National Institute Of Child Health And Development Research Articles

Grandi Byen—Integrated Responsive Parenting, Nutrition, and Hygiene for Child Growth and Development: Protocol for a Randomized Controlled Trial

Objectives Grandi Byen—to grow well in Haitian Creole—tests the effectiveness of a multicomponent intervention encompassing nutrition, responsive parenting, and WASH (water, sanitation and hygiene) during the complementary feeding period on child growth and neurobehavioral development.MethodsThis study is a three-arm, longitudinal randomized controlled trial. Mothers/caregiver and their infants (ages 6–8 months at baseline) living in Cap-Haitien, Haiti (N = 600 dyads) will be randomly and equally assigned into the following groups: 1) standard well-baby care (control); 2) nutrition intervention (one egg per day for 6 months); and 3) multicomponent Grandi Byen intervention (one egg per day for 6 months + 12-week psychoeducational intervention on responsive parenting, nutrition, and WASH practices).ResultsPrimary outcomes for this study are child growth (length-for-age-, weight-for-age-, and weight-for-length Z scores) and development (cognitive, language, motor, and social-emotional). Secondary outcomes that are hypothesized as mediators to the primary outcomes are child health (bone maturation, brain growth, diarrheal morbidity and allergies, dietary intake, nutrient biomarkers) and parent-specific outcomes (responsive parenting and parental mental health). Targeted genomics will also highlight potential interactions between host genetics, enteric pathogens, gut microbiota, and overall child development. Findings will demonstrate the reproducibility and feasibility of egg-based interventions, while testing their impact on reducing child stunting and suboptimal development. Additionally, the multicomponent intervention will demonstrate whether stimulating care and WASH education induces any incremental benefits on child nutrition and developmental outcomes.ConclusionsThis project shifts from the norm of single-component nutrition interventions (e.g., single nutrient supplements and other food-based interventions) in child health research. The Grandi Byen concept approaches child well-being holistically by addressing poor child growth and development through nutrition along with proximal environmental and psychosocial determinants of child development.Funding SourcesEunice Kennedy Shriver National Institute of Child Health and Development (NICHD).

Placental EPO mRNA Expression Is Measurable in Very Preterm to Term Placentae

ObjectivesOur objective was to evaluate placental EPO mRNA expression in term and preterm placentae and explore maternal/neonatal/placental determinants of EPO expression. MethodsPlacental tissue was collected from pregnant adolescents (n = 82, < 19 y of age) and from women (n = 62) carrying multiple fetuses (twins = 23, triplets = 39). Placental mRNA expression was evaluated using qPCR. Hemoglobin and iron status biomarkers (SF, TBI, sTfR, Hepcidin) were measured in maternal blood at delivery and in cord blood. ResultsIn this population, women delivered between 30–42 weeks of gestation. Of the 144 women, 30% delivered prematurely (< 37 weeks, n = 44) and 69% delivered at term (≥37 weeks, n = 100). As expected, preterm placentae weighed significantly less than term placenta (293 ± 93 g vs. 544 ± 143 g, p < 0.0001). Placental EPO mRNA expression was detected in all samples collected. Placental EPO mRNA expression did not significantly differ between anemic (Hb < 13 g/dL) (n = 23) and non-anemic (n = 84) neonates (p = 0.69), nor was it significantly associated with maternal anemia at delivery (p = 0.44). Placental EPO mRNA expression was also not significantly associated with maternal (p = 0.56) or neonatal (p = 0.61) Hb concentrations, placental weight (p = 0.46) or gestational age at delivery (p = 0.39). ConclusionsWhile placental EPO mRNA was detected in all placental tissue collected between 30–42 weeks of gestation none of the iron biomarkers evaluated were significantly related to placental EPO mRNA expression. Further studies are needed to understand determinants of placental EPO mRNA and protein expression. Funding SourcesThe U.S. National Institutes of Health (NIH) National Institute of Child Health and Development (NICHD) Grant 1R21HD098864, The Gerber Foundation and USDA grants 2005–35,200-15,218 and 2009–35,200-05,171.

