Report of an unusual association of Oropouche Fever with Guillain-Barré syndrome in Cuba, 2024.

Oropouche virus is the aetiological agent of Oropouche fever. At present, this is currently considered one of the most important vector-borne diseases in Latin America. On 27 May 2024, the Ministry of Public Health of Cuba reported the first ever outbreak of Oropouche fever. In this report, we describe three human cases of Oropouche virus infection with symptoms and signs of neurological disease and clinical diagnosis of Guillain-Barré Syndrome. This study offers insights regarding that Oropouche virus is a causal agent of neurological disorders and it could be involved in the etiology of the Guillain-Barré Syndrome.

Social Anxiety Profiles and Psychopathological Symptom Differences in Spanish Adolescents.

Research on social anxiety (SA) over the years has revealed its associations with different psychopathological symptoms. This study aims to characterize SA profiles in a sample of Spanish adolescents and explore their differences in psychopathological symptoms. Data from 1,288 Spanish students in the 15 to 18 age range (M = 16.30, SD = 0.97, 47.5% female) were collected using random cluster sampling. The Social Anxiety Scale for Adolescents (SAS-A) and the Symptom Assessment-45 Questionnaire (SA-45) were employed. Four SA profiles were revealed by the Latent Profile Analysis (LPA): extreme SA, high SA, moderate SA, and low SA. Statistically significant differences in psychopathological symptoms were revealed by the MANOVA (effect sizes from d = -2.13 to d = -0.37). The extreme SA profile exhibited the most severe psychopathological symptoms, whereas the low SA profile displayed the mildest manifestations. Proposed interventions aim to support adolescents with SA risk profiles.

Are suicides underreported? The impact of coroners versus medical examiners on suicide reporting.

OBJECTIVE: To evaluate if state death investigation systems affect the reporting of suicides, particularly when comparing medical examiners to coroners. DATA SOURCES AND STUDY SETTING: We used restricted-access state mortality data from National Vital Statistics System between the years 1959 to 2016. These data were matched with state-level changes in death investigation systems reported by the Centers for Disease Control and Prevention database on the Public Health Law Program: Coroner/ME Laws. STUDY DESIGN: We used difference-in-differences and event study methods for the analysis. We estimated the relative per capita changes in suicides, accidental deaths, and homicides when comparing coroner-only states with other death investigation types. Sub-analyses estimated differences by sex, race, and if coroners were required to receive training. DATA COLLECTION/EXTRACTION METHODS: Not Applicable. PRINCIPAL FINDINGS: Coroners-only states underreported suicides by 17.4% (p < 0.05) and performed 20.4% (p < 0.05) fewer autopsies compared to states with county coroners and a state medical examiner. This pattern is consistent by sex and race. Required coroner training did not affect death determination significantly. CONCLUSION: Coroners-only states underreported suicides compared to states with county coroners and a state medical examiner. The disparity in the use of autopsies is a potential mechanism for underreporting of suicides by coroners. If all coroners-only states adopted a state medical examiner, suicide reporting would increase by 2243-3100 deaths in the United States annually.

Distribution and habitat use patterns of the endangered Central American clouded oncilla (Leopardus pardinoides oncilla) in Costa Rica.

Montane cloud forests are highly threatened ecosystems that are vulnerable to climate change. These complex habitats harbor many species that suffer the negative consequences of this global phenomenon, such as shifts in their distribution and habitat use. The Central American clouded oncilla (Leopardus pardinoides oncilla) is the smallest and most endangered wild cat in Mesoamerica and is primarily reported in cloud forests throughout its distribution. The species is poorly understood, with no studies conducted in Central America assessing its habitat preferences. To bridge this knowledge gap, we sampled two mountain ranges in Costa Rica with camera traps and conducted an occupancy analysis to understand the anthropogenic and environmental features that influence oncilla habitat use within them. Additionally, we conducted spatial predictions of habitat use across its northern and southern range in Costa Rica to identify priority conservation areas for the species. We found that Central American clouded oncilla habitat use is driven primarily by environmental factors. Our results showed that oncillas select habitats with denser tree cover at high elevations, closer to permanent water sources, which may provide them with high prey density and a favorable habitat structure for their survival. Spatial predictions identified two main regions as conservation priority areas where threat mitigation efforts and monitoring should be implemented: the Caribbean slope of the Talamanca mountains, and the Arenal-Monteverde forest complex. The occupancy modeling approach turned out to be very useful to assess the spatial associations of the species with the environment and mapping the conservation priority areas. Future research and mitigation actions should focus on potential threats that could negatively impact Central American clouded oncilla populations and habitat use, including the role of mesopredators and feral species.

