style=""></span>g &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">O tempo m&#233;dio de seguimento foi de&#160;330&#160;dias&#46; Houve perda de seguimento &#40;42&#47;190&#59; 22&#37;&#41;&#44; todos em casos de HI superficial pequeno e que&#44; portanto&#44; n&#227;o necessitaram de tratamento&#46; Complica&#231;&#227;o ocorreu em 24&#37; dos pacientes &#40;46&#47;190&#41;&#46; Desses&#44; ulcera&#231;&#227;o ocorreu em 29 pacientes &#40;63&#37;&#41; e altera&#231;&#227;o funcional em 17 &#40;36&#37;&#41;&#46; Considerando todas as altera&#231;&#245;es funcionais&#44; 76&#44;4&#37; ocorreram em HI segmentar e 23&#44;5&#37; em HI focal&#46; As altera&#231;&#245;es funcionais mais frequentes foram oclus&#227;o ocular &#40;9&#47;17&#59; 52&#44;9&#37;&#41; &#8211; ocasionando ambliopia ou astigmatismo &#8211; seguido por disfun&#231;&#227;o respirat&#243;ria &#40;6&#47;17&#59; 35&#44;2&#37;&#41;&#46; Todos os HIs que causaram dificuldade respirat&#243;ria estavam localizados no l&#225;bio inferior&#46; Na avalia&#231;&#227;o de correla&#231;&#227;o&#44; ulcera&#231;&#227;o esteve relacionada estatisticamente com HI misto &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;004&#41;&#44; HI segmentar &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; e localiza&#231;&#227;o na regi&#227;o gl&#250;tea &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; A presen&#231;a de HI superficial teve rela&#231;&#227;o com a aus&#234;ncia de ulcera&#231;&#227;o &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;035&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Dos pacientes tratados&#44; 31&#37;&#160;&#40;51&#47;163&#41; tiveram alguma sequela inest&#233;tica&#46; Desses&#44; HI misto foi o subtipo mais comum &#40;28&#47;51&#44; 54&#44;9&#37;&#59; p<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;004&#41;&#44; seguido por HI profundo &#40;12&#47;51&#44; 23&#44;5&#37;&#59; p<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;8&#41; e HI superficial &#40;11&#47;51&#44; 21&#44;5&#37; &#8211; <a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; Alguma sequela inest&#233;tica foi observada em 53&#37; &#40;27&#47;51&#41; dos HIs segmentares &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; e em seis&#160;de&#160;nove&#160;pacientes com s&#237;ndrome PHACES &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">A maioria dos pacientes necessitou de algum tratamento &#40;163&#47;190&#59; 86&#37;&#41;&#46; Tratamento sist&#234;mico foi necess&#225;rio em&#160;108&#160;pacientes &#40;56&#44;8&#37;&#41;&#46; Propranolol &#40;2&#160;mg&#47;kg&#47;dia&#41; sozinho foi utilizado&#160;em 82&#160;casos&#44; e propranolol combinado com prednisolona &#40;1&#160;mg&#47;kg&#47;dia&#41;&#44; em&#160;26&#160;casos&#46; Timolol 0&#44;5&#37;&#160;t&#243;pico foi utilizado em&#160;55&#160;casos&#160;&#40;28&#44;9&#37;&#41;&#46; Dos pacientes que receberam propranolol isolado ou combinado com esteroides&#44; 90&#37; tiveram redu&#231;&#227;o de&#160;80&#37; ou mais no tamanho do hemangioma ao final do tratamento&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Em rela&#231;&#227;o &#224; dura&#231;&#227;o do tratamento com propranolol&#44; a m&#233;dia de uso foi de&#160;13&#44;15<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;2&#160;meses&#46; N&#227;o houve diferen&#231;a estat&#237;stica na dura&#231;&#227;o do tratamento entre os diferentes subtipos morfol&#243;gicos &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46; Em rela&#231;&#227;o aos outros subtipos cl&#237;nicos &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#44; pacientes com s&#237;ndrome PHACES requereram um tratamento mais prolongado &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; in&#237;cio de tratamento mais precoce &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0069&#41; e terminaram o tratamento mais tardiamente&#44; mas sem signific&#226;ncia estat&#237;stica &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0652 &#8211; <a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>A&#41;&#46; HIs segmentares tamb&#233;m necessitaram de tempo de tratamento prolongado &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#44; embora sem signific&#226;ncia estat&#237;stica no Modelo de Equa&#231;&#227;o Generalizada &#40;EEG &#8211; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0407&#41;&#59; no entanto&#44; com signific&#226;ncia estat&#237;stica na an&#225;lise <span class="elsevierStyleItalic">pos&#8208;hoc</span> tanto no in&#237;cio do tratamento &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;029&#41; quanto no final &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0396 &#8211; <a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>B&#41;&#46; Associa&#231;&#227;o significante foi encontrada entre ulcera&#231;&#227;o e dura&#231;&#227;o de tratamento&#44; com propranolol detectada com EEG modelo &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0088 &#8211; <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46; No entanto&#44; an&#225;lise <span class="elsevierStyleItalic">post hoc</span> n&#227;o encontrou diferen&#231;a estat&#237;sticas entres os grupos ulcerado e n&#227;o ulcerado &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>C&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Quanto &#224; idade de in&#237;cio do tratamento com propranolol&#44; 5&#44;68&#37;&#160;iniciaram antes dos&#160;30&#160;dias&#59; 36&#44;58&#37; acima de 2 meses&#59; 53&#44;65&#37; acima dos 3 meses&#59; 69&#44;09&#37;&#160;acima dos 4 meses&#44; e 79&#44;4&#37; acima dos 5 meses&#46; Tamb&#233;m encontramos que pacientes que iniciaram o tratamento ap&#243;s os 5 meses de idade requereram tempo de tratamento prolongado &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0001 &#8211; <a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">Recidivas ocorreram em&#160;16&#44;6&#37; dos pacientes tratados &#40;18&#47;108&#41;&#59; recidivas de pacientes utilizando apenas timolol n&#227;o foram percebidas&#46; Todos eles eram do sexo feminino &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41;&#59; 11&#160;eram HIs mistos &#40;11&#47;18&#44; 61&#44;1&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;5&#41;&#44; e sete eram HI profundo &#40;7&#47;18&#44; 38&#44;8&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;37&#41;&#46; Recidiva precoce ocorreu em oito pacientes &#40;8&#47;108&#44; 7&#44;4&#37;&#41;&#44; e tardia em 10 pacientes &#40;10&#47;108&#44; 9&#44;2&#37;&#41;&#46; Todos&#44; exceto um&#44; tinham HI localizado em cabe&#231;a&#47;pesco&#231;o &#40;17&#47;18&#44; 94&#44;4&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;012&#41;&#44; e 10 eram HI segmentar &#40;10&#47;18&#44; 55&#44;5&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;007&#41;&#46; Os HIs que mais frequente recidivaram foram os que acometiam o segmento S3<span class="elsevierStyleHsp" style=""></span>da face &#40;7&#47;18&#41;&#44; p&#225;lpebra superior &#40;7&#47;18&#41;&#44; cyrano &#40;5&#47;18&#41; e os que envolviam a par&#243;tida &#40;5&#47;18&#41;&#46; Em rela&#231;&#227;o ao crescimento tardio&#44; 8&#47;10&#160;pacientes apresentavam subtipo misto&#44; 4&#47;10&#160;eram s&#237;ndrome PHACES e 4&#47;10&#160;pacientes apresentavam m&#250;ltiplos segmentos acometidos &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#44; <a class="elsevierStyleCrossRefs" href="#fig0020">figs&#46; 4 e 5</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discuss&#227;o</span><p id="par0110" class="elsevierStylePara elsevierViewall">A classifica&#231;&#227;o em rela&#231;&#227;o &#224; extens&#227;o&#44; topografia e subtipos de HI pode predizer risco de complica&#231;&#227;o&#44; sequelas e recidivas&#46; M&#250;ltiplas les&#245;es est&#227;o associadas com acometimento visceral &#40;especialmente f&#237;gado e trato gastrintestinal&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">3&#44;9&#44;13&#8211;15</span></a> HIs segmentar e facial apresentam alto risco de sequela inest&#233;tica&#44; complica&#231;&#227;o e recidiva&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">9&#44;11&#44;13</span></a> No entanto&#44; ainda n&#227;o h&#225; diretrizes espec&#237;ficas para tratamento de HI localizados nessa topografia e que apresentam maior risco de recorr&#234;ncia&#46; Parece &#243;bvio pensar que para os HIs de alto risco para complica&#231;&#227;o&#44; o tratamento com propranolol deva ser prolongado&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Sabe&#8208;se que alguns HIs podem ter a fase de crescimento prolongada&#44; associado com recidiva precoce&#44; percebida ap&#243;s a redu&#231;&#227;o da dose do propranolol ou no final do tratamento&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">16</span></a> Por outro lado&#44; at&#233; o momento&#44; n&#227;o h&#225; uma explica&#231;&#227;o cient&#237;fica para a recidiva tardia ap&#243;s os 3 anos de idade&#46; A preval&#234;ncia da recidiva tardia &#233; pouco conhecida&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">13&#44;17</span></a> Dez a 30&#37; dos hemangiomas recidivam ap&#243;s o uso de propranolol&#44; e &#233; estimado que&#160;1&#37; dos pacientes tem fase de crescimento tardia &#40;acima dos 3 anos de idade&#41;&#46; Fatores associados &#224; recidiva s&#227;o ainda incertos&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">13&#8211;17</span></a> Neste estudo&#44; a frequ&#234;ncia de crescimento tardio foi alta&#44; o que nos leva a pensar que os casos de recidiva tardia podem estar subestimados&#46; Novos estudos s&#227;o necess&#225;rios para avaliar a verdadeira preval&#234;ncia da recidiva tardia&#46; O achado mais importante deste estudo diz respeito aos fatores de risco para recidiva recente e tardia&#46; Nossos resultados est&#227;o de acordo com os resultados do importante estudo de O&#8217;Brien et al&#46;&#44; exceto por haver mais HI mistos com crescimento tardio em nosso estudo&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">13</span></a> Interessantemente&#44; ao que parece&#44; recidivas recentes e tardias compartilham dos mesmos fatores de risco&#44; ent&#227;o esses pacientes devem ser monitorados durante toda a inf&#226;ncia&#46; Neste estudo&#44; pacientes com HI segmentar e s&#237;ndrome PHACES requereram tempo de tratamento prolongado&#46; Esse achado era esperado porque esses pacientes s&#227;o mais graves e recidivaram mais&#44; o que acarretou em tempo de tratamento prolongado&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Em coorte pr&#233;via envolvendo&#160;1096&#160;crian&#231;as&#44; Metry et al&#46; encontraram do total de casos&#160;20&#37; de HI segmentar e 2&#44;3&#37;&#160;de s&#237;ndrome PHACES&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">10</span></a> Encontramos uma frequ&#234;ncia mais alta de s&#237;ndrome PHACES e HI segmentar&#46; Uma poss&#237;vel raz&#227;o para esse achado &#233; que nosso estudo foi conduzido num centro terci&#225;rio&#44; refer&#234;ncia para casos graves&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Estima&#8208;se que ocorra ulcera&#231;&#227;o em cerca de&#160;5&#160;a&#160;21&#37; dos HIs&#59; essa foi a complica&#231;&#227;o mais comum em estudo prospectivo&#44; ocorrendo em&#160;16&#37;&#160;dos casos&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">18&#8211;21</span></a> Ulcera&#231;&#227;o pode ocasionar dor intensa&#44; sangramento e infec&#231;&#227;o secund&#225;ria&#44; em adi&#231;&#227;o ao risco de cicatriz permanente&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">19</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Recomenda&#8208;se interven&#231;&#227;o precoce e&#47;ou refer&#234;ncia a servi&#231;o especializado a partir da quarta semana de vida em casos de HI com alto risco de complica&#231;&#227;o &#40;ulcera&#231;&#227;o&#44; sequela inest&#233;tica ou perda funcional&#41; com intuito de reduzir o risco de cicatriz inest&#233;tica e sequelas permanentes&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">22</span></a> Em nosso estudo&#44; somente metade dos pacientes iniciaram o tratamento antes dos 3 meses de idade&#44; e