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The birth weight of babies is generally used as a health state indicator but is not often recorded in resource-poor settings due to limited access to medical clinics. In this work we develop a low-cost and lightweight “balance-in-a-box” that could allow remote communities to have access to a weighing balance. The “balance-in-a-box” is a cardboard mailing box which is reconstructed to form the balance tray, with a novel piezoresistive pressure sensor underneath, a paper-based readout system and battery integrated with copper tape to form an electrical circuit. The readout system comprises multiple segments of electrochromic Prussian blue/polyaniline on conductive gold nanoparticle films connected by graphite resistive separators. The color of each segment is voltage dependent and is directly correlated to the weight applied to the pressure sensor. It is shown that by varying the properties of the readout system (total resistance, individual resistance values of the graphite separators and number of gold nanoparticle segments) that it is possible to tune the critical weight values in which the gold nanoparticle segments change color. Overall, this work demonstrates that babies can be classified as very low birth weight ( 2.5 kg) using a simple, integrated paper-based system that can be deployed to resource-poor settings where babies are at greatest risk of being underweight and requiring health care treatment.

Sri Lanka Journal of Child Health , 2015: 44 (1): 3-11 DOI: http://dx.doi.org/10.4038/sljch.v44i1.7956

Iron deficiency anemia (IDA) during pregnancy continues to be of world-wide concern. IDA is a risk factor for preterm delivery and subsequent low birth weight, and possibly for poor neonatal health. Iron supplementation in pregnancy is a widely recommended practice, yet intervention programs have met with many controversies. In our study, 300 women at different trimesters of pregnancy were enrolled in a trial of oral administration of ferrous sulfate (520 mg once a day) or 30% iron-saturated bovine lactoferrin (bLf) (100 mg twice a day). Pregnant women refusing treatment represented the control group. In this group hemoglobin and total serum iron values measured after 30 d without treatment decreased significantly, especially in women at 18–31 weeks of pregnancy. In contrast, after 30 d of oral administration of bLf, hemoglobin and total serum iron values increased and to a greater extent than those observed in women treated orally for 30 d with ferrous sulfate, independently of the trimester of pregnancy. Unlike ferrous sulfate, bLf did not result in any side effects. These findings lead us to hypothesize that lactoferrin could influence iron homeostasis directly or through other proteins involved in iron transport out of the intestinal cells into the blood.

Iodine deficiency is an important nutritional deficiency, with more than 2 billion people worldwide estimated to be at risk. The developing fetus and young children are particularly at risk. During pregnancy and lactation, iodine requirements increase, whether in iodine-poor or iodine-sufficient countries, making the mother and the developing fetus vulnerable. The American Thyroid Association (ATA) recommends 250 micrograms per day of iodine intake for pregnant and lactating women. The thyroid gland is able to adapt to the changes associated with pregnancy as long as sufficient iodine is present. Dietary intake is the sole source of iodine, which is essential to the synthesis of thyroid hormones. Iodine is found in multiple dietary sources including iodized salt, dairy products, seaweed, and fish. Prenatal vitamins containing iodine are a good source of iodine, but iodine content in multivitamin supplements is highly variable. Congenital hypothyroidism is associated with cretinism. Clinical hypothyroidism has been associated with increased risk of poor perinatal outcome including prematurity, low birth weight, miscarriage, preeclampsia, fetal death, and impaired fetal neurocognitive development. Subclinical hypothyroidism is also associated with poor pregnancy outcomes and potential fetal neurocognitive deficits, but the data are more variable than those for clinical hypothyroidism. We concur with the ATA recommendation that all pregnant and lactating women should ingest (through diet and supplements) 250 micrograms of iodine daily. To achieve this goal, we recommend that all pregnant and lactating women take daily iodine supplementation of 150 micrograms. Birth Defects Research (Part A) 94:677–682, 2012. 2012 Wiley Periodicals, Inc.

Kangaroo Mother Care (KMC) is a human-based care intervention devised to complement neonatal care for low birth weight and premature infants. Kangaroo position (skin-to-skin contact on the mother's chest) offers thermal regulation, physiological stability, appropriate stimulation, and enhances bonding and breastfeeding. Kangaroo nutrition is based on breastfeeding, and kangaroo discharge policy relies on family empowerment and early discharge in kangaroo position with close ambulatory follow-up. We describe how the evidence has been developed and how it has been put into practice by means of direct preterm infants care and dissemination of the method, including training of KMC excellence centers in many countries not only in Latin America but worldwide.

