August 2025
INTRODUCTION —
Oropouche virus (OROV) is a virus that infects humans and animals and is endemic to the Caribbean, Central America, and South America; it is transmitted primarily through the bites of infected midges and possibly some mosquitoes [1,2]. The virus is named after the Oropouche region in Trinidad and Tobago, where the first case of human OROV infection was identified in a febrile forest worker in 1955, leading to an outbreak [3]. Clinical manifestations include fever, headache, myalgia, arthralgia, photophobia, and, in some cases, meningitis and encephalitis. OROV infection in pregnancy has been associated with adverse perinatal outcomes.
Online updates regarding OROV may be viewed at the following websites:
●Pan American Health Organization website
●World Health Organization website
●United States Centers for Disease Control and Prevention (CDC) website
VIROLOGY —
Oropouche virus (OROV; also called Sloth fever) is an arbovirus member in the Simbu serogroup of the genus Orthobunyavirus. Orthobunyaviruses have long held veterinary importance because of their ability to induce congenital anomalies in nonhuman mammals [4]. OROV infects a wide range of hosts, including sloths, marsupials, primates, and birds [3].
The ribonucleic acid (RNA) genome of OROV has three segments: S (small), M (medium), and L (large) according to their nucleotide lengths. These segments encode four nucleotide proteins: an RNA polymerase, two external glycoproteins, and the viral nucleocapsid. Four genotypes of OROV have been identified based on phylogenetic analysis of the nucleoprotein (N) gene [5], although a classification using the M and L genome segments proposes that there should be just two clades [6-8].
The three viral segments of OROV allow for viral reassortment, a process through which two or more different strains of virus infect the same host cell, leading to the exchange of genetic material [9]. Reassortment plays a critical role in the evolution of OROV, as it facilitates the generation of new viral strains that may be more evolutionarily fit, including greater transmissibility, changes in virulence, and the development of host evasion properties [10].
EPIDEMIOLOGY
Geographic distribution — Oropouche virus (OROV) infection was first described in 1955 in Trinidad and Tobago [11]. The first known human epidemic of OROV infection occurred in the Amazon region of Brazil in 1961 [12]. Subsequently, the virus has been associated with large human epidemics and sporadic disease in tropical areas of Brazil, Peru, Panama, Haiti, Colombia, Bolivia, Ecuador, and French Guiana. The virus has become endemic to the Amazon basin of South America, as well as neighboring areas of South and Central America and the Caribbean [5,12-20].
Since 2024, human infections have increased dramatically in Brazil and neighboring countries. This has been attributed to a viral reassortment event as early as 2022, which rendered the virus more contagious and potentially more virulent [21]. In Brazil, there were nearly 14,000 infections in 2024 and more than 3700 in the first quarter of 2025 [22-24], with two deaths reported [25]. In 2024, cases were also reported in Barbados, Bolivia, Colombia, Ecuador, Guyana, Panama, and Peru.
The first case in Cuba was reported in May 2024, and 108 imported cases were reported in the United States among travelers from Cuba [19]. Similarly, 30 European and 2 Canadian travelers acquired OROV infection in Cuba in 2024 [24]. Whole genome sequencing suggested that the outbreak in Cuba was due to a single importation of OROV infection from Brazil [26].
Thus far, local transmission within the United States has not been detected. The likelihood of widespread transmission is thought to be low because of differences in climate and use of air conditioning; however, cases may occur in limited areas where transmission vectors exist [27,28]. Additional information can be found at the United States Centers for Disease Control and Prevention (CDC) website.
Transmission — OROV has been detected in blood, urine, semen, saliva, and cerebrospinal fluid [12,29-32]. Thus far, there are no reports of OROV in vaginal secretions.
Viremia is usually present during the first week of illness [12]. Viral shedding may be detected in urine or semen for up to several weeks after acute infection [30-32].
●Arthropod-borne – OROV is transmitted by biting midges and possibly some mosquitoes [12,19,23,33]. In rural areas, the transmission cycle may also involve nonhuman primates, sloths, and birds [5,12,13,34].
•Midges – Bites from midges (Culicoides paraensis; also called "no-see-ums" in some areas) tend to be painful and highly pruritic, causing local reactions [35].