Preschoolers’ true and false reports: Comparing effects of the Sequential Interview and NICHD protocol

PurposeThe current study aimed to examine a Norwegian technique for conducting investigative interviews with preschoolers: the Sequential Interview (SI). The SI advocates for increased initial rapport building and includes a pre‐determined break before the substantive phase. To explore the potential benefits and risks of the SI, the technique was compared with an adapted version of the National Institute of Child Health and Development (NICHD) protocol.MethodsA total of 129 preschoolers (3–6 years) were interviewed with either the SI or NICHD protocol about a self‐experienced (Exp. I) or non‐experienced (Exp. II) event.ResultFor Exp. I, no significant difference was observed across interview conditions in the number of reported details about a self‐experienced event. Children interviewed with the SI exhibited a slightly lower accuracy rate compared to those interviewed with the NICHD protocol. For Exp. II, a total of 31.1% of the preschoolers initially assented to remembering a fictive (false) experience and 15.6% gave an account (&gt;40 details) of the non‐experienced event. We found no difference between interviewing conditions in assent rates or number of false accounts.ConclusionsThe study provides valuable insights into the difficulties involved when interviewing young children. The results showed few differences between the novel SI model and the well‐established NICHD protocol. While many preschoolers could provide accurate testimony, some embedded worrisome false details in their narratives. Furthermore, a minority of children gave false reports about non‐experienced events when interviewed with the two techniques. Methodological limitations and suggestions for future research will be discussed.

Children's friendship quality trajectories from middle childhood to early adolescence and prediction from sex.

We investigated the development of children's self-reported positive (Companionship and Recreation, Validation and Caring, Help and Guidance, Intimate Disclosure, and Conflict Resolution) and negative (Conflict and Betrayal) friendship quality from the third to sixth grades using The National Institute of Child Health and Development (NICHD) Study of Early Child Care and Youth Development data (NICHD SECCYD; n = 1,364; M age = 9.03 years; 51.70% boys at recruitment). Consistent with expectations, growth models suggested that children reported higher positive, and lower negative, friendship quality with age. Boys had significantly lower positive friendship quality at third grade and slower increases than girls. Boys had slower decreases in negative friendship quality than girls. It is possible that different social orientations explain sex differences in friendship quality trajectories. Further research is needed to explore other factors that might account for individual differences in friendship quality trajectories.

Heterogeneity in externalizing problems at age 3: Association with age 15 biological and environmental outcomes.

Investigating heterogeneity in antisocial behavior early in life is essential for understanding the etiology, development, prognosis, and treatment of these problems. Data from the longitudinal National Institute of Child Health and Development (NICHD) study of Early Child Care were used to identify homogeneous groups of young antisocial children differentiated on externalizing problems, internalizing problems, and callous-unemotional (CU) traits using latent profile analysis (LPA). We examined how identified subgroups were differentiated on adolescent social, biological, cognitive, and environmental outcomes, controlling for dispositional and contextual antecedents during the first 2 years of life. The sample consisted of 1,167 children (52% male) followed from toddlerhood to adolescence. LPA identified a large "low problems" group (n = 795; 49.9% male) as well as 3 antisocial groups at age 3: the first scored high on internalizing and externalizing problems but low on CU traits (Ext/Int, n = 125), the second scored high on CU traits and externalizing problems but low on internalizing problems (primary CU variant, n = 135), and the third scored high on CU traits, internalizing, and externalizing problems (secondary CU variant, n = 112), and these differences persisted into adolescence. Primary and secondary CU variants were further differentiated from one another on adolescent measures of aggression (reactive and relational), biological indices (cortisol, heart rate), cognitive abilities, and parental psychopathology, after controlling for early life risk factors (i.e., maternal sensitivity, difficult temperament, and maternal depression). We discuss implications of our findings for research, theory, and practice on early childhood externalizing problems. (PsycINFO Database Record

Pulmonary Vein Stenosis in Neonates with Severe Bronchopulmonary Dysplasia.