The European Reference Genome Atlas: piloting a decentralised approach to equitable biodiversity genomics.

A genomic database of all Earth's eukaryotic species could contribute to many scientific discoveries; however, only a tiny fraction of species have genomic information available. In 2018, scientists across the world united under the Earth BioGenome Project (EBP), aiming to produce a database of high-quality reference genomes containing all ~1.5 million recognized eukaryotic species. As the European node of the EBP, the European Reference Genome Atlas (ERGA) sought to implement a new decentralised, equitable and inclusive model for producing reference genomes. For this, ERGA launched a Pilot Project establishing the first distributed reference genome production infrastructure and testing it on 98 eukaryotic species from 33 European countries. Here we outline the infrastructure and explore its effectiveness for scaling high-quality reference genome production, whilst considering equity and inclusion. The outcomes and lessons learned provide a solid foundation for ERGA while offering key learnings to other transnational, national genomic resource projects and the EBP.

Exploration of carvacrol aggregation by laser spectroscopy.

Carvacrol is an aromatic monoterpenoid found in thyme oil. Due to its implications for human health, it is important to elucidate its structure and its intramolecular interactions. We have characterised the carvacrol monomer, its complex with water, its dimer, and even its trimer in a supersonic expansion using mass-resolved laser spectroscopy techniques complemented by quantum-chemical computations. The resonance-enhanced multiphoton ionisation spectrum of the monomer features several transitions, which were assigned to the same conformer, confirmed by ion-dip infrared spectroscopy. However, a conclusive assignment of the infrared bands to one of the four conformations of carvacrol remains elusive. The experimental spectra for the monohydrated, the homodimer, and the homotrimer point to the detection of the lowest energy isomer in each case. Their structures are governed by a balance of intramolecular interactions, specifically hydrogen bonding and dispersion forces. Comparison with other similar systems demonstrates that dispersion interactions are key to the stabilisation of the aggregates, being present in all the structures. However, the hydrogen bonding is the dominant force as observed in the lowest-energy conformations.

Recording provenance of workflow runs with RO-Crate.

Recording the provenance of scientific computation results is key to the support of traceability, reproducibility and quality assessment of data products. Several data models have been explored to address this need, providing representations of workflow plans and their executions as well as means of packaging the resulting information for archiving and sharing. However, existing approaches tend to lack interoperable adoption across workflow management systems. In this work we present Workflow Run RO-Crate, an extension of RO-Crate (Research Object Crate) and Schema.org to capture the provenance of the execution of computational workflows at different levels of granularity and bundle together all their associated objects (inputs, outputs, code, etc.). The model is supported by a diverse, open community that runs regular meetings, discussing development, maintenance and adoption aspects. Workflow Run RO-Crate is already implemented by several workflow management systems, allowing interoperable comparisons between workflow runs from heterogeneous systems. We describe the model, its alignment to standards such as W3C PROV, and its implementation in six workflow systems. Finally, we illustrate the application of Workflow Run RO-Crate in two use cases of machine learning in the digital image analysis domain.

Integrative analysis of multi-omics data reveals importance of collagen and the PI3K AKT signalling pathway in CAKUT.

Congenital Anomalies of the Kidney and Urinary Tract (CAKUT) is the leading cause of childhood chronic kidney failure and a significant cause of chronic kidney disease in adults. Genetic and environmental factors are known to influence CAKUT development, but the currently known disease mechanism remains incomplete. Our goal is to identify affected pathways and networks in CAKUT, and thereby aid in getting a better understanding of its pathophysiology. With this goal, the miRNome, peptidome, and proteome of over 30 amniotic fluid samples of patients with non-severe CAKUT was compared to patients with severe CAKUT. These omics data sets were made findable, accessible, interoperable, and reusable (FAIR) to facilitate their integration with external data resources. Furthermore, we analysed and integrated the omics data sets using three different bioinformatics strategies: integrative analysis with mixOmics, joint dimensionality reduction and pathway analysis. The three bioinformatics analyses provided complementary features, but all pointed towards an important role for collagen in CAKUT development and the PI3K-AKT signalling pathway. Additionally, several key genes (CSF1, IGF2, ITGB1, and RAC1) and microRNAs were identified. We published the three analysis strategies as containerized workflows. These workflows can be applied to other FAIR data sets and help gaining knowledge on other rare diseases.