isso pode ter contribu&#237;do para as sequelas inest&#233;ticas&#46; A alta frequ&#234;ncia de sequelas chama a aten&#231;&#227;o em nosso estudo&#46; A dificuldade de acesso a servi&#231;o terci&#225;rio e&#47;ou a falta de informa&#231;&#227;o por parte de pediatras e dermatologistas pode explicar esse atraso&#46; Nosso estudo demonstrou que crian&#231;as que iniciaram o tratamento antes dos 4 meses de idade obtiveram melhor resposta ao tratamento&#44; e crian&#231;as que iniciaram mais tarde necessitaram de tempo de tratamento prolongado&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">As limita&#231;&#245;es deste estudo foram a falta de dados e fotos em alguns prontu&#225;rios e perda de seguimento&#44; por se tratar de um estudo retrospectivo&#46; Por ter sido realizado em um &#250;nico hospital&#44; n&#227;o representa estudo de base populacional&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclus&#227;o</span><p id="par0140" class="elsevierStylePara elsevierViewall">Este &#233; o primeiro estudo a tra&#231;ar um amplo perfil epidemiol&#243;gico de HI no Sul do Brasil&#46; HIs misto&#44; segmentar e localizados na regi&#227;o gl&#250;tea s&#227;o fatores de risco para ulcera&#231;&#227;o&#46; HIs misto&#44; segmentar e localizados na cabe&#231;a e pesco&#231;o s&#227;o fatores de risco para sequelas&#46; Sexo feminino e HI segmentar s&#227;o fatores de risco para recidivas&#46; Al&#233;m disso&#44; HI localizado no segmento&#160;S3<span class="elsevierStyleHsp" style=""></span>da face&#44; p&#225;lpebra superior&#44; l&#225;bios&#44; envolvendo a par&#243;tidas e cyranos acrescentam maior risco para complica&#231;&#245;es&#46; Este estudo consolida fatores de risco para recidivas e alerta que esses pacientes devem ser cuidadosamente monitorados&#44; mesmo ap&#243;s a interrup&#231;&#227;o do tratamento&#46; Protocolos de tratamento espec&#237;ficos s&#227;o necess&#225;rios para HI com alto risco de complica&#231;&#245;es e recidivas&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Suporte financeiro</span><p id="par0145" class="elsevierStylePara elsevierViewall">O estudo foi financiado em parte pela Coordena&#231;&#227;o de Aperfei&#231;oamento de Pessoal de N&#237;vel Superior &#8211; Brasil &#40;CAPES&#41; &#8211; Finance Code 001&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Contribui&#231;&#227;o dos autores</span><p id="par0150" class="elsevierStylePara elsevierViewall">Let&#237;cia Gaertner Mariani&#58; Concep&#231;&#227;o e design do estudo&#59; aquisi&#231;&#227;o de dados&#59; esbo&#231;o do manuscrito&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">L&#237;lian Moraes Ferreira&#58; Concep&#231;&#227;o e design do estudo&#59; aquisi&#231;&#227;o de dados&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Diego Luiz Rovaris&#58; An&#225;lise e interpreta&#231;&#227;o dos dados&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Renan Rangel Bonamigo&#58; An&#225;lise e interpreta&#231;&#227;o dos dados&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Ana Elisa Kiszewski&#58; Concep&#231;&#227;o e design do estudo&#59; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conflito de interesses</span><p id="par0175" class="elsevierStylePara elsevierViewall">Ana Elisa Kiszewski &#233; consultora da Johnson &#38; Johnson&#46; Os demais autores declaram n&#227;o ter conflitos de interesse&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamentos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hemangiomas da inf&#226;ncia &#40;HI&#41; ocorrem em aproximadamente&#160;4&#37; a&#160;10&#37;&#160;da popula&#231;&#227;o pedi&#225;trica&#46; O reconhecimento dos subtipos cl&#237;nicos e condi&#231;&#245;es que indicam maior risco para complica&#231;&#245;es s&#227;o essenciais para o sucesso terap&#234;utico&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Identificar os fatores de risco para complica&#231;&#245;es&#44; recidivas e sequelas inest&#233;ticas&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Coorte retrospectiva de pacientes com hemangioma da inf&#226;ncia em acompanhamento no Departamento de Dermatologia da Universidade Federal de Ci&#234;ncias da Sa&#250;de de Porto Alegre&#44; entre&#160;2006&#160;e&#160;2018&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Dos 190&#160;pacientes inclu&#237;dos&#44; 24&#37;&#160;tiveram alguma complica&#231;&#227;o&#44; sendo ulcera&#231;&#227;o a mais frequente e 86&#37;&#160;necessitaram de algum tratamento&#46; Na avalia&#231;&#227;o de correla&#231;&#227;o&#44; ulcera&#231;&#227;o esteve relacionado estatisticamente com HI misto &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;004&#41;&#44; HI segmentar &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41; e localiza&#231;&#227;o em regi&#227;o gl&#250;tea &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; O tempo m&#233;dio de tratamento com propranolol foi de&#160;12&#44;7&#160;meses&#46; Os pacientes com s&#237;ndrome PHACES e hemangioma da inf&#226;ncia segmentar requereram tempo de tratamento mais prolongado &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001 e p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0407&#44; respectivamente&#41;&#44; bem como aqueles que iniciaram o tratamento depois de cinco meses de vida &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#46; As recidivas ocorreram em&#160;16&#44;6&#37;&#160;dos pacientes tratados&#44; sendo todos do sexo feminino&#44; 94&#37; estavam localizados na cabe&#231;a e pesco&#231;o &#40;principalmente na p&#225;lpebra superior&#44; cyrano&#44; segmento S3 e com acometimento da par&#243;tida&#41;&#59; 61&#37;&#160;e&#160;38&#44;8&#37;&#160;eram subtipos misto e profundo&#44; respectivamente&#46; Aproximadamente&#160;1&#47;3&#160;dos pacientes tiveram alguma sequela inest&#233;tica&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Limita&#231;&#245;es do estudo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Por se tratar de um estudo retrospectivo&#44; houve perda de dados e fotos de alguns pacientes&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#245;es</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Hemangiomas mistos e segmentares s&#227;o fatores de risco para ulcera&#231;&#227;o e sequelas&#46; Recidivas ocorrem mais no sexo feminino e em hemangiomas segmentares&#46; Hemangioma da inf&#226;ncia segmentar e s&#237;ndrome PHACES necessitam maior tempo de tratamento&#46; Protocolos espec&#237;ficos s&#227;o necess&#225;rios para hemangiomas da inf&#226;ncia com alto risco de recidiva&#46;</p></span>"