Objectives Pulmonary vein stenosis (PVS) is a rare, often lethal anomaly associated with poor outcomes. Given the association between bronchopulmonary dysplasia (BPD) and cardiovascular complications, we tested the hypotheses that (1) a subgroup of neonates with severe BPD develop PVS (BPD-PVS) and have worse outcomes than do neonates with severe BPD alone (BPD); (2) among a cohort of neonates with severe BPD-associated pulmonary hypertension (BPD-PH), PVS is an additional risk factor for adverse outcomes and mortality. Study Design We performed a retrospective review of neonates with severe BPD, based on the Eunice Kennedy Shriver National Institute of Child Health and Development (NICHD) criteria, at our institution between June 1, 2009, and June 30, 2013. PVS was determined based on serial review of echocardiograms performed during their hospitalization. Neonates with congenital heart disease or chromosomal anomalies were excluded. Results Of 213 patients with severe BPD, 10 (4.7%) were found to have PVS (BPD-PVS). Neonates with BPD-PVS had lower birth weight (634 ± 178 vs. 767 ± 165 g; p < 0.01) and were more likely to be intrauterine growth restricted (80 vs. 11%; p < 0.01) than neonates with BPD alone. Time on mechanical ventilation and length of hospitalization were longer in the BPD-PVS group than BPD group. Survival was lower in the BPD-PVS group than BPD group (5/10 [50%] vs. 196/203 [97%]; log-rank test p < 0.01). Among a subgroup of neonates with BPD-PH, survival was lower among infants with PVS than those without PVS (5/9 [56%] vs. 26/30 [86%]; log-rank test p = 0.01). Conclusions Compared with neonates with severe BPD alone, those with acquired PVS are at increased risk for worse outcomes, including higher mortality. Evidence-based recommendations regarding screening protocols and surveillance are needed in this high-risk subgroup of BPD neonates.

Development and validation of the Proxy-Reported Pulmonary Outcomes Scale for premature infants.

Test the feasibility of using a bedside nurse-reported tool (Proxy-Reported Pulmonary Outcome Scale, PRPOS) for evaluating the severity of bronchopulmonary dysplasia (BPD) by assessing functional, disease-related measures. Bedside nurses tested the 26-item instrument by observing preterm infants (23-30 weeks at birth) at 36 to 37(4/7) weeks postmenstrual age before, during, and after a care time. We analyzed item reliability, validity, and model fit to determine the six items to include in the final measurement tool. We completed assessments on 188 preterm infants. The frequency of an abnormal PRPOS item score increased with increasing National Institute of Child Health and Development (NICHD) BPD category. The six-candidate items produced an internally consistent scale. Addition of the NICHD BPD classification increased reliability moderately; addition of feeding items decreased reliability. The PRPOS score correlated with postmenstrual age at discharge. Infants discharged on oxygen or diuretics had higher median PRPOS scores than did infants who were not prescribed those therapies. The PRPOS is an internally consistent, proxy-reported measure of respiratory function in premature infants, based on observable, functional performance measures. Initial testing demonstrates known-groups validity and ongoing testing can assess predictive validity.

Healthcare-Associated Bloodstream Infections in a Neonatal Intensive Care Unit over a 20-Year Period (1992–2011): Trends in Incidence, Pathogens, and Mortality

To analyze trends in the incidence and pathogen distribution of healthcare-associated bloodstream infections (HABSIs) over a 20-year period (1992-2011). Historical cohort study. Thirty-two-bed neonatal intensive care unit (NICU) in a tertiary referral hospital. Neonates with HABSIs defined according to the criteria of the National Institute of Child Health and Development (NICHD). A hospital-based ongoing surveillance program was used to identify HABSI cases in neonates. A distinction between definite or possible HABSI was made according to the NICHD criteria. Incidence, incidence densities (HABSIs per 1,000 hospital-days and HABSIs per 1,000 total parenteral nutrition-days), and case fatality rate were calculated. Logistic regression analysis was used to find time trends. Four periods of 5 years were considered when executing variance analysis. In total, 682 episodes of HABSIs occurred on 9,934 admissions (6.9%). The median total incidence density rate was 3.1 (interquartile range, 2.2-3.9). A significant increasing time trend in incidence density was observed for the period 1995-2011 (P < .003). A significant decrease in the case fatality rate was found in the last 5-year period (P < .001). No neonate died following possible HABSIs, whereas the case fatality rate among neonates with definite HABSIs was 9.7%. Most HABSIs were caused by coagulase-negative staphylococci (n = 414 [60.7%]). A significant increase in Staphylococcus aureus HABSI was observed in the last 10-year period (P < .001). An increase in incidence density rate occurred, while the case fatality rate dropped. Better perinatal care could be responsible for the latter. A decrease in days before infection and a high incidence of coagulase-negative Staphylococcus HABSIs indicate the need for vigorous application of evidence-based prevention initiatives, in particular for catheter care.