Sesame Detection in Food Using DNA-Functionalized Gold Nanoparticles: A Sensitive, Rapid, and Cost-Effective Colorimetric Approach.

Food safety control is a key issue in the food and agriculture industries. For such purposes, developing miniaturized analytical methods is critical for enabling the rapid and sensitive detection of food supplements, allergens, and pollutants. Here, a novel bioanalytical methodology based on DNA-functionalized gold nanoparticles (AuNPs) and colorimetric detection was developed to detect the presence of sesame (a major allergen) through sesame seed DNA as a target, in food samples. The presence of sesame DNA induces controlled nanoparticle aggregation/desegregation, resulting in a color change (from blue to red) proportional to sesame DNA concentration. The incorporation of multicomponent nucleic acid enzymes (MNAzymes) in this strategy has been carried out to perform an isothermal signal amplification strategy to improve the sensitivity of detection. Also, open-source software for color analysis was used to ensure an unbiased visual color-change detection, enhancing detection accuracy and sensitivity and opening the possibility of performing a simple and decentralized analyte detection. The method successfully detected the presence of sesame DNA in sesame seed, sesame oil, olive oil, and sunflower oil. In brief, the developed approach constitutes a simple and affordable alternative to perform a highly sensitive detection of DNA in food without complex methodologies or the requirement of expensive instrumentation.

Incidence of Acute Kidney Injury Post Transcatheter Aortic Valve Implantation (TAVI): A Single-Center Experience.

INTRODUCTION: Transcatheter aortic valve implantation (TAVI) has dramatically changed the approach to treating aortic stenosis, particularly for patients unsuitable for surgical aortic valve replacement. Nevertheless, the possibility of quick deterioration of kidney function, known as acute kidney injury (AKI), post operation is considered one of the complications. OBJECTIVES: The study aimed to determine the incidence of AKI in adults post TAVI. METHODS: This retrospective cohort study focuses on patients who underwent the TAVI procedure at the King Faisal Cardiac Center at the Ministry of National Guard Health Affairs (MNGHA) in Jeddah, Saudi Arabia, from May 2016 to December 2022. Acute kidney injury post TAVI was defined based on RIFLE (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease) criteria. Chi-square tests and independent sample t-tests were used to compare clinical and demographic characteristics between patients who developed AKI with those who did not, using an alpha of 5%. RESULTS: The study involved 103 adult patients. Among them, 11 (10.7%) developed AKI post TAVI within seven days of the procedure, while 92 (89.3%) did not. Findings also revealed that patients with hyperlipidemia and a previous history of kidney diseases faced a higher risk of AKI post TAVI. Despite its valuable insights, the study has limitations due to its retrospective nature and small sample size. CONCLUSIONS: The study emphasizes the importance of identifying patients with hyperlipidemia and pre-existing kidney conditions and closely monitoring renal function. While some preventive methods did not significantly impact AKI occurrences, further research is needed to refine preventive strategies.

Mn-ferrite nanoparticles as promising magnetic tags for radiofrequency inductive detection and quantification in lateral flow assays.

Lateral flow assays are low-cost point-of-care devices that are stable, easy to use, and provide quick results. They are mostly used as qualitative screening tests to detect biomarkers for several diseases. Quantification of the biomarkers is sometimes desirable but challenging to achieve. Magnetic nanoparticles can be used as tags, providing both visual and magnetic signals that can be detected and quantified by magnetic sensors. In the present work, we synthesized superparamagnetic MnFe2O4 nanoparticles using the hydrothermal coprecipitation route. MnFe2O4 presents low magnetic anisotropy and high saturation magnetization, resulting in larger initial magnetic susceptibility, which is crucial for optimizing the signal in inductive sensors. We functionalized the coprecipitated nanoparticles with citric acid to achieve colloidal stability in a neutral pH and to provide carboxyl groups to their surface to bioconjugate with biomolecules, such as proteins and antibodies. The nanomaterials were characterized by several techniques, and we correlated their magnetic properties with their sensitivity and resolution for magnetic detection in radiofrequency inductive sensors. We considered the NeutrAvidin/biotin model of biorecognition to explore their potential as magnetic labels in lateral flow assays. Our results show that MnFe2O4 nanoparticles are more sensitive to inductive detection than magnetite nanoparticles, the most used nanotags in magnetic lateral flow assays. These nanoparticles present high potential as magnetic tags for the development of sensitive lateral flow immunoassays for detecting and quantifying biomarkers.