Refugee women experience more negative pregnancy and neonatal outcomes, such as low birth weight and preterm birth. The aim of the present study was to compare the clinical characteristics and pregnancy and neonatal outcomes between Turkish citizens and Syrian refugees with high-risk pregnancies. This prospective cohort study was conducted between March and December 2020 in Sanliurfa, Turkey. The maternal characteristics and pregnancy and neonatal outcomes were compared between the two groups. In this study, a total of 302 high-risk pregnant women (233 Turkish citizens and 69 Syrian refugees) were included. Parity and pregnancy spacing shorter than 2 years were significantly higher in Syrian refugees. Age, previous abortion or miscarriage and rates of cesarean section (C/S) were significantly higher in Turkish citizens. The live birth (Turkish: 94.8% vs Syrian: 92.8%), preterm birth (Turkish: 10% vs Syrian: 9.4%), low birth weight (Turkish: 7.7% vs Syrian: 3.1%) rates and birth weight (g) (Turkish: 3097.5 ± 501.3 g; Syrian: 2980.2 ± 395.0 g) were not significantly different between Turkish citizens and Syrian refugees with high-risk pregnancy. Similar pregnancy and neonatal outcomes could be attributed to the Syrians receiving adequate and free maternity care, similar to the Turkish citizens.

In the last decade, Venezuela suffers a humanitarian crisis, leading to massive emigration. One of the most vulnerable migrants´ groups is pregnant women. We analyzed the perinatal outcomes of Venezuelan migrants in Colombia and identified if migration was associated with perinatal outcomes. Birth data were obtained from the 2017 Colombian national birth registry (1085 births in migrants and 654,829 in Colombians). Logistic and linear regression models were used to identify the association between the demographic, obstetric and neonatal characteristics with premature birth (PB), low birth weight (LBW), 1-min, and 5-min Apgar score. Venezuelan were more likely to have newborns with LBW, lower Apgar scores at 1-min and 5-min in comparison to Colombians. Furthermore, a difference was observed in the low health insurance coverage and antenatal care visits among Venezuelan in comparison to natives. Access to health care services for the migrants is desirable for the improvement of perinatal health conditions.

Piglets are born wet, and evaporation of that moisture decreases body temperature, increasing the risk of mortality. The objective of this study was to compare the effect of two commercially applicable methods for drying piglets at birth on piglet rectal temperature over 24 h after birth. The study was carried out in standard commercial farrowing facilities with 52 litters, using a completely randomized design with three Drying Treatments: Control (not dried); Desiccant (dried at birth using a cellulose-based desiccant); Paper Towel (dried at birth using paper towels). Litters were randomly allotted to treatments at the birth of the first piglet. At birth, piglets were individually identified, and the treatment was applied. Rectal temperature was measured at 0, 10, 20, 30, 45, 60, 120, and 1,440 min (24 h) after birth. Data were analyzed using a repeated measures model with PROC MIXED of SAS, with litter as the experimental unit and piglet a subsample of the litter. The model included the fixed effects of treatment and time (as a repeated measure), and the interaction. There was no effect (P > 0.05) of treatment on temperature at birth, or 10 or 1,440 min after birth. Piglet temperatures between 20 and 120 min after birth were similar (P > 0.05) for the Desiccant and Paper Towel treatments, but were greater (P ≤ 0.05) than the Control. The effect of birth weight on the response to Drying Treatment was evaluated by dividing the data into Light (1.5 kg) piglet Birth Weight Categories. Piglet rectal temperature data at each measurement time were analyzed using a model that included the fixed effects of Birth Weight Category, Drying Treatment, and the interaction. Temperatures of Light piglets were lower (P ≤ 0.05) than those of Heavy piglets between 20 and 120 min after birth, with Medium piglets being intermediate and generally different to the other two weight categories at these times. The difference in temperature between Light as compared with Medium or Heavy piglets was greater for the Control than the other two Drying Treatments at 60 min after birth. These results suggest that drying piglets at birth is an effective method to reduce rectal temperature decline in the early postnatal period, especially for low birth weight piglets.

