[1] Natl Univ Asuncion, Dept Pediat, Clin Hosp, Emergency Dept, San Lorenzo, Paraguay
[2] Univ Washington, Sch Med, Seattle, WA USA
[3] Univ Washington, Sch Publ Hlth & Community Med, Seattle, WA 98195 USA
[4] Inst Privado Nino, Asuncion, Paraguay
[5] Natl Univ Asuncion, Clin Hosp, Pediat Intens Care Unit, San Lorenzo, Paraguay