Midges can breed in piles of rotting banana stumps and cacao husks [34,36,37]. Farmers with exposure to bananas, cacao, and cassava appeared to be at the highest risk for OROV infection; the frequency of transmission is highest in rural areas during the rainy season [34,36,37].
•Mosquitoes – OROV has been isolated from Culex quinquefasciatus as well as Aedes serratus (in the Brazilian Amazon region) and Coquillitidea venezuelensis (in Trinidad) [38].
Transmission in urban areas of Brazil has also been described in the 2024 to 2025 outbreak [23]; cases have been observed more frequently in smaller municipalities rather than large urban centers [39]. Urban outbreaks tend to be short-lived [39].
●Maternal-fetal transmission – Vertical transmission has been described extensively [40-42]. Pregnancy loss, fetal anomalies (eg, microcephaly, brain abnormalities), stillbirth, and neonatal death have occurred in pregnant patients with OROV infection [6,40,43,44]. Furthermore, infection has been confirmed by positive reverse-transcription polymerase chain reaction testing (RT-PCR) of the umbilical cord, placenta, and multiple fetal somatic organs, as well as by immunoglobulin (Ig)M antibodies against the virus in infant serum on the day of birth. (See 'Obstetrical and fetal manifestations' below.)
●Sexual transmission – Replication-competent OROV has been detected in semen, suggesting potential risk for sexual transmission [30]; thus far, no cases of sexual transmission have been reported.
●Laboratory exposure – OROV has been transmitted through aerosolization or ingestion of viral particles in laboratory accidents, with the development of clinical disease in exposed workers [45].
●Blood exposure – Replication-competent OROV has been detected in whole blood and serum, suggesting risk for transmission via these routes [30]. Thus far, there have been no reports of transfusion-transmitted OROV.
CLINICAL MANIFESTATIONS
Illness timeline — The incubation period for Oropouche virus (OROV) infection is typically 3 to 10 days (range 3 to 12 days) [19,46,47].
Many cases follow a biphasic course, with approximately two to four days of intense acute signs and symptoms, followed by several days of remission, then a recurrence of similar symptoms approximately 7 to 10 days after initial onset, with a gradual reduction of symptoms over the subsequent weeks.
Systemic manifestations — Signs and symptoms develop in approximately 60 percent of infected individuals [19]. These include abrupt onset of fever, chills, headache, myalgias, arthralgias, and maculopapular rash [1,11,14,19]. Conjunctival injection, retro-orbital pain, photophobia, back pain, abdominal pain, and gastrointestinal symptoms (eg, nausea, vomiting, diarrhea, abdominal pain) may also occur. Hemorrhagic manifestations (eg, petechiae, epistaxis, gingival bleeding, melena, menorrhagia) have been described; in one series, these were reported in 16 percent of patients [14,33]. Initial symptoms usually last two to five days [15,47].
Signs and symptoms can recur up to 10 days following initial recovery in up to 70 percent of infected individuals; recurrent symptoms do not represent newly acquired infection [12,33].
Laboratory abnormalities may include leukopenia, lymphopenia, and elevated transaminases. Rarely has thrombocytopenia been reported [2].
The case fatality rate among infected individuals appears to be low. In 2024 in Brazil, two deaths were reported among over 8000 infected individuals [19,33].
The duration of immunity after infection is not known [10].
Neurologic manifestations — Neurologic manifestations have been described in both the acute and recurrent phases of illness. Headache, often associated with photophobia, is common. Headache can persist for days to weeks [2].
Meningitis, encephalitis, and meningoencephalitis have been described [2,33,48,49]. In a case series from Cuba, including 38 patients with OROV infection, encephalitis was observed in 29 percent of cases [50]. Cerebrospinal fluid (CSF) in patients with meningoencephalitis may demonstrate a lymphocytic pleocytosis with normal glucose and elevated protein concentrations.
Encephalopathy, dizziness/vertigo, nystagmus, diplopia, dysgeusia, and/or hearing loss can occur. Seizures (general or focal) have also been reported.
Guillain-Barré syndrome has been described following OROV infection in Cuba. In a retrospective study in Cuba in 2024 (where an OROV outbreak occurred beginning in May of that year), OROV was detected by polymerase chain reaction (PCR) in serum and CSF from 65 patients with Guillain-Barré syndrome; of these, 62 percent had a history of an undifferentiated febrile syndrome one or two weeks prior [51]. (See "Guillain-Barré syndrome in adults: Pathogenesis, clinical features, and diagnosis".)
