Summary: A landmark randomized controlled trial conducted in low-resource neighborhoods of South Delhi, India, demonstrates that an integrated home-visit intervention package significantly improves physical growth, reduces anemia, enhances neurodevelopment, and lowers mortality among small-for-gestational-age (SGA) infants.
The study followed 1,300 term SGA infants enrolled within 14 days of birth through 12 months of age. Unlike previous trials evaluating isolated therapies, this trial tested a comprehensive package encompassing health, nutrition, early child stimulation, and maternal psychosocial support delivered via direct home visits.
Infants in the intervention group exhibited marked reductions in underweight, stunting, and wasting, along with a more than 50% reduction in anemia prevalence and superior cognitive, language, and motor development scores compared to those receiving routine care.
Key Facts
- Global Public Health Burden: Approximately 23 million infants (17% of all births) are born SGA annually worldwide, with prevalence reaching 40% in South Asia due to systemic maternal nutritional, health, and socioeconomic challenges.
- Integrated Care vs Standard Care: 1,300 term SGA infants were randomized 1:1 to receive either an integrated intervention package combining health, nutrition, early child stimulation, and psychosocial support via regular home visits (n = 647) or routine Indian government care (n = 653).
- Profound Anemia Reduction: The home-visit intervention package reduced the prevalence of infant anemia by more than half compared to the control group.
- Neurodevelopmental Enhancements: Infants receiving the integrated package achieved significantly higher composite scores in cognitive function, language acquisition, and motor skill development by 12 months of age.
- Growth and Survival Benefits: The intervention arm demonstrated lower rates of underweight, stunting, and wasting, as well as reduced overall infant mortality during the trial period.
Source: University of Bergen
Previous research on the topic has focused on standalone or partially integrated interventions and produced mixed findings. In contrast, this trial tested an integrated intervention package and showed consistent benefits in terms of growth, anemia, and neurodevelopmental outcomes for SGA babies.
Every year, about 23 million babies (17%) are born SGA globally, with a prevalence of 40% in South Asia alone, which may be due to persistent maternal nutritional, health, and socioeconomic constraints in the region. SGA babies have higher risks of poor growth, developmental delay, illness, and death during early childhood.
In the first six months of life, optimal weight and length trajectories are strongly associated with better neurodevelopmental outcomes in later childhood, and early weight gain is a strong determinant of survival in low-resource settings.
The study is a collaboration between scientists from the Society for Applied Studies in New Delhi, India, and from the University of Bergen, Norway. First authors are Ranadip Chowdhury and Rukman Manapurath and the last author is Sunita Taneja from the Society for Applied Studies, New Delhi, India, and co-authors include Ingvild Fossgard Sandøy, Director of the Bergen Centre for Ethics and Priority Setting in Health (BCEPS) at the University of Bergen, as well as Tor Strand and Jose Martines affiliated with the Centre for International Health and the Centre for Intervention Science in Maternal and Child Health (CISMAC) at the University of Bergen.
The clinical trial was conducted in low-resource neighborhoods of South Delhi, India, between January 2023 and August 2025. Term SGA infants were enrolled in the study within 14 days of birth, and 1300 infants were randomized and followed up to 12 months of age.
The infants were randomized in a 1:1 ratio to receive either the integrated intervention package, which included health, nutrition, early child stimulation, and psychosocial support, delivered through regular home visits to mothers and infants (n = 647) or the usual care provided through Indian government programs (n = 653).
The researchers found that babies in the intervention group had a lower prevalence of underweight, stunting, wasting, and anemia. The prevalence of anemia was reduced by more than half among infants receiving the intervention. In addition, they had higher cognitive scores, language scores, and motor composite scores. Fewer babies died in the intervention group than in the control group during the trial period.
These strong results underscore the importance of integrated interventions to improve the survival and healthy growth of SGA infants, not only in India or South Asia, where the prevalence of babies born SGA is particularly high, but also globally.
Key Questions Answered:
A: SGA infants are born with birth weights below the 10th percentile for their gestational age. They face heightened risks of severe illness, developmental delays, stunting, and early childhood mortality. Optimal growth trajectories during the first six months are strongly determinant of long-term neurodevelopmental and survival outcomes.
