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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Necrotising enterocolitis &#40;NEC&#41; is one of the most common and serious acquired bowel diseases a newborn can face&#46; Although it is not fully understood&#44; the cause is suspected to be a combination of vascular necrosis&#44; bacterial overgrowth and metabolic insults to the immature gut wall&#46; It is believed that after toxic or ischaemic damage to the mural wall&#44; and using the substrate proceeding from enteral feedings&#44; there is an overgrowth of bacteria&#44; especially those generating gases such as methane or hydrogen&#44; producing intramural gas &#40;pneumatosis intestinalis&#41; leading to a mural necrosis&#44; gut gangrene and&#44; finally&#44; intestinal perforation with peritonitis&#46; In recent years&#44; there has also been a greater acceptance of the theory that the host&#39;s immune system also plays an important pathophysiological role in the development of NEC&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">NEC predominantly affects premature infants&#44; with 70&#8211;85&#37; of cases of NEC occurring in very low birth weight infants &#40;&#60;1500<span class="elsevierStyleHsp" style=""></span>g&#41; or infants younger than 32 weeks&#44; whereas only 10&#8211;25&#37; of cases are term infants or late preterm infants&#46; The lower the gestational age&#44; the higher the risk of NEC&#46; Overall incidence of NEC has been reported as 7&#37; in a study conducted by the National Institute of Child Health &#40;NICHD&#41; Neonatal Research Network &#40;NRN&#41; in a population of 11&#44;072 very low birth weight infants &#40;VLBW&#41; for the period 1999&#8211;2001&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">2</span></a> Another study&#44; between the years 2003 and 2007&#44; found that the prevalence of NEC was about 11&#37; in very premature infants who were born at between 22 and 28 weeks post-menstrual age and had birth weights of 401&#8211;1500<span class="elsevierStyleHsp" style=""></span>g&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">3</span></a> The global mortality of NEC is approximately 20&#8211;40&#37;&#44; rising to 90&#8211;100&#37; in the most severe cases&#44; which represents 2&#8211;5&#37; of all neonatal intensive care unit &#40;NICU&#41; admissions&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">4</span></a> In addition&#44; between 27&#37; and 63&#37; of affected infants will undergo surgery<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">5</span></a> and one third will have a perforated bowel&#44; the short bowel syndrome being the most common complication&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Probiotics can be defined as live microorganisms which&#44; when administered in adequate amounts&#44; confer a health benefit for the host &#40;WHO&#47;FAO 2001&#41;&#46; Members of the genera Lactobacillus and Bifidobacterium are the most commonly used&#44; the <span class="elsevierStyleItalic">Lactobacillus rhamnosus</span> GG and <span class="elsevierStyleItalic">Bifidobacterium Lactis</span> being the strains with stronger evidence to support their use in humans&#46; Although the origin of the human microbiota is yet unknown&#44; it is important to note the differences after birth depend on the method of delivery&#44; type of feeding during gestation&#44; as well as the mother&#39;s microbiota&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">6</span></a> Healthy breast-fed infants have a higher amount of bifidobacteria whereas formula-fed infants tend to have a more varied range of microorganisms such as bifidobacteria&#44; bacteroidetes&#44; enterobacteria&#44; streptococci and clostridia&#46; The human microbiota will not be stable until the age of 2&#8211;3 years and&#44; even then&#44; might suffer modifications due to diet&#44; disease&#44; antibiotic use and ageing&#46; In recent years&#44; probiotics have been increasingly studied and used in clinical practice&#46; Some examples of this are the improvement of intestinal function in cystic fibrosis&#44; reducing bacterial overgrowth&#44;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">7</span></a> or the shortening of the duration of acute gastroenteritis&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">VLBW infants with increased risk of NEC have different faecal bacteria colonisation&#44; together with delayed onset of bacterial colonisation in comparison to normal term newborns&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">9</span></a> It is believed that probiotics may modify the microbiota and the immune response of the newborn&#44; reducing the risk of NEC through different mechanisms&#59; direct competition for nutrients and prebiotics&#44; transforming certain elements present in the gut into inhibitory substances&#44; producing growth factors and vitamins to promote a healthy microbiota&#44; synthesising bacteriocins&#44; competing for binding locus&#44; increasing the production of IgA&#44; increasing the immune response and reducing the inflammation when stimulating regulatory lymphocytes through IL-10 and TGF&#946;&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">10&#8211;12</span></a> Despite the potential benefits&#44; such interventions have been delayed due to the theoretical risk of bacterial sepsis that could occur in VLBW or preterm infants&#44; especially those with extremely low birth weight &#40;&#60;1000<span class="elsevierStyleHsp" style=""></span>g&#41;&#46; However&#44; there is little data to support this concern&#46; In addition&#44; infants exposed to a NICU undergo a wide range of procedures that may modify their microbiota&#58; antibiotic use&#44; diet modifications&#44; catheterisation&#44; etc&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The use of probiotics has been analysed and studied by different scientific societies&#46; An example would be the Spanish Society of Neonatology &#40;SENeo&#41;&#44; which provides the following reccommendations<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">13</span></a>&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0030" class="elsevierStylePara elsevierViewall">In situations with high NEC incidence&#44; it is recommended to provide probiotic supplementation&#46; Grade 1&#43;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0035" class="elsevierStylePara elsevierViewall">Probiotic use should be considered in neonates under 32 weeks or less than 1500<span class="elsevierStyleHsp" style=""></span>g&#44; including less than 1000<span class="elsevierStyleHsp" style=""></span>g newborns&#46; Good ethics practice&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0040" class="elsevierStylePara elsevierViewall">Probiotic use requires a strict monitoring&#46; Good ethics practice&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0045" class="elsevierStylePara elsevierViewall">Evidence suggests the use of species from the Lactobacillus and Bifidobacterium genres&#44; due to their effect in reducing NEC&#44; although the species&#44; dose and duration must be adapted according to each case&#46; Good ethics practice&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0050" class="elsevierStylePara elsevierViewall">Start the administration as soon as possible and maintain it 6 weeks or until discharge&#46; Good ethics practice&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">-</span><p id="par0055" class="elsevierStylePara