Infant mortality is among the most important indicators of health and development in global communities. One of the causes of neonatal mortality is low birth weight. This study aims at evaluating the risk factors for LBW in infants.This study was carried out using a nested case-control study in rural areas of Kurdistan province in western Iran in 2015. The selection of case and control groups was based on the nesting using the risk set sampling approach. In total, 182 and 364 subjects were selected for the case group and the control group respectively. Data analysis was performed using the Stata-12 software with the point and spatial estimation of OR using the conditional logistic regression method.The multivariate logistic regression analysis performed shows that the maternal gestational age, the mother’s health history during pregnancy, any medication abuse by the mother, any mental stress during pregnancy, are LBW risk factors (P, Journal of Preventive Medicine and Hygiene, Vol. 62 No. 2 (2021): 2021622

Objective:To establish optimal gestational weight gain (GWG) in Chinese pregnant women by Chinese-specific BMI categories and compare the new recommendations with the Institute of Medicine (IOM) 2009 guidelines.Design:Multicentre, prospective cohort study. Unconditional logistic regression analysis was used to evaluate the OR, 95 % CI and the predicted probabilities of adverse pregnancy outcomes. The optimal GWG range was defined as the range that did not exceed a 1 % increase from the lowest predicted probability in each pre-pregnancy BMI group.Setting:From nine cities in mainland China.Participants:A total of 3731 women with singleton pregnancy were recruited from April 2013 to December 2014.Results:The optimal GWG (ranges) by Chinese-specific BMI was 15·0 (12·8–17·1), 14·2 (12·1–16·4) and 12·6 (10·4–14·9) kg for underweight, normal weight and overweight pregnant women, respectively. Inappropriate GWG was associated with several adverse pregnancy outcomes. Compared with women gaining weight within our proposed recommendations, women with excessive GWG had higher risk for macrosomia, large for gestational age and caesarean section, whereas those with inadequate GWG had higher risk for low birth weight, small for gestational age and preterm delivery. The comparison between our proposed recommendations and IOM 2009 guidelines showed that our recommendations were comparable with the IOM 2009 guidelines and could well predict the risk of several adverse pregnancy outcomes.Conclusions:Inappropriate GWG was associated with higher risk of several adverse pregnancy outcomes. Optimal GWG recommendations proposed in the present study could be applied to Chinese pregnant women.

With over 1·3 million Anganwadi centres (AWC) (meaning ‘courtyard shelter’), the Indian government runs a nationwide intervention providing nutrition supplement to pregnant mothers to improve the health of their children. Using two successive rounds of the nationally representative cross-sectional National Family Health Survey data (collected during 2005–2006 and 2015–2016) of India, we assessed whether nutrition supplements given to pregnant mothers through AWC were associated with select child health indicators – extremely low birth weight (ELBW), very low birth weight (VLBW), low birth weight (LBW) and neonatal mortality (death during day 0–27) stratified by death during day 0–1, day 2–6 and day 7–27. A total of 148 019 children and 205 593 children were eligible for analysing birth weight and neonatal mortality, respectively. OR with 95% CI, estimated from multivariate logistic regression models, suggest that receipt of nutrition supplements was associated with decreased risk of VLBW (OR: 0·73, 95% CI 0·63, 0·83, P < 0·001), LBW (OR: 0·92, 95% CI 0·88, 0·96, P < 0·001), but not ELBW (OR: 0·80, 95% CI 0·56, 1·15, P = 0·226). Women who always received nutrition supplements during their pregnancy saw lower risk of death of their neonates (OR: 0·67, 95% CI 0·61, 0·73, P < 0·001), including death on day 0–1 (OR: 0·66, 95% CI 0·58, 0·74, P < 0·001), day 2–6 (OR: 0·69, 95% CI 0·58, 0·82, P < 0·001) and day 7–27 (OR: 0·68, 95% CI 0·53, 0·87, P = 0·002). Therefore, nutritional supplementation to pregnant mothers appears to be helpful in deterring various stages of neonatal mortality, VLBW and LBW, though it might not be effective in mitigating ELBW. Findings were discussed considering possible limitations of the study.