Obstetrical and fetal manifestations
●Maternal course – The maternal clinical manifestations and complications of OROV infection appear to be similar to nonpregnant individuals; data are limited [6]. (See 'Illness timeline' above and 'Systemic manifestations' above.)
●Pregnancy outcome – OROV infection during human pregnancies has been associated with a variety of adverse pregnancy outcomes [19,33,52-55]. Available information is limited to case reports and small case series that focus on anomalous fetuses and neonates. The significance of the timing of maternal infection and the absolute risk of abnormal pregnancy outcomes are uncertain. The rate of vertical transmission, types of congenital anomalies, and other adverse outcomes may vary according to the trimester of maternal infection [56,57].
The association of adverse pregnancy outcomes with OROV infection was first reported in the 1980s during early outbreaks in Brazil, when a possible link between maternal infection and miscarriage was observed [58]. In 2024, the first documented case of vertical transmission occurred in a 28-year-old woman in Pernambuco State with symptoms compatible with OROV infection at 30 weeks of gestation; maternal infection was subsequently confirmed by reverse-transcription (RT)-PCR [59]. Approximately two weeks later, she was diagnosed with a fetal demise. Fetal tissue contained OROV genetic material, confirmed by RT-PCR.
Since that case, a variety of adverse outcomes have been reported, including miscarriage, fetal demise, and fetal anomalies, particularly microcephaly with brain abnormalities such as corpus callosum abnormalities, craniosynostosis, and porencephalic changes [6,40,43,44,60]. Skeletal abnormalities (such as arthrogryposis, camptodactyly, and clubbed feet), growth restriction, hydrops fetalis, and oligohydramnios have also been reported. Some newborns had abnormal ophthalmologic findings (optic disc atrophy, chorioretinal scaring).
In one series including 73 cases of OROV infection during pregnancy, pregnancy outcome information was available in 15 cases [55]. Two maternal infections occurred in the first trimester; one resulted in a miscarriage and the other in a live birth with neonatal corpus callosum anomalies. The other 13 maternal infections occurred in the third trimester and all resulted in nonanomalous live births. In one case, maternal-fetal transmission may have occurred intrapartum; this mother reported symptoms five days before giving birth and developed preterm rupture of membranes two hours before cesarean birth. The neonate was admitted at day four of life with fever and a maculo-papular rash, recovered within a few days, and was sent home in good condition. These findings suggest that maternal infection in the first trimester may be associated with pregnancy loss or central nervous system anomalies, and third-trimester maternal infection is less likely to be associated with congenital anomalies. Cesarean birth does not appear to prevent peripartum transmission.
DIAGNOSIS
Clinical suspicion and evaluation — The diagnosis of Oropouche virus (OROV) infection should be suspected in individuals with typical clinical manifestations and relevant epidemiologic exposure (residence in or travel to an area where vector-borne transmission has been reported, or unprotected sexual contact [sex without using a male or female condom] with a person who meets these criteria).
In addition to sending diagnostic studies for OROV (see 'Establishing the diagnosis' below), we evaluate for other potential infections that occur in areas where OROV is endemic. (See 'Differential diagnosis' below.)
Our initial laboratory evaluation includes complete blood count and differential, liver enzymes, blood cultures, malaria testing (for patients with exposure to an area with malaria transmission – including blood smears and rapid diagnostic test) and rapid diagnostic testing for respiratory viruses.
Establishing the diagnosis — The diagnosis of OROV infection may be established by molecular or serologic testing. In most endemic areas, IgM assays are used for identifying acute infection, in addition to polymerase chain reaction (PCR) assays in blood and urine. A positive IgG serology confirms past OROV infection but is not helpful for patients who live in endemic areas.
In pregnant patients, acute and convalescent sera collected ≥2 weeks apart are preferred to confirm recent infection by demonstrating a ≥4-fold change in neutralizing antibody titers [53].
●Molecular testing – The diagnosis may be established based on detection of viral RNA in serum, cerebrospinal fluid (CSF), and/or urine via reverse-transcription (RT)-PCR testing [61].
●Serologic testing – IgM and IgG antibodies to OROV may be detected in serum, plasma, and CSF [40,62,63]. Neutralization assays are the gold standard serologic test; however, plaque reduction neutralization assays are seldom used for diagnosis as they are cumbersome, have long turnaround times, and require biosafety level 3 laboratories [53].