elsevierViewall">Stop probiotic supplementation in case of NEC or gastrointestinal disease&#46; Good ethics practice&#46;</p></li></ul></p><p id="par0060" class="elsevierStylePara elsevierViewall">Up to the present&#44; there have been few studies comparing the effects of specific strands of probiotics&#44; alone or in combination&#44; on NEC&#44; late-onset sepsis and mortality&#46; The objective of this study is to compare different probiotic mixtures to prevent necrotising enterocolitis and reduce late-onset sepsis and mortality in premature infants under 1500<span class="elsevierStyleHsp" style=""></span>g&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Study search</span><p id="par0065" class="elsevierStylePara elsevierViewall">In order to find the maximum number of studies connecting the use of probiotics and NEC prevention&#44; a thorough search of MEDLINE&#44; the Cochrane Central Register of Controlled Trials&#44; together with EMBASE&#44; was carried out&#46; The MEDLINE search was performed through PubMed &#40;<a id="intr0010" class="elsevierStyleInterRef" href="http://www.ncbi.nlm.nih.gov/pubmed">www&#46;ncbi&#46;nlm&#46;nih&#46;gov&#47;pubmed</a>&#41; using the MeSH terms &#8220;neonate&#8221;&#44; &#8220;Infant&#44; Newborn&#8221;&#44; &#8220;probiotic&#8221; and &#8220;enterocolitis&#44; necrotising&#8221;&#46; EMBASE was searched using the same method as the MEDLINE database&#46; Studies were considered from January 1980 to March 2014&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">In addition&#44; a manual search of different relevant studies and published reviews also took place&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Selection of studies</span><p id="par0075" class="elsevierStylePara elsevierViewall">Out of all the available studies&#44; only the randomised controlled studies that had NEC outcome&#44; very low birth weight infants &#40;&#60;1500<span class="elsevierStyleHsp" style=""></span>g&#41; or &#60;34 weeks of gestational age newborns were selected&#46; Moreover&#44; those that did not have a Jadad score&#44; a study quality evaluation scale equal or higher than 4&#44; or did not have blinded randomisation&#44; were discarded &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Finally&#44; of the remaining studies&#44; those that had a control group of infants treated without probiotics and a group of neonates treated with bacterial probiotics&#44; all mixed with donor&#44; human or formula milk&#44; were ultimately selected&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Bias risk</span><p id="par0080" class="elsevierStylePara elsevierViewall">To reduce the risk of bias&#44; all studies were observed using the Jadad Score&#44; together with the standard methods of the Cochrane Collaboration and Neonatal Review Group&#46; Information such as method of randomisation&#44; blinding and reporting of all outcomes&#44; as well as withdrawal and dropouts&#44; was taken into account&#46; If information was missing&#44; it was extracted from pre-existing meta-analyses or further contact with the authors was established&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Statistical analysis and measurement of treatment effect</span><p id="par0085" class="elsevierStylePara elsevierViewall">All data were analysed with standardised meta-analysis protocols&#46; For dichotomous outcomes&#44; the relative risk &#40;RR&#41; and numbers needed to treat &#40;NNT&#41;&#44; in conjunction with their 95&#37; confidence intervals&#44; were calculated&#46; For continuous outcomes&#44; the median difference and standard deviation were calculated&#46; The severity of NEC was classified using the modified Bell&#39;s criteria&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">14</span></a> Only severe NEC&#44; stages II and III&#44; were considered in the analysis&#46; Sepsis was considered when positive blood or cerebrospinal fluid cultures taken beyond 5 days of age&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">When comparing the effects of the different probiotic strands&#44; inference to 1000 neonates per group was calculated and then compared with chi-square analysis&#44; alongside their 95&#37; confidence intervals&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><p id="par0095" class="elsevierStylePara elsevierViewall">A total of 24 publications were selected to undergo further study&#44; of which 9 were selected for their high quality and reduced risk of bias &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; It is important to note that trials were highly variable according to their inclusion criteria&#44; risk of NEC&#44; sample size&#44; as well as the dose&#44; the type and the duration of probiotics given&#46; The characteristics of these trials are summarised in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Effect of probiotics on severe NEC &#40;stage II&#8211;III&#41;</span><p id="par0100" class="elsevierStylePara elsevierViewall">Data on severe NEC were present in all 9 studies&#46; There were a total of 3521 newborn infants divided into two groups&#58; the probiotic group and the control group&#46; In the probiotic group&#44; there were a total of 1756 neonates whereas the control group had a total of 1765 infants&#46; There was a statistically significant reduction in the relative risk of developing NEC in the probiotic group in comparison to the control group&#44; RR 0&#46;39&#59; 95&#37; CI&#58; 0&#46;26&#8211;0&#46;57&#46; The newborns needed to treat with probiotics to prevent 1 case of NEC were 33&#59; 95&#37; CI&#58; 23&#8211;54 &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">In order to study if the probiotic strand had any influence on NEC reduction&#44; data from the Dani 2002 and Manzoni 2009 vs the Lin 2005 and Lin 2008 vs Samanta 2009 and Jacobs 2013 were analysed&#46; In the first two&#44; <span class="elsevierStyleItalic">L&#46; rhamnosus GG</span> &#40;Bivos<span class="elsevierStyleSup">&#174;</span>&#41; was used&#44; whilst in the following two&#44; they used <span class="elsevierStyleItalic">Lactobacillus acidophilus</span> with <span class="elsevierStyleItalic">Bifidobacterium bifidum</span> &#40;Infloran<span class="elsevierStyleSup">&#174;</span>&#41;&#46; Finally&#44; in the last two studies&#44; three or more probiotics were used &#40;<span class="elsevierStyleItalic">Bifidobacterium infantis</span>&#44; <span class="elsevierStyleItalic">Streptococcus termophilus</span>&#44; <span class="elsevierStyleItalic">B&#46; lactis&#44; B&#46; bifidum&#44; Bifidobacterium longum</span> and <span class="elsevierStyleItalic">L&#46; acidophilus</span>&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">When studying the three different groups&#44; 446 newborns were treated with Bivos<span class="elsevierStyleSup">&#174;</span>&#44; 397 with Infloran<span class="elsevierStyleSup">&#174;</span> and 639 neonates with 3 or more probiotics&#46; The 1st group of only 1 probiotic showed no statistically significant reduction in NEC incidence&#44; whereas the 2nd of 2 probiotics and the 3rd of 3 or more probiotics did have a significant reduction in relative risk &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46; As for the NNT&#44; in the 2nd group the NNT was the lowest of the three&#44; NNT 22&#59; 95&#37; CI&#58; 14&#8211;54&#44; followed by the 3rd group&#44; NNT 28&#59; 95&#37; CI&#58; 17&#8211;75&#46; Once summarised to the same number of cases&#44; and after applying chi-square