SUMMARY Isolated maternal hypothyroxinemia (IMH) is defined as the presence of low maternal total thyroxine (TT4) level in conjunction with normal maternal thyroid-stimulating hormone (TSH) level. The aim was to investigate whether IMH is associated with adverse pregnancy outcome in North Macedonia. Dried blood spot samples were obtained from 359 pregnant women meeting the inclusion criteria and analyzed for TT4 and TSH. Postpartum data were entered from their medical histories. Out of 359 women, 131 (37.42%) belonged to IMH group. There were statistically significant differences in birth weight (p=0.043), intrauterine growth restriction (IUGR) (p=0.028), Apgar score at 1 min

Introduction: In very low birth weight (Methods: This is a single-center retrospective cohort analysis based on quality assurance data of VLBW infants born from 1978 to 2018. Estimation of sex-specific LOHS over time was based on infants discharged home from neonatal care or deceased. Estimation of sex-specific PAD over time was based on infants discharged home exclusively. Analysis of in-hospital survival was performed for all VLBW infants. Results: In 4,336 of 4,499 VLBW infants admitted from 1978 to 2018 with complete data (96.4%), survival rates improved between 1978–1982 and 1993–1997 (70.8 vs. 88.3%; hazard ratio (HR) 0.20, 95% confidence interval 0.14, 0.30) and remained stable thereafter. Boys had consistently higher mortality rates than girls (15 vs. 12%, HR 1.23 [1.05, 1.45]). Nonsurviving boys died later compared to nonsurviving girls (adjusted mean survival time 23.0 [18.0, 27.9] vs. 20.7 [15.0, 26.3] days). LOHS and PAD assessed in 3,166 survivors displayed a continuous decrease over time (1978–1982 vs. 2013–2018: LOHS days 82.9 [79.3, 86.5] vs. 60.3 [58.4, 62.1] days); PAD 40.4 (39.9, 40.9) vs. 37.4 [37.1, 37.6] weeks). Girls had shorter LOHS than boys (69.4 [68.0, 70.8] vs. 73.0 [71.6, 74.4] days) and were discharged with lower PAD (38.6 [38.4, 38.8] vs. 39.2 [39.0, 39.4] weeks). Discussion/Conclusions: LOHS and PAD decreased over the last 40 years, while survival rates improved. Male sex was associated with longer LOHS, higher PAD, and higher mortality rates.

Objective:To examine the gestational weight gain (GWG) trajectory and its possible association with pregnancy outcomes.Design:GWG trajectories were identified using the latent class growth model. Binary logistic regression was performed to examine the associations between adverse pregnancy outcomes and these trajectories.Setting:Negeri Sembilan, Malaysia.Participants:Two thousand one hundred ninety-three pregnant women.Results:Three GWG trajectories were identified: ‘Group 1 – slow initial GWG but followed by drastic GWG’, ‘Group 2 – maintaining rate of GWG at 0·58 kg/week’ and ‘Group 3 – maintaining rate of GWG at 0·38 kg/week’. Group 1 had higher risk of postpartum weight retention (PWR) (adjusted OR (AOR) 1·02, 95 % CI 1·01, 1·04), caesarean delivery (AOR 1·03, 95 % CI 1·01, 1·04) and having low birth weight (AOR 1·04, 95 % CI 1·02, 1·05) compared with group 3. Group 2 was at higher risk of PWR (AOR 1·18, 95 % CI 1·16, 1·21), preterm delivery (AOR 1·03, 95 % CI 1·01, 1·05) and caesarean delivery (AOR 1·02, 95 % CI 1·01, 1·03), but at lower risk of having small-for-gestational-age infants (AOR 0·97, 95 % CI 0·96, 0·99) compared with group 3. The significant associations between group 1 and PWR were observed among non-overweight/obese women; between group 1 and caesarean delivery among overweight/obese women; group 2 with preterm delivery and caesarean delivery were only found among overweight/obese women.Conclusions:Higher GWG as well as increasing GWG trajectories was associated with higher risk of adverse pregnancy outcomes. Promoting GWG within the recommended range should be emphasised in antenatal care to prevent the risk of adverse pregnancy outcomes.