Content Validation of the Self-Medication Scale and Trust in Online Resources: Deepening Digital Access to Health.

(1) Background: The rise of online health resources and AI has reshaped the diagnosis and treatment of disease, altering the relationship between patients and healthcare professionals and encouraging self-medication. However, questionnaires validated in the literature on self-medication seem to lack questions on the possible causes that induce such behaviors, including items that explore trust toward websites and artificial intelligence. The aim of this study is to design and validate the content of a questionnaire designed to assess self-medication in health professionals, delving into the underlying etiologies, the pharmacological categories involved and the degree of confidence placed in clinical assessments derived from AI tools. (2) Methods: Validation study of the content of an instrument consisting of two phases: 1. The content validation phase involved evaluation by a selected group of health experts, who, using a Likert-type scale, analyzed the clarity, coherence and relevance of the items. 2. Pilot study of health professionals who have indicated the practice of self-administration of medications. (3) Results: In the first phase of the study, the experts considered most of the questionnaire items to be clear, representative and consistent with the construct to be measured. In its second phase, the preliminary results of our pilot study suggest a significant trend toward self-medication among healthcare workers, along with a strong inclination to use online resources to search for health-related information. (4) Conclusions: The development of a validated instrument to measure the influence of the different causes that lead healthcare personnel to practice self-medication, guaranteeing validity and efficacy, allows us to establish strategies to reduce this growing problem.

Aspartame and Its Microhydrated Aggregates Revealed by Laser Spectroscopy: Water-Sweetener Interactions in the Gas Phase.

The popular sweetener, aspartame, is an agonist of the tongue's sweet taste receptor. How water molecules affect its conformation or which aspartame atoms are more prone to interact with solvent are helpful questions to understand its activity in different environments. Here, the combination of IR-UV spectroscopic techniques with computational simulations has been successfully applied to characterize aspartame·water0-2 clusters, showing that the addition of water molecules simplifies the conformational panorama of aspartame, favoring the formation of folded structures by interaction with the polar part of the molecule.

Rational design of structure-based vaccines targeting misfolded alpha-synuclein conformers of Parkinson's disease and related disorders.

Synucleinopathies, including Parkinson's disease (PD), multiple system atrophy (MSA), and dementia with Lewy bodies (DLB), are neurodegenerative disorders caused by the accumulation of misfolded alpha-synuclein protein. Developing effective vaccines against synucleinopathies is challenging due to the difficulty of stimulating an immune-specific response against alpha-synuclein without causing harmful autoimmune reactions, selectively targeting only pathological forms of alpha-synuclein. Previous attempts using linear peptides and epitopes without control of the antigen structure failed in clinical trials. The immune system was unable to distinguish between native alpha-synuclein and its amyloid form. The prion domain of the fungal HET-s protein was selected as a scaffold to introduce select epitopes from the surface of alpha-synuclein fibrils. Four vaccine candidates were generated by introducing specific amino acid substitutions onto the surface of the scaffold protein. The approach successfully mimicked the stacking of the parallel in-register beta-sheet structure seen in alpha-synuclein fibrils. All vaccine candidates induced substantial levels of IgG antibodies that recognized pathological alpha-synuclein fibrils derived from a synucleinopathy mouse model. Furthermore, the antisera recognized pathological alpha-synuclein aggregates in brain lysates from patients who died from DLB, MSA, or PD, but did not recognize linear alpha-synuclein peptides. Our approach, based on the rational design of vaccines using the structure of alpha-synuclein amyloid fibrils and strict control over the exposed antigen structure used for immunization, as well as the ability to mimic aggregated alpha-synuclein, provides a promising avenue toward developing effective vaccines against alpha-synuclein fibrils.

Rapid and Simple Morphological Assay for Determination of Susceptibility/Resistance to Combined Ciprofloxacin and Ampicillin, Independently, in Escherichia coli.

