DEPARTMENT OF HEALTH AND HUMAN SERVICES
NATIONAL INSTITUTES OF HEALTH
Fiscal Year 2012 Budget Request
Senate Appropriations Subcommittee on Labor, Health and Human Services,
Education and Related Agencies
Alan E. Guttmacher, M.D.
Eunice Kennedy Shriver National Institute of Child Health and Human Development
May 11, 2011
Mr. Chairman and Members of the Committee, I am pleased to present the FY 2012 President's budget request for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of $1,352,189,000. This reflects an increase of $ 23,385,000 over the FY 2010 actual level of $1,328,804,000.
In my short time as NICHD Director, the breadth and importance of the Institute’s mission have already impressed me. Our research changes clinical practice and improves health for many people, particularly those who medical research may otherwise overlook: pregnant women and their offspring, adolescents, and people with intellectual, developmental, and physical disabilities. Our research shows that even simple approaches can have significant impact. For example, a recent study found that an inexpensive program teaching newborn care to Zambian midwives reduced deaths in the first week of life by 40 percent. Today, I would like to highlight a few other examples of NICHD’s recent progress toward improving health, and describe a new effort to position our research to continue to contribute to a healthier nation and world.
Improving Health Care for Women and Children
Thanks partly to NICHD research, Centers for Disease Control and Prevention data (CDC) show that the preterm birth rate in the U.S. declined for the second year in a row in 2008. Still, 12 percent of all pregnancies end in preterm birth, a leading cause of infant death in our country. Preterm infants have greater risk for breathing problems, life-threatening infections, cerebral palsy, and developmental disabilities. In recent years, NICHD research showed that treating women who previously had a preterm baby with a type of progesterone reduced the risk of another preterm delivery. Now, a new study shows that a vaginal gel containing another type of progesterone substantially reduces the risk of premature delivery in women with a short cervix. With adoption of such treatments, the preterm birth rate should drop further.
Spina bifida, which occurs when the fetal spinal column does not close properly, affects nearly 1,500 U.S. infants a year, according to the CDC. The most common and severe form of spina bifida, myelomeningocele, can cause paralysis, problems with nerve function, and brain damage. Recently, the NICHD reported an important trial, the Management of Myelomeningocele Study (MOMS). MOMS researchers compared standard surgical repair of the spinal cord after birth to repair while the fetus is in utero. They found that repairing the spinal cord in the womb greatly reduced risk of death and need to divert fluid from the brain. It also doubled the chance of walking and improved later motor and cognitive development. Infants undergoing prenatal surgery, however, were also more likely to be born preterm, and their mothers more likely to experience a uterine tear in childbirth. While researchers continue to study this specialized surgery, the initial findings promise to improve the quality of life for thousands of children.
New findings also can improve health care for women: NICHD researchers recently showed that women’s cholesterol levels correspond with monthly changes in estrogen levels. On average, the total cholesterol level of the women studied varied 19 percent over the course of the menstrual cycle. Although previous data showed that estrogen-containing oral contraceptives or menopausal hormone therapy could affect cholesterol levels, this was the first study to show conclusively that the cyclical levels of naturally occurring hormones have similar effects. This natural variation suggests that clinicians should consider the phases of a woman’s monthly cycle when evaluating her cholesterol levels and before prescribing treatment to help protect women against heart disease.
New Technologies Advance Hope for Autism and Parkinson's
Autism spectrum disorder (ASD) encompasses a range of conditions involving impaired social interactions and communication, atypical behaviors, and health problems. While ASD is known to have genetic components, researchers have not identified a consistent pattern of variant genes. In fact, dozens of gene variants, along with other factors, are now linked with ASD, complicating, but also advancing, our understanding of the condition and ability to develop new treatments. Using advanced imaging technology, NICHD-supported researchers identified a gene that impairs communication between parts of the brain. Additional genetic studies may reveal ASD subtypes and how certain genes function and interact with each other. This could help individualize treatments based on a child’s genetic profile. New technologies also hold promise for other neurologic conditions, such as Parkinson’s disease, which results from a loss of brain cells that help coordinate movement. NICHD-supported researchers injected stem cells from the endometrium (lining of the uterus) into the brains of mice with a laboratory-induced form of the disease. These new cells took over the function of the brain cells eradicated by Parkinson’s. This is the first time that scientists showed endometrial stem cells could assume the properties of the tissue into which they were transplanted. Since endometrial stem cells are widely available, this suggests that women with Parkinson’s disease might serve as their own stem cell donors, or healthy endometrial stem cells might be stored and later matched to individuals with the disease.
Translating Science to Advance Rehabilitation
Applying basic scientific findings to clinical problems can help scientists develop new diagnostics or therapeutics for many conditions. For instance, NICHD researchers seeking to understand how the vitamin folate is metabolized found that the vitamin appears to promote healing in rats with damaged spinal cord tissue. Up to 20,000 people yearly suffer a spinal cord injury, and about 200,000 people currently live with such injuries, according to the National Center for Injury Prevention and Control. Folate, a B vitamin that naturally occurs in leafy green vegetables and other foods, plays an important role in early embryonic brain and spinal cord development. Further translational studies on folate could lead to new techniques to help regenerate nerve fibers and heal damaged nervous system tissue.
The National Children's Study (NCS)
The NCS is designed to examine the effects of a broad range of environmental factors (including physical environment, family, community, and cultural influences) and genetics on the development and health of children in the U.S. over time. The NCS will yield a rich repository of environmental and genetic/genomic data and biospecimens that can be mined by scientists for years to come and help answer questions concerning the earliest origins of health and disease. Over the past year, the NCS has been in a pilot phase, known as the “Vanguard Study,” enrolling about 650 children in 37 sites as of February 2011. Three separate recruitment strategies are being tested to optimize participation and cost management. During the coming year, a range of experts will review ongoing findings, allowing staff to develop, by late summer, 2011, evidence-based cost-estimates and recommendations for the initial phase of the Main Study.
Vision for the Future
The NICHD has embarked on crafting a vision for the future that inspires the institute and its partners to achieve critical scientific goals and meet pressing public health needs. In early 2011, in a series of workshops, we asked leading scientific and health experts to identify what the scientific future should look like in ten years and what knowledge must be obtained to reach these new frontiers. We focused on such areas as plasticity, development, cognition, behavior, reproduction, pregnancy and pregnancy outcomes, developmental origins of health and disease, environment, and diagnostics and therapeutics. Resultant white papers are posted on our website for additional public comment. In June, we will assemble another diverse group of experts to refine these concepts and identify those that are most promising. We will publish the final vision document by early 2012, helping to ensure that NICHD addresses the most important science for the nation’s women, children, families, and individuals with special needs.
Mr. Chairman and members of the Committee, thank you for your continued support of NICHD’s important work. I would be pleased to respond to any questions.