Design: Follow-up of a randomised placebo-controlled trial, masked assessors
Population: 403 children born at 34 weeks or later with asphyxia, six LMIC sites including two in India
Primary outcome: Bayley-III cognitive composite at 24 months corrected age
Effect: 90.9 vs 90.9; mean difference 0.29 (95% CI -1.77 to 2.34)

A-PLUS randomised labouring women in six low- and middle-income sites — two of them in India — to a single 2 g oral dose of azithromycin or placebo. This follow-up assessed 403 children born at 34 weeks or later with signs of asphyxia (5-minute Apgar below 7 or needing bag-and-mask ventilation), using masked Bayley-III examiners at 24 months corrected age.

Cognitive composite scores were identical (90.9 in both arms; mean difference 0.29, 95% CI -1.77 to 2.34). Language and motor scores, and all five ASQ-3 domains, did not differ, and South Asian and African sites gave the same answer.

The hypothesis was that reducing infection-driven inflammation around birth might protect the asphyxiated brain. This follow-up does not support it. Intrapartum azithromycin should be judged on its maternal infection outcomes, not on any neurodevelopmental promise.

Do not give intrapartum azithromycin with the aim of protecting the newborn brain
Newborns with Apgar below 7 at 5 minutes still need structured developmental follow-up, whatever antibiotic the mother received
The India sites contributed directly, so this answer applies to Indian labour wards
Any decision about intrapartum azithromycin rests on maternal sepsis outcomes, not child development

Why it matters

It closes off one proposed benefit of a cheap intervention that is being considered for wide use in labour.

The statistics, in plain English

A mean difference of 0.29 points on a scale with a standard deviation of about 11, with an interval from -1.77 to 2.34, rules out any clinically meaningful benefit.