Dr. Shoham Majumder is a Neonatologist with qualifications including MD, DNB (Paediatrics), and DM, DrNB (Neonatology). He is dedicated to advancing newborn health through evidence-based practice, clinical excellence, and compassionate care. His interests include POCUS, preterm nutrition, lactation, and family-centred care. Dr. Majumder is actively involved in academic writing, research appraisal, quality-improvement initiatives, and mentoring medical and nursing trainees. He has contributed to several peer-reviewed publications in journals such as Frontiers in Pediatrics, Indian Journal of Pediatrics, and BMJ Case Reports, and has authored multiple book chapters including in Cloherty & Stark’s Manual of Neonatal Care. His work has been recognised with awards such as Best Original Paper (Pedicon East Zone 2019), Best Poster (CPcon Kolkata 2019), and the Best MD/DM Thesis Award (PCNI, New Delhi 2023).

Abstract

Autism Spectrum Disorders (ASD) and Neurodevelopmental Disorders represent highly heterogeneous conditions, marked by diagnostic and therapeutic complexity, often with onset in early childhood. Traditional approaches, mostly focused on cognitive and behavioral dimensions, have proven insufficient to fully explain the diversity of clinical presentations, often neglecting the somatic, biological, and neurophysiological components of autistic functioning. In light of recent scientific evidence in the fields of precision medicine, psychoneuroimmunology, epigenetics, and nutritional psychiatry, a paradigm shift is proposed: from symptom-based treatment to a biologically informed, person-centered integrated model. The nCnCnB Model (not only Cognitive, not only Behavioral, but also Neurobiological) is operationalized within the D.ͶT. Protocol, with special attention to pediatric specificity, child neuropsychiatry, and the frequent presence of comorbidities or co-occurring conditions. Over 70% of children with ASD present at least one comorbidity, and 40% have two or more. Common conditions include: ADHD, epilepsy, intellectual disability, sleep disorders, metabolic disorders, autoimmunity, PANS/PANDAS, gut dysbiosis, sensory integration deficits, and psychiatric disorders.

Abstract 

Introduction and objective: Intermittent preventive treatment in pregnancy (IPTp) with dihydroartemisinin-piperaquine (DHA-PPQ) has recently been shown to significantly reduce overall malaria risk in African women living with HIV who take daily cotrimoxazole prophylaxis and antiretroviral therapy. Information on the effects of in utero exposure to the drug on infant development is critical for this strategy to be considered a malaria control tool that can be implemented.

 Methods: In the context of a multicenter randomized placebo-controlled trial evaluating the safety and efficacy of IPTp with DHA-PPQ in Gabon and Mozambique, 647 newborns, (330 born to placebo and 317 born to DHA-PPQ recipients), were followed up until 12 months of age. Anthropometric parameters and psychomotor development were assessed at 1, 6, 9, and 12 months of age, and the incidence of malaria, anemia, hospital admissions, outpatient visits, and mortality were determined until 12 months of age. HIV PCR was also performed at each scheduled visit to detect vertical transmission.

Results: No significant differences were found in the proportion of infants with stunting, underweight, wasting, and severe acute malnutrition at 1, 6, 9, and 12 months of age between infants born to women who received DHA-PPQ and those who received placebo. Except for one item evaluated at 9 mo of age, no significant differences were observed in the psychomotor development milestones assessed. Incidence of malaria, anemia, hospital admissions, outpatient visits, and mortality were similar between the two groups. Five infants (4 born to DHA-PPQ recipients and 1 born to a placebo recipient mother) had a positive HIV PCR test, corresponding to an overall 0.6% proportion of HIV vertical transmission.

 Conclusions: The administration of IPTp with DHA-PPQ in African women living with HIV was safe and did affect morbidity and developmental outcomes of infants exposed in utero to the antimalrial drug.

Impact/Significance: IPTp with DHA-PPQ can be considered a safe strategy and could be considered for protecting women with HIV from malaria.