Outcomes of extremely low birthweight infants with acidosis at birth

ObjectivesTo test the hypothesis that acidosis at birth is associated with the combined primary outcome of death or neurodevelopmental impairment (NDI) in extremely low birthweight (ELBW) infants, and to develop...

The role of colony stimulating factors and immunoglobulin in the prevention and treatment of neonatal infection

Bacterial systemic infection (SI) remains one of the unresolved challenges of neonatal intensive care, directly and indirectly responsible for infant death and impaired neuro-developmental outcomes. The incidence increases with lower...

The Trial to Reduce IDDM in the Genetically at Risk (TRIGR) study: recruitment, intervention and follow-up

Aims/hypothesisThe Trial to Reduce IDDM in the Genetically at Risk (TRIGR) study was designed to establish whether weaning to a highly hydrolysed formula in infancy subsequently reduces the risk of type 1 diabetes.MethodsThe study population comprises newborn infants who have first-degree relatives with type 1 diabetes and meet the increased risk HLA inclusion, but not exclusion criteria. The study is being performed in 15 countries in three continents. First-degree relatives of patients with type 1 diabetes were identified from diabetes clinics, diabetes registries, and from other endocrinology or obstetrics offices and websites. HLA typing was performed at birth from cord or heel stick blood, and the results sent to the study’s Data Management Unit within 2 weeks for communication of eligibility to the clinical study centre. All mothers recruited were encouraged to breastfeed. The intervention lasted for 6 to 8 months, and weaning formulas based on hydrolysed casein and standard cow’s milk were compared.ResultsTRIGR recruited 5,606 infants, of whom 2,160 were enrolled as eligible participants, 6% more than the target of 2,032. Of those enrolled, 80% were exposed to the study formula. The overall retention rate over the first 5 years is 87%, with protocol compliance at 94%. The randomisation code will be opened when the last recruited child turns 10 years of age, i.e. in 2017.Conclusions/interpretationThe TRIGR experience demonstrates the feasibility and successful implementation of an international dietary intervention study. TRIGR is the first ever primary prevention trial for type 1 diabetes and, if completed successfully, will provide a definite answer to the research question.Trial registrationClinicalTrials.gov NCT00179777FundingThe study was funded by the National Institute of Child Health and Development (NICHD) and National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH) (grant numbers HD040364, HD042444 and HD051997), Canadian Institutes of Health Research, the Juvenile Diabetes Research Foundation International and the Commission of the European Communities (specific RTD programme ‘Quality of Life and Management of Living Resources’, contract number QLK1-2002-00372 ‘Diabetes Prevention’. Other funding came from the EFSD/JDRF/Novo Nordisk Focused Research Grant, Academy of Finland, Dutch Diabetes Research Foundation and Finnish Diabetes Research Foundation).Electronic supplementary materialThe online version of this article (doi:10.1007/s00125-010-1964-9) includes details of the TRIGR Writing Group, plus a complete list of investigators and other TRIGR staff members, and is available to authorised users.