analysis&#44; there was no statistically significant difference between them &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Effect of probiotics on late-onset sepsis</span><p id="par0115" class="elsevierStylePara elsevierViewall">In all the publications&#44; there was data referring to sepsis studies through different cultures such as blood&#44; LCR and peritoneal fluid&#44; as well as bronchial secretions&#44; if present&#46; There were 1756 infants in the probiotic group and 1765 newborns in the control group&#46; Amongst these patients&#44; there was no statistically significant difference in relative risk&#44; RR 0&#46;91&#59; 95&#37; CI&#58; 0&#46;78&#8211;1&#46;06&#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41;&#46; There was a discrete advantage in using 3 or more probiotics&#44; when compared to the other combinations&#44; RR 0&#46;73&#59; 95&#37; CI&#58; 0&#46;57&#8211;0&#46;95&#46; These differences are still present between the 2 probiotics group and the 3 or more probiotic group &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;028&#41;&#44; with the chi-square analysis &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Effect of probiotics on mortality</span><p id="par0120" class="elsevierStylePara elsevierViewall">Data on all-cause mortality was recorded in 9 of the randomised controlled trials &#40;RCTs&#41;&#44; with a total of 3521 infants divided into a probiotic group &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1756&#41; and a control group &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1765&#41;&#46; There was also a statistically significant reduction in all-cause mortality&#44; RR 0&#46;70&#59; 95&#37;CI&#58; 0&#46;52&#8211;0&#46;93&#46; The numbers needed to treat to prevent 1 death from all-cause mortality was 53&#59; 95&#37; CI&#58; 30&#8211;238&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">When analysing the NEC-associated mortality&#44; it was only reported in 4 of the 9 trials&#46; A total of 2339 infants were studied&#44; divided into the probiotic group &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1170&#41; and the control group &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1169&#41;&#46; In this case&#44; the NEC-associated mortality was lower in the probiotic group and this reduction was statistically significant&#44; RR 0&#46;35&#59; 95&#37; CI&#58; 0&#46;14&#8211;0&#46;89 &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">Strand-associated difference was also taken into account &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#59; the 2nd group&#44; with 2 probiotics&#44; had a reduction in the relative risk of mortality that was significant in comparison to the other groups&#44; RR 0&#46;32&#59; 95&#37; CI&#58; 0&#46;15&#8211;0&#46;66&#46; The newborns needed to treat for the Infloran<span class="elsevierStyleSup">&#174;</span> group were 20&#59; 95&#37; CI&#58; 12&#8211;50&#46; After equalling the numbers of cases and applying the chi-square analysis&#44; there was a statistically significant difference between the different groups&#59; 2 probiotics versus 1 probiotic &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;016&#41; and also compared to 3 or more probiotics &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;004&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discussion</span><p id="par0135" class="elsevierStylePara elsevierViewall">Although there have been systematic publications and good quality reviews that sustain the correct use of probiotics for preventing NEC&#44; probiotics have still not truly been implemented worldwide&#46; In order to provide more data supporting the use of probiotics as a medical tool to prevent NEC&#44; this meta-analysis was performed using only high-quality studies&#44; based on their allocation concealments procedures and blinding of the intervention&#46; Therefore&#44; after making a pre-selection of 24 studies&#44; only 9 of them where finally considered adequate for the analysis given that they had a good allocation concealment procedure&#44; good blinding interventions and also provided information on all factors that influence the incidence of NEC&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Regarding the study selection criteria&#44; infants less than 34 weeks or weighing less than 1500<span class="elsevierStyleHsp" style=""></span>g were selected due to their increased risk of suffering from NEC&#46; In addition&#44; the majority of studies also contemplated these age&#47;weight groups for the aforementioned reasons&#46; Moreover&#44; preterm infants will experiment a growth in number&#44; especially in those countries where maternal age increases and with the upsurge in artificial methods of conception&#46; Under such circumstances&#44; it seems important to pay special attention to the group with a higher risk of NEC for which a prevention method could be very important&#46; In term infants&#44; or late preterm infants&#44; the incidence of NEC is significantly lower&#44; meaning that the costs of preventing a NEC case could be much higher than the possible risks associated with NEC&#46; Furthermore&#44; the use of probiotics for prevention could render no positive results&#46; For the bias risk assessment&#44; the Jadad score was used because it has been recognised as a good method for reducing the blinding bias&#44; in conjunction with others&#44; and increases the statistical quality of systematic reviews and meta-analysis&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">24</span></a> In addition to the use of the Jadad score&#44; the standard methods of the Cochrane Collaboration and Neonatal Review Group were also taken into account since this institution is very well regarded for its scientific and research rigour&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">25</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">When considering the actual effect of probiotics in NEC prevention&#44; it is clear that there is a reduction of severe NEC&#44; consistent with many other existing meta-analyses<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">5&#44;26&#8211;31</span></a> and studies&#44; as well as a reduction in mortality without any effect on late-onset sepsis&#58; neither reduction nor increase &#40;late-onset sepsis is the principal feared risk of giving such prophylactic measures&#41;&#46; Although the numbers needed to treat to prevent a NEC case are relatively high&#44; 33&#44; and the numbers to prevent death in neonates are even higher&#44; 53&#44; these have to be taken into account when facing the fact that premature births are increasing&#44; the costs of a NEC episode are high and probiotics are easy to handle in addition to having a low cost&#46; However&#44; since NEC has a high morbimortality&#44; would it not be unethical to keep this inexpensive measure from newborns&#63; In future trials&#44; it would seem better to focus on the effect of different probiotic strands in order to identify the best combination possible for these patients&#46; Following this direction&#44; in the current meta-analysis&#44; strand-associated difference was studied and noted&#46; Although there was no difference between probiotics when it came to reducing NEC incidence&#44; there was a clear benefit in death reduction when giving a two probiotic combination &#40;<span class="elsevierStyleItalic">L&#46; acidophilus and B&#46; bifidum</span>&#41;&#44; compared to three or more probiotics &#40;<span class="elsevierStyleItalic">B&#46; infantis</span>&#44; <span class="elsevierStyleItalic">S&#46; termophilus</span>&#44; <span class="elsevierStyleItalic">B&#46; lactis</span>&#44; <span class="elsevierStyleItalic">B&#46; bifidum</span>&#44; <span class="elsevierStyleItalic">B&#46; longum and L&#46; acidophilus</span>&#41; or just one probiotic &#40;<span class="elsevierStyleItalic">L&#46; rhamnosus GG</span>&#41;&#46; When focusing on late-onset-sepsis&#44; the combination of 3 or more probiotics proved to be beneficial when compared to the rest&#46; Therefore&#44; both the combination of 2 probiotics and 3 or more probiotics would be beneficial for the newborns&#44; one especially for mortality and the other for late-onset sepsis&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">As for the dose of probiotics&#44; it is important to achieve an optimal mass of probiotic in order to survive and colonise the gut&#44; proliferating in adequate amounts&#44; to confer a health benefit&#46; The evidence suggests this dose should be minimally 10<span class="elsevierStyleSup">6</span>&#8211;10<span class="elsevierStyleSup">7</span> colony-forming units in each gram of product&#46;<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">32&#8211;34</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">Finally&#44; concerning the strengths and weaknesses&#44; this meta-analysis is the first to study the different probiotic compounds and mixtures existing and the first to find out if there is a probiotic mix or compound with superior performance when compared with the rest&#46; However&#44; neither the mix of probiotics nor the dose nor the duration of their administration are always the same&#44; leading to a reduction in the certainty of the results&#46; Moreover&#44; in some cases&#44; although concealment and blinding of intervention were correct&#44; there was a substantial difference in the age at birth between groups&#44; a fundamental factor for the risk of NEC&#44; making it difficult to know if the reduction of relative risk was due to probiotics or simply because the maturity was different between groups&#46; Other studies&#44; although still correct&#44; had poor data analysis and lacked information concerning the kind of feeding infants received&#44; or lacked information about some risk or prevention factors concerning NEC&#46; It is also important to note that no studies have assessed the effect of probiotics in extremely low birth weight neonates &#40;&#60;1000<span class="elsevierStyleHsp" style=""></span>g&#41; where the risk of late-onset sepsis could be higher&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">To conclude&#44; the use of probiotics as a method to prevent severe necrotising enterocolitis in preterm neonates has been proven&#44; with the combination of <span class="elsevierStyleItalic">L&#46; acidophilus and B&#46; bifidum</span> emerging as the best in reducing overall cause mortality&#46; Therefore&#44; probiotics should be given routinely to all high-risk neonates&#46; Where there are safety concerns&#44; probiotics could be continued within a research framework that does not necessarily need studies with a placebo comparison&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflict of interests</span><p id="par0165" class="elsevierStylePara elsevierViewall">Authors declare no conflict of interest&#46;</p></span></span>"
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          "titulo" => "Resumen"
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          "titulo" => "Palabras clave"
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          "titulo" => "Introduction"
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          "titulo" => "Methods"
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              "titulo" => "Study search"
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              "identificador" => "sec0020"
              "titulo" => "Selection of studies"
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              "identificador" => "sec0025"
              "titulo" => "Bias risk"
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              "titulo" => "Statistical analysis and measurement of treatment effect"
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              "identificador" => "sec0040"
              "titulo" => "Effect of probiotics on severe NEC &#40;stage II&#8211;III&#41;"
            ]
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              "identificador" => "sec0045"
              "titulo" => "Effect of probiotics on late-onset sepsis"
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              "identificador" => "sec0050"
              "titulo" => "Effect of probiotics on mortality"
            ]
          ]
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          "identificador" => "sec0055"
          "titulo" => "Discussion"
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          "identificador" => "sec0060"
          "titulo" => "Conflict of interests"
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          "titulo" => "References"
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    "pdfFichero" => "main.pdf"
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    "fechaRecibido" => "2015-06-02"
    "fechaAceptado" => "2015-07-27"
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          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec749905"
          "palabras" => array:6 [
            0 => "Very-low birth weight infants"
            1 => "Necrotising enterocolitis"
            2 => "Probiotics"
            3 => "Premature infant"
            4 => "Mortality"
            5 => "Late-onset sepsis"
          ]
        ]
      ]
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec749906"
          "palabras" => array:6 [
            0 => "Neonatos de muy bajo peso"
            1 => "Enterocolitis necrotizante"
            2 => "Probi&#243;ticos"
            3 => "Prematuro"
            4 => "Mortalidad"
            5 => "Sepsis tard&#237;a"
          ]
        ]
      ]
    ]
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    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Necrotising enterocolitis &#40;NEC&#41; is one of the most common and serious acquired bowel diseases a premature newborn can face&#46; This meta-analysis was performed comparing different probiotic mixtures to ascertain their benefits as a routine tool for preventing necrotising enterocolitis and reducing late-onset sepsis and mortality in premature neonates of less than 1500<span class="elsevierStyleHsp" style=""></span>g&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A systematic review of randomised controlled trials&#44; between January 1980 and March 2014&#44; on MEDLINE&#44; the Cochrane Central Register of Controlled Trials&#44; together with EMBASE&#44; was carried out&#46; Studies with infants &#60;1500<span class="elsevierStyleHsp" style=""></span>g or &#60;34 weeks were selected&#44; discarding those with Jadad scores lower than 4&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">9 studies were selected for further investigation&#44; pooling a total of 3521 newborns&#46; Probiotics were found to reduce the NEC incidence &#40;RR 0&#46;39&#59; 95&#37; CI&#58; 0&#46;26&#8211;0&#46;57&#41; and mortality &#40;RR 0&#46;70&#59; 95&#37; CI&#58; 0&#46;52&#8211;0&#46;93&#41;&#44; with no difference to placebo regarding