A: The package combined healthcare monitoring, nutritional support, structured early child stimulation activities, and maternal psychosocial guidance. Trained health worker home visits delivered these elements directly to mothers and infants, ensuring comprehensive caregiver support.
A: Earlier research largely focused on single or partially integrated interventions (such as isolated nutritional supplementation), which yielded mixed results. This trial proves that bundling health, nutrition, stimulation, and maternal support into a unified, home-delivered package produces consistent, large-scale gains across growth, blood health, and brain development.
Editorial Notes:
- This article was edited by a Neuroscience News editor.
- Journal paper reviewed in full.
- Additional context added by our staff.
About this neurodevelopment research news
Author: Jana Wilbricht
Source: University of Bergen
Contact: Jana Wilbricht – University of Bergen
Image: The image is credited to Neuroscience News
Original Research: Open access.
“Multidomain Intervention for Growth in Term Small-for-Gestational-Age Infants” by Ranadip Chowdhury, Rukman Manapurath, Ravi Prakash Upadhyay, Ingvild Fossgard Sandøy, Saijuddin Shaikh, Harish Chellani, Abhinav Jain, Neeta Dhabhai, Savita Sapra, Afreen Khan, Tarun Shankar Choudhary, Kiran Bhatia, Jose Martines, Nita Bhandari, Tor A. Strand, Sunita Taneja. JAMA
DOI:10.1001/jama.2026.12117
Abstract
Multidomain Intervention for Growth in Term Small-for-Gestational-Age Infants
Importance
Small-for-gestational-age (SGA) infants face elevated risk of undernutrition and developmental delays. Multidomain interventions may be needed to promote growth and neurodevelopment.
Objective
To evaluate the effect of an integrated intervention package on growth and neurodevelopment in term SGA infants.
Design, Setting, and Participants
Individually randomized clinical trial conducted in low-resource neighborhoods of South Delhi, India. Term SGA infants were enrolled within 14 days of birth; 1300 infants were randomized and followed up to 12 months of age. Recruitment occurred from January 14, 2023, until July 31, 2024, with follow-up completed on August 6, 2025. Outcome assessors were blinded to participant allocation.
Interventions
Infants were randomized in a 1:1 ratio to receive either an integrated intervention package including health, nutrition, early child stimulation, and psychosocial support (n = 647) or usual care through government programs (n = 653).
Main Outcomes and Measures
The primary outcomes were weight and weight-for-age z score at 12 months. Secondary outcomes included linear growth, neurodevelopment (assessed using the Bayley Scales of Infant and Toddler Development, Third Edition), anemia, and mortality.
Results
At 12 months, 1261 infants (97%) (mean age, 6 days; 48.1% male) had completed follow-up. The mean weight was 8.0 kg (SD, 0.9 kg) in the intervention group vs 7.8 kg (SD, 0.9 kg) in the usual care group (mean difference, 0.22 kg [95% CI, 0.11-0.32 kg]). The mean weight-for-age z score was −1.3 (SD, 0.9) vs −1.6 (SD, 1.0), respectively (mean difference, 0.24 [95% CI, 0.14-0.35]). The intervention group had a lower prevalence of underweight (23.9% vs 32.6%; risk difference, −8.75 [95% CI, −13.70 to −3.80] percentage points), stunting (20.1% vs 27.2%; risk difference, −7.17 [95% CI, −11.85 to −2.49] percentage points), wasting (13.9% vs 19.4%; risk difference, −5.52 [95% CI, −9.63 to −1.41] percentage points), and anemia (34.0% vs 72.5%; risk difference, −38.49 [95% CI, −44.36 to −32.61] percentage points) and higher cognitive scores (mean difference, 1.73 [95% CI, 0.32-3.14]), language scores (mean difference, 2.74 [95% CI, 1.51-3.98]), and motor composite scores (mean difference, 2.32 [95% CI, 1.25-3.38]). Nine children in the usual care group and 5 in the intervention group died.
Conclusions and Relevance
Among term SGA infants, an integrated intervention improved weight and weight-for-age z scores at 12 months.
Trial Registration
Clinical Trials Registry–India Identifier: CTRI/2021/11/037881
