Neural crest progenitor cells give rise to neuroblasts, the growing nerve cells of the sympathetic nervous system. These cells can undergo changes leading to neuroblastoma, a malignancy responsible for 15% of all pediatric cancer-related deaths. The molecular pathogenesis of this pediatric cancer involves complex genetic alterations, such as MYCN amplification, chromosomal abnormalities, and gene expression changes. Despite aggressive therapies, survival rates for children with high-risk neuroblastoma (HRNB) have not improved significantly compared to those with less severe forms of the disease. This highlights the challenge of managing HRNB and underscores the need for new, effective treatments. A comprehensive treatment regimen, including immunotherapy, radiation therapy, myeloablative chemotherapy, and surgical removal, has been employed to achieve remission in HRNB patients. While dinutuximab beta immunotherapy is an effective and widely used treatment, it has several potential side effects that must be carefully monitored. New drugs are being developed to reduce these side effects without compromising efficacy. One such drug is DL-alpha-difluoromethylornithine (DFMO), approved by the FDA under the brand name Iwilfin. Numerous clinical trials have shown that DFMO, when used as maintenance therapy, significantly improves event-free survival and overall survival in neuroblastoma patients. However, DFMO has adverse effects that require continuous monitoring. Further research is needed to minimize these side effects and improve its efficacy, particularly in addressing resistance caused by long-term use.

Background: There is an increased demand for nutrition during pregnancy to improve fetal growth and development. Several dietary interventions have been recommended to pregnant women to meet their maternal needs. Using a larger sample size, we aim to assess the effect of balanced protein–energy supplementation given to pregnant women on birth outcomes. Objective: To evaluate the effect of balanced protein–energy supplementation given to pregnant women on birth outcomes. Design: Search included PubMed, Cochrane Central, and Embase from initiation till 20 March 2023 to select relevant studies examining perinatal factors associated with balanced protein–energy supplementation. Mean differences (MD) and risk ratios (RRs) with a 95% confidence interval (CI) were calculated using Review Manager. Data sources and methods: Randomized controlled trials and observational studies were included. Out of 218,720 studies initially identified, 24 met the inclusion criteria, involving pregnant women who received balanced protein–energy supplementation and reported outcomes related to perinatal death, birthweight, length, or head circumference. Results: Meta-analysis of pooled studies revealed that balanced protein supplementation had a significant effect on birthweight (g) (MD: 62.67, CI: 27.92–97.43), low birth weight (LBW) (RR: 0.73, CI: 0.57–0.95), birth length (MD: 0.20, CI: 0.10–0.30), and small-for-gestational-age (SGA) babies (RR: 0.74, CI: 0.59–0.93) and had no significant effect on the birth head circumference (MD: 0.05, CI: −0.09 to 0.20), perinatal death (RR: 0.83, CI: 0.50–1.37), and preterm birth (RR: 0.86, CI: 0.68–1.08). Conclusion: Balanced protein–energy supplementation is an effective intervention for birth length, birth weight, risk of LBW, and SGA births, particularly in women who are undernourished.