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BACKGROUND: Low birth weight (LBW) is associated with neonatal mortality and sequelae of lifelong health problems; prioritizing the most promising antenatal interventions may guide resource allocation and improve health outcomes. OBJECTIVE: We sought to identify the most promising interventions that are not yet included in the policy recommendations of the World Health Organization (WHO) but could complement antenatal care and reduce the prevalence of LBW and related adverse birth outcomes in low- and middle-income settings. METHODS: We utilized an adapted Child Health and Nutrition Research Initiative (CHNRI) prioritization method. RESULTS: In addition to procedures already recommended by WHO for the prevention of LBW, we identified six promising antenatal interventions that are not currently recommended by WHO with an indication for LBW prevention, namely: (1) provision of multiple micronutrients; (2) low-dose aspirin; (3) high-dose calcium; (4) prophylactic cervical cerclage; (5) psychosocial support for smoking cessation; and (6) other psychosocial support for targeted populations and settings. We also identified seven interventions for further implementation research and six interventions for efficacy research. CONCLUSION: These promising interventions, coupled with increasing coverage of currently recommended antenatal care, could accelerate progress toward the global target of a 30% reduction in the number of LBW infants born in 2025 compared to 2006-10.

Objective To investigate the effect of kangaroo mother care for low-birth-weight and preterm infants on parents' mental and physical health. Methods The Cochrane Central Register of Controlled Trials, Cochrane Register of Studies Online, PubMed[R], Web of Science, Scopus and EMBASE[R] databases were searched on 16 January 2023 for randomized and quasi-randomized trials on kangaroo mother care. Records identified were screened independently by two reviewers. Pooled relative risks (RRs) are reported for categorical variables, and standardized mean differences (SMDs) or mean differences are reported for continuous variables. Evidence quality was assessed using the GRADE approach. Findings The search identified 30 studies involving 7719 preterm or low-birth-weight infants. There was high- certainty evidence that kangaroo mother care substantially reduced the risk of moderate-to-severe postpartum maternal depressive symptoms compared with no kangaroo mother care (RR: 0.76; 95% confidence interval, CI: 0.59 to 0.96). In addition, there was low-certainty evidence that kangaroo mother care reduced scores for maternal stress (SMD: -0.82; 95% CI: -1.32 to -0.32) and anxiety (SMD: -0.62; 95% CI: -1.01 to -0.23) and increased mother-infant attachment and bonding scores (SMD: 1.19; 95% CI: 0.27 to 2.10). Limited evidence indicated father-infant interactions may be improved, though no marked effect on paternal depression or stress was observed. No trial reported parental physical health outcomes. Conclusion Kangaroo mother care for preterm and low-birth-weight infants was associated with less postpartum maternal depression, stress and anxiety and better mother-infant attachment and bonding. More research is required to evaluate effects on paternal health. Objectif Etudier les effets, sur la sante mentale et physique des parents, de la methode <> appliquee aux nouveau-nes prematures ou de faible poids de naissance. Methodes Nous avons parcouru les bases de donnees du Registre central Cochrane des essais controles, du Registre Cochrane des etudes en ligne, de PubMed[R], de Web of Science, de Scopus et d'EMBASE[R] le 16 janvier 2023, a la recherche d'essais randomises et quasi-randomises sur la methode <>. Les documents retenus ont ete passes en revue separement par deux reviseurs. Les risques relatifs combines (RR) ont ete signales pour les variables nominales, tandis que les differences moyennes standardisees (DMS) ou differences moyennes l'ont ete pour les variables continues. Enfin, la qualite des donnees probantes a ete evaluee selon l'approche GRADE. Resultats La recherche a permis d'identifier 30 etudes impliquant 7719 nouveau-nes prematures ou de faible poids de naissance. Nous pouvons affirmer avec un degre eleve de certitude que le risque d'apparition des symptomes d'une depression post-partum moderee a severe est nettement plus faible chez les meres ayant adopte la methode <> que chez celles ne l'ayant pas adoptee (RR: 0,76; intervalle de confiance de 95%, IC: 0,59 a 0,96). En outre, il existe des preuves de faible certitude selon lesquelles la methode <> ferait baisser le niveau de stress maternel (DMS: -0,82; IC de 95%: -1,32 a -0,32) et d'anxiete (DMS: -0,62; IC de 95%: -1,01 a -0,23), tout en renforcant les relations mere-enfant et la formation de liens affectifs (DMS: 1,19; IC de 95%: 0,27 a 2,10). Des donnees limitees indiquent que les interactions pere-enfant pourraient s'en trouver ameliorees, meme si aucun impact significatif n'a ete constate sur le stress ou la depression paternelle. Aucun essai n'a fait etat d'une influence sur la sante physique des parents. Conclusion La methode <> appliquee aux nouveaunes prematures ou de faible poids de naissance etait associee a une diminution du stress, de l'anxiete et de la depression post-partum du cote maternel, ainsi qu'a un attachement et des liens plus forts entre la mere et l'enfant. D'autres recherches sont necessaires pour evaluer ses effets sur la sante paternelle. Objetivo Investigar los efectos del metodo madre canguro para recien nacidos prematuros y de bajo peso al nacer sobre la salud mental y fisica de los padres. Metodos Se realizaron busquedas en las bases de datos del Registro Cochrane Central de Ensayos Controlados, del Registro Cochrane de Estudios en Linea, de PubMed[R], de Web of Science, de Scopus y de EMBASE[R] el 16 de enero de 2023 para obtener ensayos aleatorizados y cuasialeatorizados sobre el metodo madre canguro. Dos revisores analizaron de forma independiente los registros identificados. Se informan los riesgos relativos (RR) agrupados para las variables categoricas y las diferencias de medias estandarizadas (DME) o las diferencias de medias para las variables continuas. La calidad de la evidencia se evaluo mediante el enfoque GRADE. Resultados La busqueda identifico 30 estudios con 7719 recien nacidos prematuros o de bajo peso al nacer. Hubo pruebas de alta certeza de que el metodo madre canguro redujo significativamente el riesgo de sintomas depresivos posparto de moderados a graves en comparacion con ningun metodo madre canguro (RR: 0,76; intervalo de confianza del 95%, IC: 0,59 a 0,96). Ademas, hubo pruebas de baja certeza de que el metodo madre canguro redujo las puntuaciones de estres materno (DME: -0,82; IC del 95%: -1,32 a -0,32) y ansiedad (DME: -0,62; IC del 95%: -1,01 a -0,23) y aumento las puntuaciones de apego y vinculacion madre-hijo (DME: 1,19; IC del 95%: 0,27 a 2,10). Las pruebas limitadas indicaron que las interacciones padre-hijo pueden mejorar, aunque no se observo un efecto marcado sobre la depresion o el estres paterno. Ningun ensayo informo desenlaces de salud fisica de los padres. Conclusion El metodo madre canguro para recien nacidos prematuros y de bajo peso al nacer se asocio con menos depresion, estres y ansiedad maternos, posparto y mejor apego y vinculacion madre-hijo. Se necesitan mas investigaciones para evaluar los efectos sobre la salud paternal., Introduction Pregnancy and childbirth are critical periods in women's lives involving major physiological, psychological, domestic and sociodemographic changes. During the first 6 months postpartum, (1) an estimated 15% to 33% [...]