Other serologic tools include enzyme immunoassays, counterpart fixation tests, immunofluorescence tests, and hemagglutination inhibition [64]. Serologic tests based on the nucleocapsid (N) protein, which generates a robust humoral immune response, may cross-react with antibodies to other Simbu serogroup viruses. (See 'Virology' above.)
Serologic testing should be conducted by highly trained personnel in laboratories equipped with appropriate containment facilities.
In the United States, diagnostic testing may be pursued through local and state public health agencies [19].
DIFFERENTIAL DIAGNOSIS
Maternal infection — Many areas with Oropouche virus (OROV) transmission also have ongoing transmission of other infections such as malaria, dengue, Zika, chikungunya, and others [23]. Given similar clinical manifestations, distinguishing these infections usually requires laboratory testing.
●Viruses
•Zika virus – Symptoms and signs of Zika virus infection include low-grade fever, rash, headache, arthralgia, myalgia, and conjunctivitis. As with OROV, Zika virus has been associated with neurologic complications and adverse pregnancy outcomes. In a case series including 65 newborns in Brazil with microcephaly of unknown cause from 2015 to 2021, three cases of OROV infection were identified [40]. The diagnosis of Zika virus is established by polymerase chain reaction (PCR) or serology. As Zika is a flavivirus, there is no serologic cross-reactivity between Zika and OROV antibodies. (See "Zika virus infection: An overview", section on 'Clinical manifestations'.)
•Chikungunya virus – Chikungunya virus infection is characterized by acute febrile polyarthralgia and arthritis, as well as skin rash in some cases. The diagnosis is established via serology or PCR. As chikungunya virus is a togavirus, there is no serologic cross-reactivity between chikungunya virus and OROV. (See "Chikungunya fever: Epidemiology, clinical manifestations, and diagnosis".)
•Dengue fever – Dengue fever is an acute febrile illness accompanied by headache, retro-orbital pain, and marked muscle and bone pains. A rash occurs in approximately half of the cases. Hemorrhagic manifestations and thrombocytopenia can also occur. The diagnosis is established via serology or reverse-transcription (RT)-PCR [65]. As dengue viruses are flaviviruses, there is no serologic cross-reactivity between dengue viruses and OROV antibodies. (See "Dengue virus infection: Clinical manifestations and diagnosis".)
•Yellow fever – Yellow fever is characterized by acute infection with nonspecific symptoms, followed by a period of remission and a subsequent episode of illness with hepatic and renal dysfunction. It is transmitted by Aedes aegypti mosquitoes and forest-dwelling mosquitoes in tropical regions of South America and sub-Saharan Africa; the incubation period is three to eight days. The diagnosis is established via serology or PCR. As yellow fever virus is a flavivirus, there is no serologic cross-reactivity between yellow fever virus and OROV antibodies. (See "Yellow fever: Epidemiology, clinical manifestations, and diagnosis".)
•Mayaro virus – Mayaro virus is an arbovirus found mainly in South America and occurs in small sporadic epidemics, causing arthritis and fever. Diagnostic tools include serology and molecular methods [66]. As Mayaro virus is a togavirus, there should not be serologic cross-reactivity with OROV antibodies. (See "Viral arthritis: Causes and approach to evaluation and management".)
•Parvovirus – Parvovirus infection can present with acute and symmetric arthritis or arthralgia, most frequently involving the small joints of the hands, wrists, knees, and feet. Rash may or may not be present. The diagnosis is established via serology, with no serologic cross-reactivity with OROV. (See "Clinical manifestations and diagnosis of parvovirus B19 infection".)
●Measles – Clinical manifestations of measles include fever, cough, sore throat, coryza, conjunctivitis, and lymphadenitis. Koplik spots may precede the generalized rash. The diagnosis is established via clinical findings and serology. (See "Measles: Clinical manifestations, diagnosis, treatment, and prevention".)
●Malaria – Malaria is characterized by fever, malaise, nausea, vomiting, abdominal pain, diarrhea, myalgia, and anemia. The diagnosis of malaria is established by visualization of parasites on peripheral smear. (See "Malaria: Clinical manifestations and diagnosis in nonpregnant adults and children".)