late-onset sepsis &#40;RR 0&#46;91&#59; 95&#37; CI&#58; 0&#46;78&#8211;1&#46;06&#41;&#46; Finally&#44; when analysing the different strands&#44; the use of a 2-probiotic combination &#40;<span class="elsevierStyleItalic">Lactobacillus acidophilus</span> with <span class="elsevierStyleItalic">Bifidobacterium bifidum&#41;</span> proved to be statistically significant in reducing all-cause mortality when compared to other probiotic combinations &#40;RR 0&#46;32&#59; 95&#37; CI&#58; 0&#46;15&#8211;0&#46;66&#44; NNT 20&#59; 95&#37; CI&#58; 12&#8211;50&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Probiotics are a beneficial tool in the prevention of NEC and mortality in preterm neonates&#46; Moreover&#44; the combination of 2 probiotics &#40;<span class="elsevierStyleItalic">L&#46; acidophilus</span> with <span class="elsevierStyleItalic">B&#46; bifidum</span>&#41; seems to produce the greatest benefits&#46; However&#44; due to the differences in probiotic components and administration&#44; it would be wise to perform a randomised controlled trial comparing different probiotic mixtures&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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            "identificador" => "abst0020"
            "titulo" => "Conclusions"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Los reci&#233;n nacidos pret&#233;rminos y de muy bajo peso presentan mayor riesgo de enterocolitis necrosante &#40;NEC&#41; dado que su colonizaci&#243;n a nivel intestinal se produce m&#225;s tard&#237;amente y es diferente respecto a los reci&#233;n nacidos a t&#233;rmino&#44; adem&#225;s de presentar con mayor frecuencia otros factores favorecedores como isquemia intestinal&#46; Se cree que los probi&#243;ticos pueden modificar la microbiota y la respuesta immune de los reci&#233;n nacidos&#44; disminuyendo la incidencia de NEC&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Objetivo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Revisar los estudios realizados con diferentes probi&#243;ticos y comparar diferentes combinaciones de &#233;stos para ver si es beneficiosa su administraci&#243;n de forma rutinaria en reci&#233;n nacidos pret&#233;rmino de menos de 1500<span class="elsevierStyleHsp" style=""></span>g para evitar la enterocolitis necrosante&#44; reducir la sepsis tard&#237;a y la mortalidad&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Material y M&#233;todos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se llev&#243; a cabo una revisi&#243;n sistem&#225;tica entre enero 1980 y marzo 2014&#44; en MEDLINE&#44; EMBASE y Cochrane Central Register of Controlled Trials&#46; Se seleccionaron los estudios cl&#237;nicos con reci&#233;n nacidos prematuros de &#60;1500<span class="elsevierStyleHsp" style=""></span>g y&#47;o &#60;34 semanas descartando aquellos con puntuaciones de Jadad menores de 4&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Resultados</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se seleccionaron 9 estudios&#44; de 24 pre-seleccionados&#44; con un total de 3521 reci&#233;n nacidos&#46; Se observ&#243; que los probi&#243;ticos reducen la incidencia de NEC &#40;RR 0&#44;39&#59; 95&#37; CI&#58; 0&#44;26-0&#44;57&#41; y la mortalidad &#40;RR 0&#44;70&#59; 95&#37; CI&#58; 0&#44;52-0&#44;93&#41;&#46; No se detectaron diferencias significativas con el placebo en la disminuci&#243;n de sepsis tard&#237;a &#40;RR 0&#44;91&#59; 95&#37; CI&#58; 0&#44;78-1&#44;96&#41;&#46; Finalmente&#44; cuando se analizan las distintas cepas&#44; la combinaci&#243;n de 2 probi&#243;ticos &#40;<span class="elsevierStyleItalic">Lactobacillus acidophilus</span> con <span class="elsevierStyleItalic">Bifidobacterium bifidum</span>&#41; demostr&#243; reducir la mortalidad de forma significativa comparada con otras combinaciones de probi&#243;ticos &#40;RR 0&#44;32&#59; 95&#37; CI&#58; 0&#44;15-0&#44;66&#44; NNT 20&#59; 95&#37; CI&#58; 12-50&#41;&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusiones</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Los probi&#243;ticos son beneficiosos en cuanto a la prevenci&#243;n de NEC y reducen la mortalidad en pret&#233;rminos de menos de 1&#46;500<span class="elsevierStyleHsp" style=""></span>g&#46; Adem&#225;s&#44; la combinaci&#243;n de dos probi&#243;ticos &#40;<span class="elsevierStyleItalic">Lactobacillus acidophilus</span> con <span class="elsevierStyleItalic">Bifidobacterium bifidum</span>&#41; presenta mayor beneficio&#46; Dada la diferencia de composici&#243;n de probi&#243;ticos son necesarios estudios aleatorizados comparando diferentes combinaciones de probi&#243;ticos&#46;</p></span>"
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            "titulo" => "Introducci&#243;n"
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            "titulo" => "Objetivo"
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            "titulo" => "Material y M&#233;todos"
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            "titulo" => "Resultados"
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            "titulo" => "Conclusiones"
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    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Baucells BJ&#44; Mercadal Hally M&#44; &#193;lvarez S&#225;nchez AT&#44; Figueras Aloy J&#46; Asociaciones de probi&#243;ticos para la prevenci&#243;n de la enterocolitis necrosante y la reducci&#243;n de la sepsis tard&#237;a y la mortalidad neonatal en reci&#233;n nacidos pret&#233;rmino de menos de 1500<span class="elsevierStyleHsp" style=""></span>g&#58; Una revisi&#243;n sistem&#225;tica&#46; An Pediatr &#40;Barc&#41;&#46; 2016&#59;85&#58;247&#8211;255&#46;</p>"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Flux diagram of study selection&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Item&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Scoring&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Randomisation</td><td class="td" title="table-entry  " align="left" valign="top">Described&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 point&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Correct randomisation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 additional point&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Incorrect randomisation&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Double blinding</td><td class="td" title="table-entry  " align="left" valign="top">Described&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 point&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Correct randomisation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 additional point&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Incorrect randomisation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 point deducted&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Withdrawals and dropouts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Number and reasons for withdrawal are stated&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 point&nbsp;\t\t\t\t\t\t\n