Pregnant women are at increased risk of morbidity and mortality from influenza and are recognized as a priority group for influenza vaccination. Despite this, uptake is often poor and one reason cited for this is concerns about safety. The objective of this study was to perform a systematic review of the safety of inactivated influenza vaccination (IIV) in pregnancy. Studies were included if they were: (i) observational or experimental design; (ii) included a comparator group comprising of unvaccinated pregnant women; (iii) comprised of either seasonal IIV or monovalent H1N1 IIV (including adjuvanted vaccines); and (iv) addressed one of the following outcomes: preterm birth (PTB), small for gestational age (SGA), fetal death (including stillbirth or spontaneous abortion), low birth weight (LBW) or congenital abnormalities. Two reviewers screened abstracts and titles and selected full texts for retrieval. Crude odds ratios were calculated from reported event rates, using binomial standard errors. Adjusted odds ratios, hazard ratios and relative rates were extracted as reported in each paper. After removal of duplicates and full text eligibility assessment, 40 studies remained. The aOR for PTB was 0.87 (0.78–0.96), for LBW 0.82 (0.76–0.89), congenital abnormality 1.03 (0.99–1.07), SGA 0.99 (0.94–1.04) and stillbirth 0.84 (0.65–1.08). This study contributes to the increasing body of safety data for IIV in pregnancy and reports a protective effect on PTB and LBW.

Objective:To analyse the determinants of exclusive breast-feeding (EBF) discontinuation in southeastern Brazil between 2008 and 2013.Design:Secondary cross-sectional data were analysed from three waves of child feeding surveys conducted in the city of Marília, São Paulo, Brazil, in 2008, 2011 and 2013 (n 1645 children under 6 months). Multivariable Poisson regression models were used to test the association between EBF discontinuation and socio-economic, demographic and biomedical factors in a pooled sample and within each survey wave.Setting:Regionally representative cross-sectional survey from Brazil.Participants:The analytical sample included 1645 infants under 6 months old.Results:In the pooled sample, 40·7 % of the infants were exclusively breastfed. Between 2008 and 2013, there was a significant increase in C-section (35·1–42·7 %) and pacifier use (41·4–48·8 %). The determinants of EBF discontinuation in the pooled analysis were mothers working outside the home (adjusted prevalence ratio (APR) = 1·10; 95 % CI 1·00, 1·21), first-time mothers (APR = 1·10; 95 % CI 1·01, 1·20), pacifier use (APR = 1·48; 95 % CI 1·36, 1·61) and low birth weight (APR = 1·17; 95 % CI 1·05, 1·32).Conclusions:Mothers working outside the home, first-time moms, pacifier use and low birth weight were the factors associated with EBF discontinuation. Evidence-based counselling strategies during antenatal and early postpartum care in primary healthcare are needed to address the modifiable determinants of EBF discontinuation and ultimately to improve its rates in southeastern Brazil.

Background: Immune immaturity may put premature infants at increased risk for infections. DTaP-IPV-Hib-HepB vaccine (Vaxelis™), a hexavalent vaccine studied in >6,800 children, has acceptable safety and immunogenicity profiles generally similar to control vaccines. Here we evaluate safety and immunogenicity of DTaP-IPV-Hib-HepB vaccine in premature infants. Methods: Premature infants were identified using prior medical conditions terms “premature baby/delivery” and/or “low birth weight baby”. Immunogenicity and safety data were summarized across one Phase II and four Phase III randomized, active-comparator-controlled clinical trials (Protocol 004 in Canada [Control: PENTACEL™]; Protocols 005 and 006 in the US [Control: PENTACEL™]; and Protocols 007 and 008 in the EU [Control: INFANRIX™ hexa]) and one Phase III clinical trial in the UK (PRI01C); no formal statistical comparisons were performed. Results: Overall, 160 infants were considered premature (DTaP-IPV-Hib-HepB = 111 Control = 49). The incidence of adverse events (AEs) for DTaP-IPV-Hib-HepB was comparable between overall and premature populations for all AEs days 1–15 postvaccination (Overall = 96.3%; Premature = 97.3%;), solicited injection-site AEs days 1–5 postvaccination (Overall = 84.1%; Premature = 75.5%), and solicited systemic AEs days 1–5 postvaccination (Overall = 93.7%; Premature = 94.5%). A high percentage of premature infants mounted protective immune responses to antigens contained in DTaP-IPV-Hib-HepB vaccine. Response rates in preterm infants for all antigens (80-99%) were in a similar range to all infants (80-99%) for both DTaP-IPV-Hib-HepB and control vaccines. Conclusions: DTaP-IPV-Hib-HepB vaccine has a low incidence of AEs, an acceptable safety profile, and elicited satisfactory immune responses in premature infants comparable to the overall study population. These findings support vaccination with DTaP-IPV-Hib-HepB vaccine in healthy premature infants.