●Leptospirosis – Leptospirosis is characterized by fever, rigors, myalgia, conjunctival suffusion, and headache. Less common symptoms and signs include cough, nausea, vomiting, diarrhea, abdominal pain, and arthralgia. The diagnosis is established via serology. (See "Leptospirosis: Epidemiology, microbiology, clinical manifestations, and diagnosis".)
●Rickettsial infection – Rickettsial infections include African tick bite fever and relapsing fever. African tick bite fever can occur among travelers to the Caribbean and is characterized by headache, fever, myalgia, solitary or multiple eschars with regional lymphadenopathy, and generalized rash; the diagnosis is established via serology. Relapsing fever is characterized by fever, headache, neck stiffness, arthralgia, myalgia, and nausea; diagnostic tools include direct smear and PCR. (See "Other spotted fever group rickettsial infections" and "Clinical features, diagnosis, and management of relapsing fever".)
Other common viral infections (influenza, coronavirus disease 2019 [COVID-19], adenovirus, enterovirus) also warrant consideration.
Neonatal infection — The differential diagnosis of neonatal infection is discussed below. (See 'Neonates' below.)
MANAGEMENT
Supportive care for all patients — Treatment of patients with Oropouche virus (OROV) infection consists of supportive care with rest, fluid, and acetaminophen as needed; no specific antiviral drugs are available [19]. Nonsteroidal anti-inflammatory agents (NSAIDs) should be avoided to reduce the risk of bleeding; in addition, NSAIDs should be used with caution in the late second trimester and avoided in the third trimester because of the potential for adverse fetal/neonatal renal and cardiac effects. (See "Use and risks of NSAIDs in pregnancy".)
Pregnant patients — Once OROV infection is suspected or confirmed, we favor performing a detailed fetal anatomic survey, with serial fetal growth assessments and evaluation of fetal neuroanatomy by ultrasound every four weeks [53,67]. The role of amniotic fluid testing for diagnosis of fetal infection is not established; local health departments should be contacted to determine availability of polymerase chain reaction (PCR) testing.
Given the association between maternal OROV infection and fetal demise, discussing the risks and benefits of fetal surveillance (eg, nonstress tests, biophysical profiles) with the patient may be warranted. However, thus far, there is no evidence demonstrating the benefit of fetal surveillance to prevent or reduce the risk of stillbirth in pregnancies complicated by OROV infection.
In cases of known or suspected OROV maternal infection, the placenta should be sent for histopathology and OROV molecular testing, if available.
Neonates — Infants born to mothers with known or suspected OROV infection should be examined carefully for congenital anomalies [53]. Affected neonates should have clinical evaluation to evaluate for OROV infection as well as other congenital infections (such as Zika, toxoplasmosis, rubella, cytomegalovirus, herpes simplex virus, and syphilis). (See 'Diagnosis' above and "Overview of TORCH infections".)
Thus far, there are no guidelines for evaluation of infants with congenital OROV infection. A reasonable approach is to perform the same assessment as for infants with congenital Zika virus infection (see "Congenital Zika virus infection: Clinical features, evaluation, and management of the neonate", section on 'Evaluation') – as well as abdominal ultrasound and echocardiogram (given reports of hepatosplenomegaly and cardiac abnormalities in infants with congenital OROV infection).
Among asymptomatic infants born to mothers with intrapartum OROV infection, the risk of neurodevelopmental sequelae is unknown at this time; close long-term follow-up is prudent given the lack of prognostic information.
PREVENTION
●Preventing insect bites – Individuals in areas where Oropouche virus (OROV) is known to spread can take personal measures to prevent acquiring infection from biting midges and mosquitoes.
These include using insect repellants such as DEET (N,N-diethyl-3-methylbenzamide), wearing clothing that covers the skin (eg, long-sleeve shirts, pants), and using mosquito nets and mesh screens. However, biting midges may be small enough to pass through fine mesh mosquito nets. (See "Prevention of arthropod bites: Repellents and other measures".)
Pregnant individuals can use permethrin-treated clothing and gear, DEET, and picaridin.
●Travel precautions – Travelers (particularly pregnant travelers) should review travel advisories and avoid travel to regions with ongoing transmission.
Travelers returning from regions with ongoing transmission should avoid biting midge and mosquito exposures for three weeks after return, to prevent importation and spread of the virus in unaffected regions [19,33].