The COVID-19 pandemic is disrupting health systems globally. Maternity care disruptions have been surveyed, but not those related to vulnerable small newborns. We aimed to survey reported disruptions to small and sick newborn care worldwide and undertake thematic analysis of healthcare providers' experiences and proposed mitigation strategies. Using a widely disseminated online survey in three languages, we reached out to neonatal healthcare providers. We collected data on COVID-19 preparedness, effects on health personnel and on newborn care services, including kangaroo mother care (KMC), as well as disruptors and solutions. We analysed 1120 responses from 62 countries, mainly low and middle-income countries (LMICs). Preparedness for COVID-19 was suboptimal in terms of guidelines and availability of personal protective equipment. One-third reported routine testing of all pregnant women, but 13% had no testing capacity at all. More than 85% of health personnel feared for their own health and 89% had increased stress. Newborn care practices were disrupted both due to reduced care-seeking and a compromised workforce. More than half reported that evidence-based interventions such as KMC were discontinued or discouraged. Separation of the mother-baby dyad was reported for both COVID-positive mothers (50%) and those with unknown status (16%). Follow-up care was disrupted primarily due to families' fear of visiting hospitals (~73%). Newborn care providers are stressed and there is lack clarity and guidelines regarding care of small newborns during the pandemic. There is an urgent need to protect life-saving interventions, such as KMC, threatened by the pandemic, and to be ready to recover and build back better.