Current antibiograms cannot discern the particular effect of a specific antibiotic when the bacteria are incubated with a mixture of antibiotics. To prove that this task is achievable, Escherichia coli strains were treated with ciprofloxacin for 45 min, immobilized on a slide and stained with SYBR Gold. In susceptible strains, the nucleoid relative surface started to decrease near the MIC, being progressively condensed as the dose increased. The shrinkage level correlated with the DNA fragmentation degree. Ciprofloxacin-resistant bacilli showed no change. Additionally, E. coli strains were incubated with ampicillin for 45 min and processed similarly. The ampicillin-susceptible strain revealed intercellular DNA fragments that increased with dose, unlike the resistant strain. Co-incubation with both antibiotics revealed that ampicillin did not modify the nucleoid condensation effect of ciprofloxacin, whereas the quinolone partially decreased the background of DNA fragments induced by ampicillin. Sixty clinical isolates, with different combinations of susceptibility-resistance to each antibiotic, were co-incubated with the EUCAST breakpoints of susceptibility of ciprofloxacin and ampicillin. The morphological assay correctly categorized all the strains for each antibiotic in 60 min, demonstrating the feasible independent evaluation of a mixture of quinolone and beta-lactam. The rapid phenotypic assay may shorten the incubation times and necessary microbial mass currently required for evaluation.

Impact of SGLT2 Inhibitors on Very Elderly Population with Heart Failure with Reduce Ejection Fraction: Real Life Data.

(1) Background: The validation of new lines of therapy for the elderly is required due to the progressive ageing of the world population and scarce evidence in elderly patients with HF with reduced ejection fraction (HFrEF). The purpose of our study is to analyze the effect of SGLT2 inhibitors (SGLT2i) in this subgroup of patients. (2) Methods: A single-center, real-world observational study was performed. We consecutively enrolled all patients aged ≥ 75 years diagnosed with HFrEF and for treatment with SGLT2i, and considered the theoretical indications. (3) Results: A total of 364 patients were recruited, with a mean age of 84.1 years. At inclusion, the mean LVEF was 29.8%. Median follow-up was 33 months, and there were 122 deaths. A total of 55 patients were under SGLT2i treatment. A multivariate Cox logistic regression test for all-cause mortality was performed, and only SGLT2i (HR 0.39 [0.19-0.82]) and glomerular filtration rate (HR 0.98 [0.98-0.99]) proved to be protective factors. In parallel, we conducted a propensity-score-matched analysis, where a significant reduction in all-cause mortality was associated with the use of SGLT2i treatment (HR 0.39, [0.16-0.97]). (4) Conclusions: Treatment with SGLT2i in elderly patients with HFrEF was associated with a lower rate of all-cause mortality. Our data show that SGLT2i therapy could improve prognosis in the elderly with HFrEF in a real-world study.

Phase Angle as a Predictor of Mortality in Older Patients with Hip Fracture.

The aim of our study is to determine if there is an association between phase angle obtained by bioelectrical impedance analysis (BIA) and mortality in older patients with fragility hip fractures. A prospective study of patients over 65 years old and hospitalized with a diagnosis of hip fracture was conducted. BIA was performed 24 to 48 h after surgery. Mortality was recorded, and the optimal phase angle cut-off value for predicting mortality was determined by using receiver operating characteristic (ROC) curves. A total of 262 patients were included. Of the patients studied, 10 (3.8%), 21 (8%), 39 (14.9%) and 53 (20.2%) died at 1, 3, 6 and 12 months after surgery, respectively. The phase angle cut-off for mortality at 12 months was 4.05° in women and 4.65° in men. A total of 94 patients (35.9%) were considered to have a low phase angle. After adjustment for possible confounders, mortality in patients with a low phase angle was 5.1 times higher at 1 month, 3.1 times higher at 3 months, 2.9 times higher at 6 months, and 2.8 times higher at 12 months. Phase angle is associated with prognosis in patients admitted for hip fracture regardless of age and comorbidities and can be positioned as a prognostic tool for mortality at 1, 3, 6 and 12 months.

Evaluating the Safety of the Intragastric Balloon: Spanish Multicenter Experience in 20,680 Cases and with 12 Different Balloon Models.