Objective:To investigate the association of folic acid (FA) supplementation with birth weight, the risk of small for gestational age (SGA) and low birth weight (LBW) in singleton and twin pregnancy.Design:A population-based cross-sectional survey.Setting:Twenty counties and ten districts in Shaanxi Province of northwestern China, 2013.Participants:28 174 pregnant women with their infants, covering 27 818 single live births and 356 twin live births.Results:The prevalence of FA supplementation in singletons and twins was 63·9 and 66·3 %. The mean birth weight was 3267 (sd 459·1) g, 2525 (sd 534·0) g and 2494 (sd 539·5) g; the prevalence of SGA was 14·3, 51·4 and 53·4 %; the prevalence of LBW was 3·4, 42·4 and 46·6 % among singleton, twin A and twin B, respectively. Compared with non-users, women with FA supplementation were (β 17·3, 95 % CI 6·1, 28·4; β 166·3, 95 % CI 69·1, 263·5) associated with increased birth weight, lower risk of SGA (OR 0·85, 95 % CI 0·80, 0·92; OR 0·45, 95 % CI 0·30, 0·68) and LBW (OR 0·82, 95 % CI 0·71, 0·95; OR 0·50, 95 % CI 0·33, 0·75) in singletons and twins, and more prominent effects in twins. Moreover, there were significant interactions between FA supplementation and plurality on birth weight, SGA and LBW.Conclusions:The present study suggests the association of periconceptional 0·4 mg/d FA supplementation with increased birth weight and reduced risk of SGA and LBW in both singletons and twins, and this association may be more prominent in twins.

Highlights • Applicability of GAIA definitions were assessed using medical records in LMICs. • LBW, preterm birth and neonatal death definitions were applicable in the field. • SGA, stillbirth, neonatal infection, congenital microcephaly definitions were less applicable. • Suggestions to the improvement in GAIA definitions were made. • Better documentation of maternal immunization is suggested for vaccine-safety studies., Standardized case definitions strengthen post-marketing safety surveillance of new vaccines by improving generated data, interpretation and comparability across surveillance systems. The Global Alignment of Immunization Safety Assessment in Pregnancy (GAIA) project developed standardized case definitions for 21 key obstetric and neonatal terms following the Brighton Collaboration (BC) methodology. In this prospective cohort study, we assessed the applicability of GAIA definitions for maternal immunization exposure and for low birth weight (LBW), preterm birth, small for gestational age (SGA), stillbirth, neonatal death, neonatal infection, and congenital microcephaly. We identified the missing data elements that prevented identified cases and exposures from meeting the case definition (level 1–3 of BC diagnostic certainty). Over a one-year period (2019–2020), all births occurring in 21 sites (mostly secondary and tertiary hospitals) in 6 Low Middle Income Countries and 1 High Income Country were recorded and the 7 perinatal and neonatal outcome cases were identified from routine medical records. Up to 100 cases per outcome were recruited sequentially from each site. Most cases recruited for LBW, preterm birth and neonatal death met the GAIA case definitions. Birth weight, a key parameter for all three outcomes, was routinely recorded at all sites. The definitions for SGA, stillbirth, neonatal infection (particularly meningitis and respiratory infection) and congenital microcephaly were found to be less applicable. The main barrier to obtaining higher levels of diagnostic certainty was the lack of sonographic documentation of gestational age in first or second trimester. The definition for maternal immunization exposure was applicable, however, the highest level of diagnostic certainty was only reached at two sites. Improved documentation of maternal immunization will be important for vaccine safety studies. Following the field-testing of these 8 GAIA definitions, several improvements are suggested that may lead to their easier implementation, increased standardization and hence comparison across studies.

