Integrated Infant Care Improves Growth in Small-for-Gestational-Age Babies: JAMA

A clinical trial published in The Journal of the American Medical Association revealed that small-for-gestational-age (SGA) infants in South Delhi has found that an integrated package of health care, nutrition, and early stimulation significantly improved growth at 12 months compared with usual care. Infants receiving the intervention had higher body weight and better weight-for-age z scores, demonstrating the effectiveness of comprehensive early-life support in promoting healthy growth.

The study enrolled 1,300 term SGA infants within the first two weeks of life and randomly assigned them to either receive the integrated intervention or continue with standard government-supported care. This research followed the children until they reached 12 months of age, with 97% completing the study.

By the end of the first year, infants who received the integrated care package demonstrated better physical growth than those receiving usual care. Their average weight reached 8.0 kg, when compared to 7.8 kg in the control group, while their weight-for-age z score also showed a significant improvement, indicating healthier growth patterns.

The rates of underweight, stunting, and wasting were all lower among infants receiving the multidomain support. The intervention group also experienced a dramatic reduction in anemia, with only 34% of children affected compared with 72.5% in the usual care group.

Infants exposed to the integrated program achieved higher scores in cognitive, language, and motor development assessments, suggesting that combining nutrition with responsive caregiving and early stimulation can promote healthier brain development during the critical first year of life.

This intervention addressed multiple challenges simultaneously by supporting infant feeding practices, preventive health care, developmental stimulation, and caregiver well-being. This holistic approach may explain why improvements were observed across both growth and neurodevelopmental outcomes rather than in a single health measure.

Mortality was also lower in the intervention group, with 5 deaths recorded when compared to 9 among infants receiving routine care, although the trial was primarily designed to evaluate growth rather than survival.

SGA infants are at increased risk of poor growth, malnutrition, developmental delays, and long-term health complications. The findings suggest that interventions addressing nutrition alone may not be sufficient and that integrating health services with caregiver support and early learning activities can provide broader benefits during infancy.

Overall, delivering an integrated package of health, nutrition, psychosocial support, and early stimulation during infancy can meaningfully improve both physical growth and developmental outcomes among term SGA infants.

Reference:

Chowdhury, R., Manapurath, R., Upadhyay, R. P., Sandøy, I. F., Shaikh, S., Chellani, H., Jain, A., Dhabhai, N., Sapra, S., Khan, A., Choudhary, T. S., Bhatia, K., Martines, J., Bhandari, N., Strand, T. A., Taneja, S., & Small Babies Trial Study Group. (2026). Multidomain intervention for growth in term small-for-gestational-age infants: A randomized clinical trial: A randomized clinical trial. The Journal of the American Medical Association. https://doi.org/10.1001/jama.2026.12117