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Summary scores of the Bayley-III cognitive, language and motor subscales at 6 and 12 months of age will be the primary outcome in the current study, while the assessment at 24 months will serve as secondary outcome

Treatment sequencing affects combination effectiveness - some users begin peptides first assessing response before considering Botox, adding injections only for areas proving peptide-resistant after 3-6 month trial, while others start Botox for immediate results then incorporate peptides reducing future Botox needs through preventive maintenance

This limits the proliferation of Enterococcus and Klebsiella pneumoniae , while also inhibiting excessive growth of Escherichia coli through the induction of antimicrobial peptides