Black Gotham: African Americans in New York City, 1900–2000

For almost four centuries, African Americans in New York City have engaged in ethnic “dream-work,” shaping the city and being shaped by the city in return. The longstanding practice of racism forced a heterogeneous community of Blacks—originating in different parts of the country and the world, speaking many languages, and comprised of different economic classes— to coalesce as a community in order to challenge their subjugation. This article explores the issues, conditions, and experiences that frame the coalescence of the African American community in New York City during the twentieth century, highlighting how racial identities have been produced in the city. In the first part of this article, I reflect on the presence of Blacks in New York City to illuminate some of the common themes that have emerged from the African American experience in Gotham. The second section is a historical exploration of the black experience in New York City, illuminating the conditions, expectations, events, and spaces that have shaped its formation. The research for this article was conducted while the author was a postdoctoral fellow at the Center for Urban Research (CUNY Graduate Center) on the “Immigrant Second Generation in Metropolitan New York” project. The Russell Sage Foundation, The Ford Foundation, the Mellon Foundation, the Rockefeller Foundation, the National Institute of Child Health and Development (NICHD), and the UJA-Federation provided funding for the “Second Generation” project. I greatly appreciate the support of John Mollenkopf, Phillip Kasinitz, and Mary Waters. Kristin Norget, Michelle McKenzie, and Jennifer Ramirez provided extensive editorial comments.

Special Education Eligibility: Developmental Precursors over the First Three Years of Life

From the National Institute of Child Health and Development (NICHD) Study of Early Child Care sample, two groups of children at age 36 months were examined—children identified by medical professionals as needing special services and children eligible for special services based on developmental assessments. Demographic information, children's behavioral functioning, mothers' psychological functioning, mother-child interactions, and quality of the home environment were examined. Early home environment and later behavior problems and children's health problems significantly contributed to the prediction model for membership in the group identified by medical professionals. Early home environment and socioeconomic status (SES) significantly contributed to the prediction model for the group identified based on developmental assessments. Results have implications for efforts to screen and detect young children likely to benefit from special education services.

Overview

This symposium entitled, "Bacterial Colonization of the Gut and the Use of Pre- and Probiotics" was organized by the Shanghai Children's Medical Center of the Second Shanghai Medical University in conjunction with the Combined Program in Pediatric Gastroenterology and Nutrition at Harvard Medical School to underscore a 10-year agreement between both medical centers to provide training of academic pediatricians from China in basic and translational research. The training program is supported by a training grant from the National Institute of Child Health and Development (NICHD)/Fogarty Center (1-U01A145441-01), and research projects are, in part, supported by a research grant from Wyeth Nutritionals International, Inc., (Philadelphia, PA, U.S.A.) The symposium, itself, was sponsored from an educational grant from Wyeth Nutritionals International, Inc. for which the the organizers are grateful. The topic for this initial Sino-American symposium represents an important area of research in pediatrics and a major research interest of the two organizing groups. Dr. W. Allan Walker, a pediatric gastroenterologist with a strong research interest in the development of host defense, introduces the topic of the symposium by considering the importance of pre- and probiotics in the development of intestinal host defense in the extrauterine environment. He reviews the effects of initial colonization of the gut on the development of the effector immune response to antigen stimulation. At birth, the gut's lymphoid tissue has the capacity to respond to microbial-food antigens. However, the initial colonization of the newborn gut with indigenous microflora provides the appropriate "adjuvant effect" to activate antibody production and T-cell activation. Furthermore, the nature of initial oral feedings (breast-milk vs. formula) helps to determine the nature of colonizing bacteria (lactobacilli and bifidobacteria vs. enterobacteria and Escherichia coli). In addition, specific nutrients such as nucleotides, omega-3 fatty acids, and lactoferrin can enhance the effects of indigenous flora on strengthening the mucosal barrier and minimizing inflammatory responses to pathologic bacteria colonization. Dr. David S. Newburg, a glycobiologist from Harvard Medical School, reviews the importance of oligosaccharides in human milk on the attachment of pathologic bacteria to glycoconjugates and glycolipids and proteins in the intestinal microvillus membrane. Oligosaccharides, a natural prebiotic, has an influence on the nature of colonizing bacteria. He notes that enterocyte cell surface glycoconjugates are pathogen receptors and help to influence pathologic colonization of the newborn gut. In contrast, soluble oligosaccharides in breast milk can attach to "adhesions" on pathogens and thereby block their interaction with the intestinal surface and reduce their colonization. He cites examples of breast milk protection by oligosaccharides for Campylobacter and rotaviral infection. These studies may help to identify additives to future infant formula. Dr. Michael S. Caplan, a neonatologist from North-western University with a strong research interest in necrotizing enterocolitis, and Dr. Tamas Jilling reviews the possible role of probiotics in the treatment of necrotizing enterocolitis. The immature human enteric surface has an immature glycosylation pattern favoring colonization with pathologic organisms. In the premature neonate, this process may contribute to the pathogenesis of necrotizing enterocolitis. If probiotics are introduced into the diet of the newborn at birth, their presence could block pathologic colonization and thereby reduce the incidence of necrotizing enterocolitis. The authors provide evidence in an experimental model for necrotizing enterocolitis that the use of probiotics (Lactobacillus GG) can prevent the upregulation of platelet-activating factor, an inflammatory cytokine and indicator of early necrotizing enterocolitis. Dr. Dingwei Dai, an investigator at the Shanghai Children's Medical Center and a research fellow in the Developmental Gastroenterology Laboratory of the Combined Program in Pediatric Gastroenterology and Nutrition at Harvard Medical School, and colleagues from the United States present exciting new data to support the notion that glycosylation of microvillus membrane lipids and protein through glycosyltransferase activity is developmentally regulated and that cortisone treatment of pregnant or newborn animals can activate the maturation of this process. They also provide preliminary evidence that glycosylation in the human fetus is also under developmental regulation. These observations help explain pathologic colonization of the human newborn and the potential for treatment of this process with growth factors such as cortisone. Finally, Dr. Jon A. Vanderhoof, a pediatric gastroenterologist from the University of Nebraska Medical Center, reviews the use of probiotics in the treatment inflammatory disorders in infants and children. He reviews clinical studies to suggest that Lactobacillus GG administered orally to children who have rotaviral infection reduces the severity and length of time of the clinical illness. He also reviews its use in the treatment of allergic dermatitis of children and its preliminary use in the treatment of inflammatory bowel disease. These presentations provide an excellent review of the current state of our knowledge of the role of nutrients in bacterial colonization in health and disease of infants and children.