Key Points: Question: How does a package of multidomain interventions addressing health, nutrition, psychosocial care and support, and environmental hygiene delivered during preconception, pregnancy, and early childhood affect child neurodevelopment at 24 months? Findings: In this second report of a randomized trial in India assessing interventions during preconception, pregnancy, and early childhood on childhood preterm births and childhood growth as primary outcomes, the secondary outcome was neurodevelopment at 24 months. Among 1712 children assessed, preconception, pregnancy, and early childhood interventions were associated with modest improvements in scores and lower incidence of moderate to severe neurodevelopmental delay in the cognitive, language, and socioemotional domains. Meaning: Multidomain interventions in the preconception period, along with those in pregnancy and early childhood, may be beneficial for child neurodevelopment. Importance: Multidomain interventions in pregnancy and early childhood have improved child neurodevelopment, but little is known about the effects of additional preconception interventions. Objective: To evaluate the effect of a multifaceted approach including health; nutrition; water, sanitation, and hygiene (WASH); and psychosocial support interventions delivered during the preconception period and/or during pregnancy and early childhood on child neurodevelopment. Design, Setting, and Participants: In this randomized trial involving low- and middle-income neighborhoods in Delhi, India, 13 500 participants were assigned to preconception interventions or routine care for the primary outcome of preterm births and childhood growth. Participants who became pregnant were randomized to pregnancy and early childhood interventions or routine care. Neurodevelopmental assessments, the trial's secondary outcome reported herein, were conducted in a subsample of children at age 24 months, including 509 with preconception, pregnancy, and early childhood interventions; 473 with preconception interventions alone; 380 with pregnancy and early childhood interventions alone; and 350 with routine care. This study was conducted from November 1, 2000, through February 25, 2022. Interventions: Health, nutrition, psychosocial care and support, and WASH interventions delivered during preconception, pregnancy, and early childhood periods. Main Outcomes and Measures: Cognitive, motor, language, and socioemotional performance at age 24 months, assessed using the Bayley Scales of Infant and Toddler Development 3 tool. Results: The mean age of participants at enrollment was 23.8 years (SD, 3.0 years). Compared with the controls at age 24 months, children in the preconception intervention groups had higher cognitive scores (mean difference [MD], 1.16; 98.3% CI, 0.18-2.13) but had similar language, motor, and socioemotional scores as controls. Those receiving pregnancy and early childhood interventions had higher cognitive (MD, 1.48; 98.3% CI, 0.49-2.46), language (MD, 2.29; 98.3% CI, 1.07-3.50), motor (MD, 1.53; 98.3% CI, 0.65-2.42), and socioemotional scores (MD, 4.15; 98.3% CI, 2.18-6.13) than did controls. The pregnancy and early childhood group also had lower incidence rate ratios (RRs) of moderate to severe delay in cognitive (incidence RR, 0.62; 98.3% CI, 0.40-0.96), language (incidence RR, 0.73; 98.3% CI, 0.57-0.93), and socioemotional (incidence RR, 0.49; 98.3% CI, 0.24-0.97) development than did those in the control group. Children in the preconception, pregnancy, and early childhood intervention group had higher cognitive (MD, 2.60; 98.3% CI, 1.08-4.12), language (MD, 3.46; 98.3% CI, 1.65-5.27), motor (MD, 2.31; 98.3% CI, 0.93-3.69), and socioemotional (MD, 5.55; 98.3% CI, 2.66-8.43) scores than did those in the control group. Conclusions and Relevance: Multidomain interventions during preconception, pregnancy and early childhood led to modest improvements in child neurodevelopment at 24 months. Such interventions for enhancing children's development warrant further evaluation. Trial Registration: Clinical Trials Registry–India CTRI/2017/06/008908 This randomized trial assesses interventions that span preconception through early childhood compared with usual care on neurodevelopment among children at age 24 months in low- and middle-income neighborhoods in India. [ABSTRACT FROM AUTHOR]

Inadequate protein intake and lack of micronutrients may affect neurodevelopment in infants. This randomised controlled trial was conducted to measure the effect of two milk–cereal mixes with modest and high amounts of protein and enriched with multiple micronutrients, given between 6 and 12 months, on cognitive, language, motor and behavioural scores at 12 and 24 months of age, compared with no-supplementation. The two supplements were also compared with each other. The study was conducted in urban Delhi, India, and the infants were randomised in a 1:1:1 ratio to the three study groups. At 12 and 24 months of age, 1134 and 1214 children were available, respectively. At 12 months of age, compared with no-supplement group, an increase in the motor scores (mean difference, MD 1·52, 95 % CI: 0·28, 2·75) and a decrease in the infant temperament scores (MD − 2·76, 95 % CI: −4·23, −1·29) in the modest-protein group was observed. Those in the high-protein group had lower socio-emotional scores (MD − 1·40, 95 % CI: −2·43, −0·37) and higher scores on Infant Temperament Scale (MD 2·05, 95 % CI: 0·62, 3·48) when compared with modest-protein group. At 24 months, no significant differences in any of the neurodevelopment scores between the three study groups was found. In conclusion, supplementation with modest amount of protein and multiple micronutrients may lead to short-term small improvements in motor function and infant temperament. There appears no advantage of supplementing with high protein, rather negative effects on infant behaviour were observed [ABSTRACT FROM AUTHOR]

Aim: To learn how to achieve high‐quality, effective coverage of Kangaroo Mother Care (KMC), defined as 8 hours or more of skin‐to‐skin contact per day and exclusive breastfeeding in district Sonipat in North India, and to develop and evaluate an implementation model. Methods: We conducted implementation research using a mixed‐methods approach, including formative research, followed by repeated, rapid cycles of implementation, evaluation and refinement until a model with the potential for high and effective coverage was reached. Evaluation of this model was conducted over a 12‐month period. Results: Formative research findings informed the final implementation model. Programme learning was critical to achieve high coverage. The model included improving the identification of small babies, creating KMC wards, modification in hospitalisation criteria, private sector engagement and in‐built programme learning to refine implementation progress. KMC was initiated in 87% of eligible babies. At discharge, 85% received skin‐to‐skin contact care, 60% effective KMC and 80% were exclusively breastfed. At home, 7‐day post discharge, 81% received skin‐to‐skin care and 79% were exclusively breastfed in the previous 24 hours. Conclusion: Achieving high KMC coverage is feasible in the study setting using a model responsive to the local context and led by the Government. [ABSTRACT FROM AUTHOR]