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        "etiqueta" => "Table 2"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Trial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Birth weight and gestational age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Probiotic agents&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Dosage and duration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Type of feeding&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Primary outcome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dani et al&#46; &#40;2002&#41;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">15</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;1500<span class="elsevierStyleHsp" style=""></span>g&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">L&#46; rhamnosus</span> GG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">9</span><span class="elsevierStyleHsp" style=""></span>CFU&#47;24<span class="elsevierStyleHsp" style=""></span>h until discharge&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Breastfeed&#44; formula or donor milk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">UTI&#44; sepsis&#44; NEC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lin et al&#46; &#40;2005&#41;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">16</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;1500<span class="elsevierStyleHsp" style=""></span>g&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">L&#46; acidophilus</span> and <span class="elsevierStyleItalic">B&#46; infantis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">125<span class="elsevierStyleHsp" style=""></span>mg&#47;kg twice daily&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Breastfeed or donor milk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NEC&#44; death&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lin et al&#46; &#40;2008&#41;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">17</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;34 weeks and &#60;1500<span class="elsevierStyleHsp" style=""></span>g&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">L&#46; acidophilus</span> and <span class="elsevierStyleItalic">B&#46; bifidum</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">9</span><span class="elsevierStyleHsp" style=""></span>CFU&#47;24<span class="elsevierStyleHsp" style=""></span>h for 6 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Breastfeed or formula&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NEC&#44; death&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Manzoni et al&#46; &#40;2009&#41;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">18</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;1500<span class="elsevierStyleHsp" style=""></span>g&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">L&#46; rhamnosus</span> GG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">9</span><span class="elsevierStyleHsp" style=""></span>CFU&#47;24<span class="elsevierStyleHsp" style=""></span>h for 4 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Breastfeed&#44; formula or donor milk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Late-onset sepsis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Roug&#233; et al&#46; &#40;2009&#41;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">19</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;32 weeks and &#60;1500<span class="elsevierStyleHsp" style=""></span>g&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">L&#46; rhamnosus</span> GG and <span class="elsevierStyleItalic">B&#46; longum</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">9</span> CFU&#47;24<span class="elsevierStyleHsp" style=""></span>hours until discharge&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Breastfeed&#44; formula or donor milk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Enteral feed intake at day 14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Samanta et al&#46; &#40;2009&#41;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">20</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;34 weeks and &#60;1500<span class="elsevierStyleHsp" style=""></span>g&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">B&#46; infantis</span>&#44; <span class="elsevierStyleItalic">B&#46; bifidum</span>&#44; <span class="elsevierStyleItalic">L&#46; acidophilus</span>&#44; <span class="elsevierStyleItalic">B&#46; longum</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;5<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">9</span><span class="elsevierStyleHsp" style=""></span>CFU&#47;12<span class="elsevierStyleHsp" style=""></span>h until discharge&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Breastfeed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NEC&#44; death&#44; sepsis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sari et al&#46; &#40;2010&#41;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">21</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;33 weeks and &#60;1500<span class="elsevierStyleHsp" style=""></span>g&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">L&#46; sporogenes</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;5<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">8</span><span class="elsevierStyleHsp" style=""></span>CFU&#47;24<span class="elsevierStyleHsp" style=""></span>h until discharge&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Breastfeed or formula milk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NEC&#44; death&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bragard et al&#46; &#40;2011&#41;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">22</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;1500<span class="elsevierStyleHsp" style=""></span>g&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">L&#46; casei</span> and <span class="elsevierStyleItalic">B&#46; breve</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;5<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">7</span>&#8211;3&#46;5<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">9</span><span class="elsevierStyleHsp" style=""></span>CFU&#47;24<span class="elsevierStyleHsp" style=""></span>h until infant 30 days of life&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Breastfeed&#44; formula or donor milk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NEC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Jacobs et al&#46; &#40;2013&#41;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">23</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;32 weeks and &#60;1500<span class="elsevierStyleHsp" style=""></span>g&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">B&#46; infantis</span>&#44; <span class="elsevierStyleItalic">S&#46; termophilus</span> and <span class="elsevierStyleItalic">B&#46; lactis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">9</span><span class="elsevierStyleHsp" style=""></span>CFU&#47;24<span class="elsevierStyleHsp" style=""></span>h until discharge&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Breastfeed or formula milk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Late-onset sepsis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Characteristics of selected studies for meta-analysis&#46;</p>"