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                  \t\t\t\t">190 &#40;100&#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"><span class="elsevierStyleHsp" style=""></span>Masculino&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\ttable-entry\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">176 &#40;93&#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"><span class="elsevierStyleHsp" style=""></span>Superficial&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\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Misto&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">110 &#40;62&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\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>Profundo&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\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">Localiza&#231;&#227;o &#8211; n &#40;&#37;&#41;</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="left" valign="\n
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                  \t\t\t\t">187 &#40;98&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\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>Cabe&#231;a e pesco&#231;o&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">140 &#40;74&#44;8&#41;&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="elsevierStyleHsp" style=""></span>Anogenital&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\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\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>Focal&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\ttable-entry\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\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Parto &#8211; n &#40;&#37;&#41;</span>&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="elsevierStyleHsp" style=""></span>Cesareana&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="elsevierStyleHsp" style=""></span>Vaginal&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\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sim&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"><span class="elsevierStyleHsp" style=""></span>N&#227;o&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\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">Prematuridade &#40;&#60; 37&#160;semanas&#41; &#8211; n &#40;&#37;&#41;</span>&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"><span class="elsevierStyleHsp" style=""></span>Sim&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\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">120&#47;89&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">120&#47;89&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"><span class="elsevierStyleHsp" style=""></span>Cabe&#231;a e pesco&#231;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;1231&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;3215&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  " align="left" valign="\n
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                  \t\t\t\t">0&#44;0088&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">123&#47;89&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
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                  \t\t\t\t"><span class="elsevierStyleItalic">In&#237;cio do Propranolol &#40;antes&#160;5&#160;meses ou depois&#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">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&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">122&#47;88<span class="elsevierStyleSup">c</span>&nbsp;\t\t\t\t\t\t\n
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                  """
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Topografia&nbsp;\t\t\t\t\t\t\n
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                  \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">Idade de in&#237;cio e fim do tratamento&nbsp;\t\t\t\t\t\t\n
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                  \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">Idade da recidiva&nbsp;\t\t\t\t\t\t\n
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                  \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">Tratamento&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cabe&#231;a e pesco&#231;o</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Profundo</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Focal</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P&#225;lpebra superior</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">In&#237;cio&#58; 7m&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  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1a 9m</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PPL</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">Fim&#58; 1a 6m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#193;rea anogenital</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Misto</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Focal</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vulva</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">In&#237;cio&#58; 2m&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  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1a 2m</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PPL<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>prednisolona</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">Fim&#58; 1a 1m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cabe&#231;a e