Background Currently there are trials in Africa and Asia investigating whether prophylactic azithromycin during pregnancy reduces infection-related neonatal morbidity and mortality. We undertook a systematic review and meta-analysis to determine the effect of azithromycin during pregnancy on perinatal and neonatal outcomes. Methods We identified articles between January 1990 and 13th June 2021 by searching five electronic databases. Randomised control trials (RCTs) that included pregnant women administered azithromycin alone or in combination with other medications, and that reported outcomes of low birthweight (LBW), prematurity, stillbirth, and neonatal deaths, infections, and admissions, were eligible. Fixed effects meta-analyses were used for primary analysis. Quality appraisal was performed using Cochrane's Risk of Bias 2 tool. This review was registered with PROSPERO, CRD42019127099. Findings The search generated 5777 studies, of which 14 studies were included involving 17,594 participants. Most studies investigated azithromycin as Intermittent Preventive Treatment in Pregnancy (IPTp) for malaria. More than 50% of the studies had low risk of bias for all outcomes, except for LBW and neonatal admissions. Fixed-effects meta-analyses found that azithromycin reduced the risk of LBW (seven studies, Pooled RR 0·79; 95% CI 0·68-0·93; I2 = 0·00%), and prematurity compared to controls (eight studies, Pooled RR 0·87; 95% CI 0·78-0·98; I2 = 23·28%). There was no strong evidence of any effect on neonatal mortality, infections and admissions. There was an increase in stillbirth but the 95% CI crossed the null value (seven studies, Pooled RR 1·39; 95% CI 0·94 – 2.07; I2=0·00%). However this review was limited by differences in the types of intervention and study populations, and inconsistency in outcome reporting between studies. Interpretation Prophylactic azithromycin during pregnancy reduces LBW and prematurity. However, as azithromycin has been investigated as part of IPTp, it is unclear whether it would improve perinatal and neonatal outcomes in non-malaria endemic settings. The potential harm on stillbirth rates needs further investigation. Funding None

Background: The coronavirus disease 2019 (COVID-19) pandemic may have exacerbated existing socioe- conomic inequalities in health. In Argentina, public hospitals serve the poorest uninsured segment of the population, while private hospitals serve patients with health insurance. This study aimed to assess whether socioeconomic inequalities in low birth weight (LBW) risk changed during the first wave of the COVID-19 pandemic. Methods: This multicenter cross-sectional study included 15929 infants. A difference-in-difference (DID) analysis of socioeconomic inequalities between public and private hospitals in LBW risk in a pandemic cohort (March 20 to July 19, 2020) was compared with a prepandemic cohort (March 20 to July 19, 2019) by using medical records obtained from ten hospitals. Infants were categorized by weight as LBW < 2500 g, very low birth weight (VLBW) < 1500 g and extremely low birth weight (ELBW) < 1000 g. Log binomial regression was performed to estimate risk differences with an interaction term representing the DID estimator. Covariate-adjusted models included potential perinatal confounders. Findings: Of the 8437 infants in the prepandemic cohort, 4887 (57 ? 9%) were born in public hospitals. The pandemic cohort comprised 7492 infants, 4402 (58 ? 7%) of whom were born in public hospitals. The DID estimators indicated no differences between public versus private hospitals for LBW risk ( −1 ? 8% [95% CI −3 ? 6, 0 ? 0]) and for ELBW risk ( −0 ? 1% [95% CI −0 ? 6, 0 ? 3]). Significant differences were found between public versus private hospitals in the DID estimators ( −1 ? 2% [95% CI, −2 ? 1, −0 ? 3]) for VLBW risk. The results were comparable in covariate-adjusted models. Interpretation: In this study, we found evidence of decreased disparities between public and private hos- pitals in VLBW risk. Our findings suggest that measures that prioritize social spending to protect the most vulnerable pregnant women during the pandemic contributed to better birth outcomes. Funding: No funding was secured for this study. Fil: Cuestas, Eduardo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones en Ciencias de la Salud. Universidad Nacional de Córdoba. Instituto de Investigaciones en Ciencias de la Salud; Argentina Fil: Gómez Flores, Martha E.. Gobierno de la Provincia de Buenos Aires. Hospital Doctor Ramón Carrillo; Argentina Fil: Charras, María D.. Gobierno de la Provincia de Buenos Aires. Hospital Doctor Ramón Carrillo; Argentina Fil: Peyrano, Alberto J.. Hospital Materno Provincial Dr. Raúl Felipe Lucini; Argentina Fil: Montenegro, Clara. Hospital Materno Provincial Dr. Raúl Felipe Lucini; Argentina Fil: Sosa Boye, Ignacio. No especifíca; Fil: Burgos, Verónica. Universidad Católica de Córdoba. Facultad de Medicina. Clínica Universitaria Reina Fabiola; Argentina Fil: Giusti, Graciela. Clínica y Maternidad del Sol; Argentina Fil: Espósito, Mario. Clínica y Maternidad del Sol; Argentina Fil: Blanco Pool, Silvyana S.. Hospital Misericordia Nuevo Siglo ; Gobierno de la Provincia de Cordoba; Argentina Fil: Gurevich, Debora P.. Hospital Misericordia Nuevo Siglo ; Gobierno de la Provincia de Cordoba; Argentina Fil: Ahumada, Luis A.. Hospital Misericordia Nuevo Siglo ; Gobierno de la Provincia de Cordoba; Argentina Fil: Pontoriero, Ricardo D.. Hospital Misericordia Nuevo Siglo ; Gobierno de la Provincia de Cordoba; Argentina Fil: Rizzotti, Alina. Hospital Privado Universitario de Córdoba; Argentina Fil: Bas, José I.. Hospital Privado Universitario de Córdoba; Argentina Fil: Vaca, María B.. Hospital Universitario de Maternidad y Neonatología; Argentina Fil: Miranda, María J.. Hospital Universitario de Maternidad y Neonatología; Argentina Fil: Ferreyra, Mirta E.. Hospital Misericordia Nuevo Siglo ; Gobierno de la Provincia de Cordoba; Argentina Fil: Moreno, Gabriela C.. Gobierno de la Provincia de Buenos Aires. Hospital Doctor Ramón Carrillo; Argentina Fil: Pedicino, Héctor. Hospital Italiano; Argentina Fil: Rojas Rios, Melvy. Hospital Italiano; Argentina

