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Multidomain Intervention for Growth in Term Small-for-Gestational-Age Infants: A Randomized Clinical Trial
Ranadip Chowdhury1, Rukman Manapurath1,2, Ravi Prakash Upadhyay1
1Society for Applied Studies, New Delhi, India.
Insights
An integrated intervention significantly improved growth and neurodevelopment in small-for-gestational-age (SGA) infants. This multidomain approach reduced undernutrition and developmental delays, promoting better health outcomes for these vulnerable newborns.
Area of Science:
- Pediatrics
- Public Health
- Developmental Psychology
Background:
- Small-for-gestational-age (SGA) infants are at high risk for undernutrition and developmental delays.
- Multidomain interventions are crucial for optimizing growth and neurodevelopment in SGA infants.
Purpose of the Study:
- To assess the impact of an integrated intervention package on the growth and neurodevelopment of term SGA infants.
Main Methods:
- A randomized clinical trial involving 1300 term SGA infants in low-resource South Delhi neighborhoods.
- Infants received either an integrated intervention (health, nutrition, stimulation, psychosocial support) or usual care.
- Primary outcomes included weight and weight-for-age z-score at 12 months; secondary outcomes covered linear growth, neurodevelopment, anemia, and mortality.
Main Results:
- The intervention group showed significantly improved weight (0.22 kg difference) and weight-for-age z-scores (0.24 difference) at 12 months.
- Lower prevalence of underweight, stunting, wasting, and anemia was observed in the intervention group.
- Enhanced cognitive, language, and motor scores were noted in infants receiving the integrated intervention.
Conclusions:
- An integrated, multidomain intervention effectively improved growth and neurodevelopment in term SGA infants.
- This approach offers a promising strategy to mitigate the long-term health risks associated with SGA.
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.
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