pesco&#231;o</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Misto</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Segmentar</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S1&#44; S2&#44; S3&#44; S4&#44; par&#243;tida&#44; cyrano&#44; p&#225;lpebra superior PHACES</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">In&#237;cio&#58; 2m&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  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5a</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PPL</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">Fim&#58; 2a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cabe&#231;a e pesco&#231;o</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Misto</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Segmentar</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S2&#44; S3&#44; par&#243;tida&#44; l&#225;bio inferior PHACES</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">In&#237;cio&#58; 2m&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  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4a</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PPL</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">Fim&#58; 2a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cabe&#231;a e pesco&#231;o</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Profundo</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Focal</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P&#225;lpebra superior</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">In&#237;cio&#58; 5m&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  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1a 7m</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PPL</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">Fim&#58; 1a 4m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cabe&#231;a e pesco&#231;o</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Profundo</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Focal</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cyrano</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">In&#237;cio&#58; 1m&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  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1a 3m</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PPL</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">Fim&#58; 8m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cabe&#231;a e pesco&#231;o</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Misto</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Segmentar</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S1&#44; S2&#44; p&#225;lpebra superior</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">In&#237;cio&#58; 3m&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  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2a 2m</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PPL</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">Fim&#58; 1a 8m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cabe&#231;a e pesco&#231;o</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Misto</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Segmentar</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S1&#44; S2&#44; S3&#44; cervical&#44; par&#243;tida&#44; p&#225;lpebra superior</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">In&#237;cio&#58; 3m&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  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3a</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PPL<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>prednisolona</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">Fim&#58; 1a 7m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cabe&#231;a e pesco&#231;o</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Profundo</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Focal</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cyrano</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">In&#237;cio&#58; 2m&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  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4a 7m</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PPL</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">Fim&#58; 3a 2m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cabe&#231;a e pesco&#231;o</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Profundo</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Focal</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P&#225;lpebra superior</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">In&#237;cio&#58; 6m&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  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3a 4m</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PPL</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">Fim&#58; 2a 1m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cabe&#231;a e pesco&#231;o</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Misto</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Segmentar</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S3&#44; pesco&#231;o&#44; l&#225;bios PHACES</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">In&#237;cio&#58; 3m&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  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3a</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PPL<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>prednisolona</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">Fim&#58; 2a 10m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cabe&#231;a e pesco&#231;o</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Profundo</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Focal</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P&#225;lpebra superior</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">In&#237;cio&#58; 4m&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  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1a 3m</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PPL</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">Fim&#58; 