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      4 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Studies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">NEC probiotic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">NEC control&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Relative Risk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dani et al&#46; &#40;2002&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#47;295&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#47;290&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;49 &#91;0&#46;15&#8211;1&#46;61&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lin et al&#46; &#40;2005&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#47;180&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#47;187&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;21 &#91;0&#46;05&#8211;0&#46;94&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lin et al&#46; &#40;2008&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#47;217&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#47;217&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;29 &#91;0&#46;10&#8211;0&#46;85&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Manzoni et al&#46; &#40;2009&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#47;151&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#47;153&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;05 &#91;0&#46;00&#8211;0&#46;90&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Roug&#233; et al&#46; &#40;2009&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#47;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#47;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;18 &#91;0&#46;2&#8211;23&#46;21&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Samanta et al&#46; &#40;2009&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#47;91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#47;95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;34 &#91;0&#46;13&#8211;0&#46;92&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sari et al&#46; &#40;2010&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#47;110&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#47;111&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;12 &#91;0&#46;01&#8211;2&#46;19&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Braga et al&#46; &#40;2011&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#47;119&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#47;112&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;10 &#91;0&#46;01&#8211;1&#46;92&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Jacobs et al&#46; &#40;2013&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#47;548&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&#47;551&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;56 &#91;0&#46;31&#8211;0&#46;99&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="char" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Global&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34&#47;1756&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">88&#47;1765&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;39 &#91;0&#46;26&#8211;0&#46;57&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">NNT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33 &#91;23&#8211;54&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Probiotics vs control&#44; severe NEC &#40;stage II-III&#41; in &#60;1500<span class="elsevierStyleHsp" style=""></span>g infants&#46;</p>"
        ]
      ]
      5 => array:7 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "tabla" => array:1 [
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Probiotic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Control&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Relative risk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">NNT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">NEC &#40;stage II-III&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>1 probiotic &#40;Bivos<span class="elsevierStyleSup">&#174;</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#47;446&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#47;443&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;36 &#91;0&#46;12&#8211;1&#46;13&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>2 Probiotics &#40;Infloran<span class="elsevierStyleSup">&#174;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#47;397&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&#47;404&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;26 &#91;0&#46;11&#8211;0&#46;62&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22 &#91;14&#8211;54&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8805;3 probiotics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#47;639&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39&#47;646&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;41 &#91;0&#46;23&#8211;0&#46;73&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28 &#91;17&#8211;75&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Mortality</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>1 probiotic &#40;Bivos<span class="elsevierStyleSup">&#174;</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#47;446&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#47;443&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;99 &#91;0&#46;32&#8211;3&#46;06&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>2 Probiotics &#40;Infloran<span class="elsevierStyleSup">&#174;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#47;397&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29&#47;404&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;32 &#91;0&#46;15&#8211;0&#46;66&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#91;12&#8211;50&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8805;3 probiotics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31&#47;639&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42&#47;646&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;74 &#91;0&#46;47&#8211;1&#46;17&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Sepsis</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>1 probiotic &#40;Bivos<span class="elsevierStyleSup">&#174;</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#47;446&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#47;443&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;99 &#91;0&#46;55&#8211;1&#46;79&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>2 Probiotics &#40;Infloran<span class="elsevierStyleSup">&#174;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62&#47;397&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60&#47;404&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;05 &#91;0&#46;76&#8211;1&#46;46&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8805;3 probiotics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">85&#47;639&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">117&#47;646&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;73 &#91;0&#46;57&#8211;0&#46;95&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21 &#91;11&#8211;119&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Probiotic strand associated differences&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Studies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sepsis probiotic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sepsis control&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Relative risk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dani et al&#46; &#40;2002&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#47;295&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#47;290&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;15 &#91;0&#46;54&#8211;2&#46;44&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lin et al&#46; &#40;2005&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22&#47;180&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36&#47;187&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;63 &#91;0&#46;39&#8211;1&#46;04&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lin et al&#46; &#40;2008&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40&#47;217&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&#47;217&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;67 &#91;1&#46;04&#8211;2&#46;67&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Manzoni et al&#46; &#40;2009&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#47;151&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#47;153&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;27 &#91;0&#46;12&#8211;0&#46;60&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Roug&#233; et al&#46; &#40;2009&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#47;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#47;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;26 &#91;0&#46;67&#8211;2&#46;34&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Samanta et al&#46; &#40;2009&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#47;91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#47;95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;48 &#91;0&#46;27&#8211;0&#46;87&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sari et al&#46; &#40;2010&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29&#47;110&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&#47;111&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;13 &#91;0&#46;71&#8211;1&#46;78&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Braga et al&#46; &#40;2011&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40&#47;119&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42&#47;112&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;90 &#91;0&#46;63&#8211;1&#46;27&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Jacobs et al&#46; &#40;2013&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">72&#47;548&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">89&#47;551&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;81 &#91;0&#46;61&#8211;1&#46;08&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Global&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">252&#47;1756&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">279&#47;1765&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;91 &#91;0&#46;78&#8211;1&#46;06&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Probiotic vs control culture positive sepsis&#46;</p>"
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Studies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Death probiotic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Death control&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Relative risk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">All cause</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Dani et al&#46; &#40;2002&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#47;295&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#47;290&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;20 &#91;0&#46;01&#8211;4&#46;08&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Lin et al&#46; &#40;2005&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#47;180&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#47;187&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;36 &#91;0&#46;16&#8211;0&#46;84&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Lin et al&#46; &#40;2008&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#47;217&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#47;217&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;22 &#91;0&#46;05&#8211;1&#46;02&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Manzoni et al&#46; &#40;2009&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#47;151&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#47;153&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;56 &#91;0&#46;21&#8211;1&#46;45&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Roug&#233; et al&#46; &#40;2009&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#47;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#47;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;54 &#91;0&#46;10&#8211;2&#46;83&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Samanta et al&#46; &#40;2009&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#47;91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#47;95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;30 &#91;0&#46;10&#8211;0&#46;86&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sari et al&#46; &#40;2010&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#47;110&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#47;111&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;76 &#91;0&#46;17&#8211;3&#46;30&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Braga et al&#46; &#40;2011&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&#47;119&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27&#47;112&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;91 &#91;0&#46;46&#8211;1&#46;45&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Jacobs et al&#46; &#40;2013&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27&#47;548&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#47;551&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;97 &#91;0&#46;58&#8211;1&#46;62&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Global&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">77&#47;1756&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">111&#47;1765&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;70 &#91;0&#46;52&#8211;0&#46;93&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>NNT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">53 &#91;30&#8211;238&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">NEC mortality</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Dani et al&#46; &#40;2002&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#47;295&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#47;290&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;20 &#91;0&#46;01&#8211;2&#46;75&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Lin et al&#46; &#40;2008&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#47;217&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#47;217&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;67 &#91;0&#46;11&#8211;3&#46;95&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sari et al&#46; &#40;2010&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#47;110&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#47;111&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;34 &#91;0&#46;01&#8211;8&#46;17&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Jacobs et al&#46; &#40;2013&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#47;548&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#47;551&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;37 &#91;0&#46;12&#8211;1&#46;14&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Global&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#47;1170&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&#47;1169&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;35 &#91;0&#46;14&#8211;0&#46;89&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>NNT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">106 &#91;58&#8211;702&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Probiotic vs control mortality&#46;</p>"
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