Evidence from multicenter neworks on the current use and effectiveness of antenatal corticosteroids in low birth weight infants

Corticosteroid treatment of pregnant women at risk for preterm delivery enhances fetal lung maturity and improves neonatal outcomes.’ Despite convincing evidence of these effects, a consensus has not been reached about the indications for antenatal steroids, and the frequency with which they are used remains low in some countries, including the United States. In response to this situation, the National Institutes of Health (NIH) convened a Consensus Development Conference on the Effects of Corticosteroids for Fetal Maturation on Perinatal Outcomes.’ The following reports were prepared at the request of the panel; they describe the effects of antenatal steroid treatment on neonatal outcome from five current observational databases: those of the National Institute of Child Health and Development (NICHD) Neonatal Research Network, the Vermont-Oxford Trials Network, Ross Laboratories, and Burroughs Wellcome (BW) Co. The purpose of this article is to present an overview of the findings of these five large databases.

To treat or not to treat: hyperprolactinemia

ABSTRACT Physicians are overtreating hyperprolactinemia, says Michele C. S. Koppelman, MD, of the National Institute of Child Health and Development (NICHD), Bethesda, Md.At the recent meeting of the Endocrine Society in San Francisco, Koppelman reported on a follow-up study of 25 female patients with long-standing, untreated hyperprolactinemia. Most of the patients' conditions remained stable or improved clinically over the years, and some showed apparent regression of pituitary adenomas.On average, the onset of the patients' symptoms predated the follow-up study by 11.3 years and the diagnoses of hyperprolactinemia by 5.3 years. Half of the women had had initial serum prolactin levels higher than 200 ng/mL, and two thirds had had levels exceeding 100 ng/mL. In 15 patients, skull x-ray films and polytomography of the pituitary fossa had shown abnormalities in the sella turcica. None of the patients with these abnormalities had visual field defects, but several had headaches.At the