8m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cabe&#231;a e pesco&#231;o</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Misto</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Focal</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cyrano</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">In&#237;cio&#58; 3m&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  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1a 4m</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PPL</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">Fim&#58; 1a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cabe&#231;a e pesco&#231;o</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Profundo</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Segmentar</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S3&#44; par&#243;tida</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">In&#237;cio&#58; 6m&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  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2a 6m</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PPL</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">Fim&#58; 2a 5m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cabe&#231;a e pesco&#231;o</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Misto</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Segmentar</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S3&#44; par&#243;tida&#44; l&#225;bios&#44; PHACES</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">In&#237;cio&#58; 3m&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  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4a</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PPL<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>prednisolona</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">Fim&#58; 1a 3m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cabe&#231;a e pesco&#231;o</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Misto</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Segmentar</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S2&#44; S3&#44; pesco&#231;o&#44; l&#225;bios PHACES</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">In&#237;cio&#58; 3m&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  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3a 10m</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PPL</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">Fim&#58; 3a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cabe&#231;a e pesco&#231;o</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Misto</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Segmentar</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S4&#44; l&#225;bios&#44; cyrano</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">In&#237;cio&#58; 2m&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  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6a</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PPL<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>prednisolona</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">Fim&#58; 2a 1m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cabe&#231;a e pesco&#231;o</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Misto</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Segmentar</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S2</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">In&#237;cio&#58; 8m&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  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3a 5m</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PPL</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">Fim&#58; 2a 10m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2824198.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Hemangiomas infantis recidivantes&#58; quadro cl&#237;nico&#44; idade da recidiva e tratamento</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Refer&#234;ncias"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:22 [
            0 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnosis and Management of Infantile Hemangiomas"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "K&#46;B&#46; P&#252;ttgen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.pcl.2013.11.010"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Clin North Am&#46;"
                        "fecha" => "2014"
                        "volumen" => "61"
                        "paginaInicial" => "383"
                        "paginaFinal" => "402"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24636652"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hemangioma&#58; clinical course&#44; complications&#44; and management"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46; Luu"
                            1 => "I&#46;J&#46; Frieden"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/bjd.12436"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol&#46;"
                        "fecha" => "2013"
                        "volumen" => "169"
                        "paginaInicial" => "20"
                        "paginaFinal" => "23"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23701395"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Recent progress in studies of infantile hemangioma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Jinnin"
                            1 => "T&#46; Ishihara"
                            2 => "E&#46; Boye"
                            3 => "B&#46;R&#46; Olsen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1346-8138.2010.00927.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Dermatol&#46;"
                        "fecha" => "2010"
                        "volumen" => "37"
                        "paginaInicial" => "939"
                        "paginaFinal" => "955"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21039783"
                            "web" => "Medline"
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