●Sexual transmission – Males should consider waiting at least six weeks after symptom onset (if symptomatic) or last possible OROV exposure (if asymptomatic) before unprotected sex [68].
●Blood donation – Donor volunteers recently diagnosed with OROV are advised to defer blood donation for four weeks after last known exposure [69].
There is no vaccine available for prevention of OROV.
SOCIETY GUIDELINE LINKS —
Links to society and government-sponsored guidelines from selected countries and regions around the world are provided separately. (See "Society guideline links: TORCH infections".)
SUMMARY AND RECOMMENDATIONS
●Epidemiology
•Geographic distribution – Oropouche virus (OROV) is a virus that infects humans and animals in the Caribbean, Central America, and South America. Imported cases in returning travelers to the United States, Canada, and Europe have occurred. (See 'Geographic distribution' above.)
•Transmission – OROV is transmitted primarily through the bites of infected midges and possibly some mosquitoes. Maternal-fetal transmission can also occur; other possible modes of transmission include sexual and bloodborne exposure. (See 'Transmission' above.)
●Clinical manifestations – The incubation period for OROV infection is typically 3 to 10 days (range 3 to 12 days). Many cases follow a biphasic course, with approximately two to four days of intense acute symptoms, followed by several days of remission, then a recurrence of similar symptoms approximately 7 to 10 days after initial onset.
•Systemic manifestations – Systemic manifestations include fever, chills, headache, myalgias, arthralgias, and maculopapular rash. Conjunctival injection, retro-orbital pain, photophobia, back pain, abdominal pain, and gastrointestinal symptoms may occur. Hemorrhagic manifestations (eg, petechiae, epistaxis, gingival bleeding, melena, and menorrhagia) have also been described. (See 'Systemic manifestations' above.)
•Neurologic manifestations – Neurologic manifestations, including meningitis, encephalitis, and meningoencephalitis, may occur; in addition, Guillain-Barré syndrome has been described. (See 'Neurologic manifestations' above.)
•Obstetrical and fetal manifestations – OROV infection during pregnancy has been associated with a variety of adverse pregnancy outcomes, including miscarriage, fetal demise, and fetal anomalies, particularly microcephaly with brain abnormalities. The clinical presentation in pregnancy appears to be similar to that in nonpregnant individuals. (See 'Obstetrical and fetal manifestations' above.)
●Diagnosis
•Clinical suspicion – The diagnosis of OROV infection should be suspected in individuals with typical clinical manifestations and relevant epidemiologic exposure (residence in or travel to an area where vector-borne transmission has been reported, or unprotected sexual contact [sex without using a male or female condom] with a person who meets these criteria). (See 'Clinical suspicion and evaluation' above.)
•Establishing the diagnosis – The diagnosis of OROV infection may be established by molecular or serologic testing. In most endemic areas, IgM assays are used for identifying acute infection, in addition to polymerase chain reaction (PCR) assays in blood and urine. A positive IgG serology confirms past OROV infection but is not helpful for patients who live in endemic areas.
In pregnant patients, acute and convalescent sera collected ≥2 weeks apart are preferred to confirm recent infection by demonstrating a ≥4-fold change in neutralizing antibody titers. (See 'Establishing the diagnosis' above.)
●Management
•Supportive care for all patients – Treatment consists of supportive care with rest, fluid, and acetaminophen as needed; no specific antiviral drugs are available. Nonsteroidal anti-inflammatory agents (NSAIDs) should be avoided to reduce the risk of bleeding. (See 'Supportive care for all patients' above.)
•Pregnant patients – In pregnant patients, we suggest performing a detailed fetal anatomic survey, serial fetal growth assessments, and evaluation of neuroanatomy by ultrasound every four weeks. Fetal surveillance (eg, nonstress tests, biophysical profiles) is reasonable given reports of fetal demise. There is no clear role for amniocentesis to diagnose fetal infection. (See 'Pregnant patients' above.)
•Neonates – Infants born to mothers with known or suspected OROV infection should be examined carefully for congenital anomalies. Affected infants should have clinical evaluation to evaluate for OROV infection as well as other congenital infections. For asymptomatic infants born to mothers with intrapartum OROV infection, close long-term follow-up is prudent given the lack of prognostic information. (See 'Neonates' above.)
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