Background: The COVID-19 pandemic restrictions affect provision and quality of neonatal care. This global study explores parents' experiences regarding the impact of the restrictions on key characteristics of infant and family-centred developmental care (IFCDC) during the first year of the pandemic. Methods: For this cross-sectional study, a pre-tested online survey with 52 questions and translated into 23 languages was used to collect data between August and November 2020. Parents of sick or preterm infants born during the pandemic and receiving special/intensive care were eligible for participation. Data analysis included descriptive statistics and statistical testing based on different levels of restrictive measures. Findings: In total, 2103 participants from 56 countries provided interpretable data. Fifty-two percent of respondents were not allowed to have another person present during birth. Percentages increased with the extent of restrictions in the respondents' country of residence (p = 0.002). Twenty-one percent of total respondents indicated that no-one was allowed to be present with the infant receiving special/intensive care. The frequency (p < 0.001) and duration (p = 0.001) of permitted presence largely depended on the extent of restrictions. The more restrictive the policy measures were, the more the respondents worried about the pandemic situation during pregnancy and after birth. Interpretation: COVID-19 related restrictions severely challenged evidence-based cornerstones of IFCDC, such as separating parents/ legal guardians and their newborns. Our findings must therefore be considered by public health experts and policy makers alike to reduce unnecessary suffering, calling for a zero separation policy. Funding: EFCNI received an earmarked donation by Novartis Pharma AG in support of this study. (c) 2021 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Objective:Chronic aflatoxin exposure has been associated with childhood stunting (length-for-age/height-for-age < –2 sd), while data lacks for Bangladesh, a country with substantial burden of childhood stunting. This paper examined the association between aflatoxin exposure and childhood stunting in a slum setting of Dhaka city.Design:In this MAL-ED aflatoxin birth cohort study, plasma samples were assayed for aflatoxin B1-lysine adduct (AFB1-lys) by MS at 7, 15, 24 and 36 months of age for 208, 196, 173 and 167 children to assess chronic aflatoxin exposure. Relationship between aflatoxin exposure and anthropometric measures was examined by mixed-effects logistic regression models.Setting and participants:The study was conducted in Mirpur, Dhaka, where children were followed from birth to 36 months.Results:Prevalence of stunting increased from 21 % at 7 months to 49 % at 36 months of age. Mean AFB1-lys concentrations at 7, 15, 24 and 36 months were 1·30 (range 0·09–5·79), 1·52 (range 0·06–6·35), 3·43 (range 0·15–65·60) and 3·70 (range 0·09–126·54) pg/mg albumin, respectively, and the percentage of children with detectable AFB1-lys was 10, 21, 18 and 62 %, respectively. No association was observed between aflatoxin exposure and stunting in multivariable analyses. Factors associated with childhood stunting were age, low birth weight, maternal height, stool myeloperoxidase and number of people sleeping in one room.Conclusions:A relatively lower exposure to aflatoxin may not influence the linear growth of children. This finding indicates a threshold level of exposure for linear growth deficit and further investigation in other areas where higher concentrations of aflatoxin exposure exist.