Reduction of infant intrauterine growth retardation (IUGR) through Direct Observation Dietary Supplementation (DODS) of malnourished pregnant women with early identification of at-risk newborns through mobile technologies in rural Gujarat

Nearly half of all infant deaths occur in the first 28 days after birth, with prematurity and low birth weight as leading causes. We propose to assess the feasibility of development and distribution of an indigenous energy protein supplement to at-risk pregnant women attending health centers in rural Gujarat to reduce infant intrauterine growth retardation and monitor key biological parameters of their at-risk infants through a low cost mobile device. At-risk pregnant women will be identified early in their pregnancy using clinical and anthropometric predictors and provided with the supplement. To ensure compliance, direct observation of dietary supplementation will be supervised by community health workers at weekly home visits. These women will be followed throughout their pregnancy and evaluated for weight gain, body composition, anemia and their infant's birth weight. As newborn assessments are often challenging in these rural settings, we propose to develop and test a specific and sensitive early warning indicator that identifies at-risk newborns based on critical changes including rapid maturation of cardiac function, respiration, thermal regulation, and blood vessel branching. We hypothesize that the interplay between these factors enables robust maturation and infant survival. Current advances in sensor and mobile data processing technology provide unprecedented ability to develop novel approaches and use associated low cost devices in low resource field settings. Analysis in real time of these biological parameters will allow derivation of a NAI to enable rapid and early identification frail newborns, target treatment, and improved newborn health and survivability.