INTRODUCTION: Intragastric balloon (IGB) is a minimally invasive and reversible option for obesity treatment. There is a worldwide growing number of different IGB models. The efficacy and safety profile for each model must be demonstrated. We aim to evaluate IGB safety profile according to the experience of the Spanish Bariatric Endoscopy Group (GETTEMO). METHODS: A survey of 37 IGBs safety-related questions was sent to all GETTEMO members, to retrospectively collect a multicenter Spanish registry. Incidence, causes, and resolution of both major and minor complications and adverse events (AEs), including legal consequences, differentiated for each balloon model were evaluated. Secondary outcome was weight loss data to confirm efficacy. RESULTS: Twenty-one Spanish hospitals experienced in IGBs responded. The overall data encompassed 20,680 IGBs, including 12 different models. Mean %TBWL of 17.66 ± 2.5% was observed. Early removal rate due to intolerance was 3.62%. Mean major complications rate was 0.70% (> 1% in Spatz2, HB, and Spatz3 models), mainly complicated gastric ulcer. Minor AEs rate was 6.37%, mainly esophagitis. Nine cases (0.04%) required surgery. A single case of mortality (0.0048%) occurred. Seven lawsuits (0.0034%) were received, all with favorable resolution. CONCLUSIONS: In the Spanish experience accumulating 20,680 IGBs and including 12 different balloon models, a low incidence rate of major complications and minor AEs are observed (0.70% and 6.37%, respectively), mostly resolved with medical/endoscopic management. IGB shows good tolerance and efficacy profile. These safety data are within the accepted quality standards.

Evidence on the benefits of probiotics for preterm infants.

Introduction: This article reviews the evidence for the use of different strains of probiotics in the prevention of prevalent pathologies in premature neonates. A systematic review was conducted of the use of probiotics in neonates with less than 37 weeks of gestational age, based on a search for systematic reviews and observational and experimental studies performed during the period from January 2014 to February 2021. For this purpose, the PubMed, MEDLINE and Cochrane Library databases were consulted. The aim of this article was to review the existing data on the relationship between the administration of probiotics (with different strains and doses) and the risk of necrotising enterocolitis, mortality, late sepsis and other disease parameters in premature infants. The literature search obtained 240 articles, of which we selected 16, representing a total sample of over 200,000 premature infants. Analysis of the data obtained reveals statistical evidence that the combined administration of probiotics (especially of Lactobacillus and Bifidobacterium strains) reduces the incidence of grade II or higher necrotising enterocolitis, all-cause mortality, late sepsis, length of hospital stay and time until complete enteral nutrition is achieved. However, no benefits were apparent with respect to alleviating bronchopulmonary dysplasia, retinopathy of prematurity or intraventricular haemorrhage. Further research is needed to determine the most appropriate strains, doses and treatment duration for preterm infants to achieve the health benefits identified.

Introducción: En este artículo se revisa la evidencia del uso de las diferentes cepas de probióticos en la prevención de diversas patologías prevalentes en recién nacidos prematuros. Se ha realizado una revisión sistemática sobre el uso de probióticos en recién nacidos de menos de 37 semanas de edad gestacional, realizando una búsqueda de revisiones sistemáticas, estudios observacionales y experimentales desde enero de 2014 hasta febrero de 2021. Para ello se han utlizado motores de búsqueda como PubMed, MEDLINE y la biblioteca Cochrane. El objetivo de este artículo fue revisar los datos existentes sobre la relación entre la administración de probióticos (con diferentes cepas y dosis) y el riesgo de enterocolitis necrotizante, mortalidad, sepsis tardía, y otros parámetros de enfermedad en prematuros. En la búsqueda se obtuvieron 240 artículos, de los que seleccionamos 16, obteniendo más de 200.000 recién nacidos prematuros como muestra. En esta revisión se muestra con evidencia estadística, que la administración combinada de probióticos (espcialmente cepas de Lactobacillus y Bifidobacterium) reducen la incidencia de NEC en grado II o mayor, mortalidad por todas las causas, sepsis tardía, días de estancia hospitalaria y tiempo en lograr nutrición enteral completa. No se han podido evidenciar beneficios en cuanto a la displasia broncopulmonar, retinopatía de la prematuridad y hemorragia intraventricular. Se precisan nuevos estudios para conocer las cepas, dosis y tiempo de tratamiento más adecuados en neonatos prematuros para lograr beneficios en salud.