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Background: The safety and efficacy of antenatal glucocorticoids in women in low-resource countries who are at risk for preterm birth are uncertain., Methods: We conducted a multicountry, randomized trial involving pregnant women between 26 weeks 0 days and 33 weeks 6 days of gestation who were at risk for preterm birth. The participants were assigned to intramuscular dexamethasone or identical placebo. The primary outcomes were neonatal death alone, stillbirth or neonatal death, and possible maternal bacterial infection; neonatal death alone and stillbirth or neonatal death were evaluated with superiority analyses, and possible maternal bacterial infection was evaluated with a noninferiority analysis with the use of a prespecified margin of 1.25 on the relative scale., Results: A total of 2852 women (and their 3070 fetuses) from 29 secondary- and tertiary-level hospitals across Bangladesh, India, Kenya, Nigeria, and Pakistan underwent randomization. The trial was stopped for benefit at the second interim analysis. Neonatal death occurred in 278 of 1417 infants (19.6%) in the dexamethasone group and in 331 of 1406 infants (23.5%) in the placebo group (relative risk, 0.84; 95% confidence interval [CI], 0.72 to 0.97; P = 0.03). Stillbirth or neonatal death occurred in 393 of 1532 fetuses and infants (25.7%) and in 444 of 1519 fetuses and infants (29.2%), respectively (relative risk, 0.88; 95% CI, 0.78 to 0.99; P = 0.04); the incidence of possible maternal bacterial infection was 4.8% and 6.3%, respectively (relative risk, 0.76; 95% CI, 0.56 to 1.03). There was no significant between-group difference in the incidence of adverse events., Conclusions: Among women in low-resource countries who were at risk for early preterm birth, the use of dexamethasone resulted in significantly lower risks of neonatal death alone and stillbirth or neonatal death than the use of placebo, without an increase in the incidence of possible maternal bacterial infection. (Funded by the Bill and Melinda Gates Foundation and the World Health Organization; Australian and New Zealand Clinical Trials Registry number, ACTRN12617000476336; Clinical Trials Registry-India number, CTRI/2017/04/008326.)., (Copyright © 2020 Massachusetts Medical Society.)

Objective: To evaluate the effectiveness of intermittent pulse oximetry in guiding oxygen therapy in neonates in a low-resource setting., Design and Setting: Prospective validation study at three hospitals in southwest Nigeria. We performed concealed continuous pulse oximetry on participants to evaluate intermittent SpO 2 monitoring., Patients: We recruited all preterm or low birthweight neonates, and all term neonates who required oxygen therapy, who were admitted to the neonatal ward(s) of the study hospitals during the study period., Main Outcome Measures: Proportion of time preterm/low birthweight neonates on oxygen spent within, above and below the target SpO 2 range of 90%-95%; and the proportion of time term neonates and neonates not on oxygen spent within and below the target range of 90%-100%., Results: Preterm/low birthweight neonates receiving oxygen therapy (group A) spent 15.7% (95% CI 13.3 to 18.9) of time in the target SpO 2 range of 90%-95%. They spent 75.0% (63.6-81.1) of time above 95%, and 2.7% (1.7-5.6) of time below 85%. Term neonates and all neonates not receiving oxygen (group B) spent 97.3% (95% CI 96.4 to 98.6) of time within the target range of 90%-100%, and 0.9% (0.3-1.4) of time below 85%. Guidelines recommended SpO 2 monitoring 3 times per day for all patients, however neonates in groups A and B were monitored an average of 4.7 and 5.3 times per day, respectively., Conclusions: To better maintain SpO 2 within the target range, preterm/low birthweight neonates on oxygen should have their SpO 2 monitored more frequently than the current 4.7 times per day. In all other neonates, however, monitoring SpO 2 5.3 times per day appears suitable., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)

Background: The occurrence of adverse events following immunization (AEFI) in national immunization programmes is very rare; however, if they occur causality assessment is conducted to identify the associated cause. In the report, we describe a case of severe necrotizing fasciitis in the left arm of a 9-month old boy following administration of the measles vaccine., Case Presentation: A 9-month old boy presented with swelling on the left upper arm and adjoining the chest area, low-grade continuous fever, frequent passage of loose watery stool and persistent cries 24 h after measles vaccine was administered on the left upper arm. On examination, he was mildly pale, febrile, anicteric. Extensive erythema of the left upper arm occurred thereafter with extensive scalded skin lesions involving the deltoid area, the upper chest wall and arm. This was followed by desquamation of the affected areas and severe necrosis. A diagnosis of severe necrotizing fasciitis was made. A causality assessment was conducted by the state AEFI committee using the detailed AEFI investigation forms to identify the cause of the incidence., Conclusion: Here we present a rare case of necrotizing fasciitis which could have been caused by incorrect use of reconstituted measles vaccine. Hence we recommend training of routine immunization service providers on proper vaccine management as well as intensified supervision of immunization sessions.

Background: Physician-mothers' breastfeeding behaviour is being studied because it is believed to impact their anticipatory guidance to their patients, which in turn influences patients' breastfeeding initiation and continuation. Study assessed the breastfeeding practices of physician-mothers; their reasons for stopping exclusive breastfeeding and factors associated with their breastfeeding practices., Methods: Study design was cross-sectional, conducted in Osun East Senatorial District, Nigeria. A self-administered semi-structured questionnaire was administered to all eligible 56 physician-mothers in public primary, secondary and tertiary health facilities in the reproductive age-group whose youngest child was aged d"five years. Informed consent was obtained. Outcome measures were time breastfeeding was initiated, duration of exclusive breastfeeding; reasons for stopping exclusive breastfeeding and duration of continued breastfeeding. Data was analysed using SPSS version 17, statistical significance was determined at p-value < 0.05., Results: Fifty (89.3%) responded. Seventy per cent initiated breastfeeding within 1 hour after birth; exclusive breastfeeding rate was 28.0% with a mean duration of 4.1 +/- 1.9 months. Mean duration of continued breastfeeding was 14.5 +/- 4.5 months. Commonest reason for stopping exclusive breastfeeding was 'baby old enough' (35.8%). Mode of delivery was statistically significantly associated with time to initiate breastfeeding. Time to initiate breastfeeding was statistically significantly associated with duration of exclusive breastfeeding., Conclusion: Breastfeeding practices of physician-mothers do not conform to the standards in the Innocenti Declaration. The impact of this on their professional support to clients' should be measured in further studies. It is recommended that targeted interventions be done to improve the attitude and breastfeeding practices of physician-mothers.