Summary: A landmark randomized controlled trial carried out in low-resource neighborhoods of South Delhi, India, shows that a structured, home-based integrated intervention substantially improves growth, reduces anemia, enhances neurodevelopment, and lowers mortality among term small-for-gestational-age (SGA) infants.
This trial enrolled 1,300 term SGA infants within 14 days of birth and followed them to 12 months of age. Unlike earlier studies that tested single or partial interventions, investigators delivered a comprehensive package—health monitoring, nutritional support, early child stimulation, and maternal psychosocial guidance—through regular, trained home visits. The integrated approach produced consistent and clinically meaningful improvements across growth, blood health, cognitive and motor development, and survival.
Key Facts
- Global burden: Roughly 23 million infants (about 17% of births worldwide) are born SGA each year, with prevalence in South Asia reaching as high as 40% because of persistent maternal nutritional, health, and socioeconomic challenges.
- Study design: An individually randomized trial assigned 1,300 term SGA infants 1:1 to receive either the integrated home-visit intervention package (n = 647) or routine government-provided care (n = 653).
- Major reductions in anemia: Infants in the intervention group experienced more than a 50% reduction in anemia prevalence at 12 months compared with controls.
- Neurodevelopmental gains: By 12 months, the intervention group scored higher on cognitive, language, and motor composite measures.
- Growth and survival: The integrated package reduced rates of underweight, stunting, and wasting and was associated with fewer deaths during the trial period.
Source: University of Bergen
SGA infants—those with birth weights below the 10th percentile for gestational age—are at elevated risk for impaired growth, developmental delays, illness, and early childhood mortality. Early growth, particularly in the first six months, strongly influences later neurodevelopment and survival in low-resource settings. This trial targeted that critical early window with a multidomain, home-delivered strategy.
The trial was conducted in South Delhi from January 2023 through August 2025 and was led by a collaboration between the Society for Applied Studies (New Delhi) and researchers at the University of Bergen. First authors included Ranadip Chowdhury and Rukman Manapurath; senior contributors included Sunita Taneja and several investigators from the University of Bergen and affiliated centers in maternal and child health.
Enrollment took place within 14 days of birth, and 1,300 infants were randomized and followed to 12 months. Outcome assessors were blinded to group allocation. The integrated package combined routine health checks, counseling on breastfeeding and complementary feeding, micronutrient and nutritional guidance as needed, structured activities to stimulate early cognitive and motor development, and psychosocial support for mothers delivered by trained community health workers during home visits.
At 12 months, 1,261 infants (97%) completed follow-up. Mean weight in the intervention group was 8.0 kg versus 7.8 kg in the usual-care group (mean difference 0.22 kg). Weight-for-age z scores were higher in the intervention group (mean difference 0.24). The intervention group also showed lower prevalence of underweight (23.9% vs 32.6%), stunting (20.1% vs 27.2%), and wasting (13.9% vs 19.4%). The prevalence of anemia fell from 72.5% in the control group to 34.0% in the intervention group (risk difference −38.5 percentage points). Cognitive, language, and motor composite scores were all significantly higher in the integrated-intervention arm. Mortality during the trial was lower in the intervention arm (5 deaths) compared with usual care (9 deaths).
Key Questions Answered
A: SGA infants are those born below the 10th percentile for weight at their gestational age. They are at higher risk for severe illness, growth faltering, developmental delays, and early mortality. Rapid and appropriate weight and length gain in the first six months is strongly associated with improved neurodevelopmental outcomes and survival.
Q: What components were included in the integrated intervention package?
A: The package combined regular health monitoring, nutrition counseling and supplementation where needed, structured early child stimulation activities to support cognitive and motor development, and maternal psychosocial support. These elements were delivered through scheduled home visits by trained health workers to ensure family-centered support.
Q: How do these results differ from previous trials?
A: Prior trials often evaluated single interventions—such as nutritional supplementation alone—and reported inconsistent results. This trial demonstrates that bundling multiple, complementary interventions into a single, home-delivered program yields consistent, cross-cutting benefits for growth, blood health, neurodevelopment, and survival among SGA infants.
Editorial Notes
- Edited by a Neuroscience News editor.
- The journal article was reviewed in full by editorial staff.
- Additional context was provided to clarify study design and public health implications.
About this neurodevelopment research news
Author: Jana Wilbricht
Source: University of Bergen
Contact: Jana Wilbricht – University of Bergen
Image credit: Neuroscience News
Original research (open access): “Multidomain Intervention for Growth in Term Small-for-Gestational-Age Infants” by Ranadip Chowdhury et al., published in JAMA. DOI: 10.1001/jama.2026.12117
Abstract
Importance
Small-for-gestational-age infants face elevated risks of undernutrition and developmental delays. Multidomain interventions may be necessary to support growth and neurodevelopment in this vulnerable group.
Objective
To evaluate the effect of an integrated intervention package on growth and neurodevelopment in term SGA infants.
Design, Setting, and Participants
An individually randomized clinical trial in low-resource neighborhoods of South Delhi. Term SGA infants were enrolled within 14 days of birth. A total of 1,300 infants were randomized and followed to 12 months. Recruitment ran from January 14, 2023, until July 31, 2024, with follow-up completed on August 6, 2025. Outcome assessors were blinded to allocation.
Interventions
Infants were randomized 1:1 to receive either an integrated home-visit intervention (health, nutrition, early stimulation, psychosocial support; n = 647) or usual care through government programs (n = 653).
Main Outcomes and Measures
Primary outcomes were weight and weight-for-age z score at 12 months. Secondary outcomes included linear growth, neurodevelopment (assessed with the Bayley Scales of Infant and Toddler Development, Third Edition), anemia, and mortality.
Results
At 12 months, 1,261 infants (97%) completed follow-up. Mean weight was 8.0 kg (intervention) vs 7.8 kg (usual care); mean difference 0.22 kg. Weight-for-age z scores improved by 0.24 in the intervention group. The intervention reduced underweight, stunting, wasting, and anemia and produced higher cognitive, language, and motor scores. Fewer deaths occurred in the intervention group during the trial.
Conclusions and Relevance
Among term SGA infants, a multidomain, home-delivered integrated intervention improved weight and weight-for-age z scores at 12 months and produced broad benefits in anemia prevalence, neurodevelopment, and survival.
Trial Registration: Clinical Trials Registry–India Identifier: CTRI/2021/11/037881