Neonatal Azithromycin Administration and Growth during Infancy: A Randomized Controlled Trial

Area of Science:

• Global Health
• Pediatric Health
• Infectious Diseases

Background:

• Observational studies suggest early-life antibiotic exposure may increase childhood obesity risk in high-income countries.
• The impact of neonatal antibiotic administration on infant growth in low-income settings remains less understood.

Purpose of the Study:

• To evaluate the effect of a single neonatal dose of azithromycin on infant growth parameters at six months of age in Burkina Faso.
• To determine if azithromycin administration in neonates influences weight gain, length, and mid-upper-arm circumference (MUAC).

Main Methods:

• A randomized controlled trial involving 21,832 neonates (aged 8-27 days, weight ≥2,500g) in Burkina Faso.
• Participants received either a single oral dose of azithromycin (20 mg/kg) or a placebo.
• Growth outcomes including weight, length, MUAC, and Z-scores (WAZ, WLZ, LAZ) were measured at baseline and six months.

Main Results:

• No significant differences were observed in weight gain (mean difference -0.009 g/day), length change (mean difference 0.003 mm/day), or MUAC change (mean difference 0.01 cm) between the azithromycin and placebo groups.
• Similarly, no statistically significant differences were found in weight-for-age Z-score (WAZ), weight-for-length Z-score (WLZ), or length-for-age Z-score (LAZ).
• The study found no evidence that azithromycin administration in neonates promotes infant growth.

Conclusions:

• A single neonatal dose of azithromycin does not appear to alter infant growth trajectories at six months in the studied population in Burkina Faso.
• These findings do not support the hypothesis that azithromycin possesses growth-promoting properties when administered neonatally in this context.
• Further research may explore long-term effects or different antibiotic classes in diverse settings.