Institute Activities and Advances
Several organizational units within the NICHD support and conduct research on various aspects of infant care and infant health.
Pregnancy and Perinatology Branch (PPB)
The mission of the NICHD's PPB is to improve the health of mothers and children, with focuses on maternal health, pregnancy, fetal well-being, labor and delivery, and the developing child. The PPB supports research to determine the basic mechanisms of normal and disease processes; identify new treatments, methodologies, and preventive strategies; assess the dissemination and actual impact of therapeutic and preventive interventions; and increase scientific resources through recruitment and training of investigators.
The NICHD, led by the PPB, has been the primary federal resource for research on sudden infant death syndrome (SIDS) since the SIDS Act of 1974 was passed. Its efforts have included and still include studies on the causes of SIDS, ranging from basic research with animal models to more applied methods involving responses to environmental risk factors; research on the incidence and prevalence of SIDS, especially among certain portions of the U.S. population; and outreach designed to educate parents, caregivers, and health care providers about ways to reduce the risk of SIDS, especially among those populations in which incidence is higher. Additional research strives to identify infants at risk for SIDS and to develop preventive approaches.
Through its program on Disorders of the Newborn, the PPB focuses on basic and clinical studies concerned with the etiology, pathophysiology, therapy, and follow-up of conditions such as disordered adaptation to extrauterine life, hyperbilirubinemia, and sequelae of prematurity (e.g., asphyxia, respiratory distress, bronchopulmonary dysplasia, hypoglycemia, anemia, and infection), that are associated with the perinatal and neonatal period.
The PPB also studies issues related to preterm labor and birth, currently a primary cause of neonatal mortality, with significant short- and long-term morbidities for those who survive. Research supported by the PPB is contributing to the state of understanding of optimal care (medical and behavioral-based care) of the preterm infant.
Recent PPB advances in infant health research include:
- Back to Sleep becomes Safe to Sleep. The NICHD and its collaborators recently expanded the Back to Sleep campaign into the Safe To Sleep® campaign to more accurately reflect its broad focus on SIDS risk reduction and safe sleep environments. The Safe to Sleep® campaign incorporates the NICHD's research findings on SIDS, as well as the latest safe sleep recommendations.
- Benefits of higher oxygen, breathing device persist after infancy. By the time they reached toddlerhood, very preterm infants originally treated with higher oxygen levels continued to show benefits when compared to a group treated with lower oxygen levels, according to a follow-up study by the NICHD-funded Neonatal Research Network (NRN) that confirms earlier network findings, Moreover, infants treated with a respiratory therapy commonly prescribed for adults with obstructive sleep apnea fared as well as those who received the traditional therapy for infant respiratory difficulties, the new study found. Read more about this study.
- Iron-fortified formula may contribute to developmental problems. A recent study supported by the NICHD PPB found that healthy children who received iron-fortified formula in infancy had more developmental problems related to intelligence quotient (IQ), achievement in arithmetic, and motor coordination than did infants fed low-iron formula. To learn more, read the study.
- New findings on infection treatment for preterm infants. A recent study by researchers with the NRN detected similar morbidity and mortality rates in very low birthweight (VLBW) infants infected with methicillin-susceptible Staphylococcus aureus (MSSA) and in VLBW infants with methicillin-resistant S. aureus (MRSA). The study results suggest that health care providers should focus equally on preventing and managing both MRSA and MSSA infections among VLBW infants. Learn more about these infections by reading the study.
Pediatric Growth and Nutrition Branch (PGNB)
The NICHD's PGNB is supporting several areas of research pertinent to infant care and infant health. For example, the Growth and Development program is focusing on basic research about growth-promoting polypeptides and hypothalamic-releasing factors that interact to influence normal growth and physiological development. Basic and clinical studies of the etiology of growth retardation and treatment for this disorder are also being supported.
The PGNB's Nutrition program is studying the complex nutritional relationships between the mother and her fetus, the placental transfer of nutrients, and the role of nutrition in infant development. Research interests focus on the nutrient requirements of normal, premature, and growth-retarded infants and on the contributions of human milk and its components to optimal infant nutrition. Researchers are encouraged to assess how maternal factors affect milk composition and lactation performance. Read about a recent PGNB-supported finding within this research area:
- Protein in human milk affects infant weight gain. An increasing number of children worldwide are overweight or obese. Overweight and obese children are at a higher risk for a range of medical problems, including type 2 diabetes. Previous studies have indicated that children who were breastfed were less likely to become obese in early life, compared with children who were fed with infant formula. Scientists questioned whether adinopectin, a protein found in breast milk, could account for the lower weight in children who were breastfed. To better understand the relationship between breastfeeding and childhood obesity, researchers examined weight gain for the first 2 years after birth in 192 infants.
Scientists found that high levels of adinopectin in breast milk were associated with lower infant weight during the first 6 months after birth, but also with accelerated weight gain in the second year after birth. Combined, these results indicate that human milk adinopectin may help reduce weight gain early, but the infants may "catch up" and gain weight faster after breastfeeding has ended. Understanding these complex interactions may help reduce the risk of childhood obesity in the future. Learn more about this study.
As a complement to its studies on nutrition, the PGNB is supporting research into the normal development of the infant gastrointestinal system and digestive function, including research on necrotizing enterocolitis (NEC)
, which remains a major cause of morbidity in the neonatal period. The PGNB began funding seven projects on NEC in 2008.
The research priorities of the Prevention of Chronic Disease program include obesity, hyperlipidemia, and insulin resistance in childhood and adolescence. Special emphasis is placed on developing methods for detecting children with potential diabetes and for developing successful techniques of immunomodulation to prevent or mitigate the body's immune attack on the pancreatic beta cell. Similarly, studies of obesity and hyperlipidemia focus on the etiology, consequences, and prevention of childhood obesity and hyperlipidemia.
Intellectual and Developmental Disabilities Branch (IDDB)
Newborn screening research initiatives within the IDDB have experienced considerable growth and reemphasis. Newborn screening enables the identification of infants who are at risk for congenital disorders (often biochemical, endocrinologic, and/or genetic) for which early interventions and treatments have the potential to reduce morbidity and mortality.
Although routine screening has occurred at the state level since the 1970s, the screening tests available have historically varied significantly by state; similarly, few states have systematically evaluated the rationale for or efficacy of the tests. Because these programs screen more than 4 million infants per year, newborn screening represents the most common form of genetic testing performed in the United States.
Division of Intramural Research (DIR)
Research within the NICHD's DIR includes the development of vaccines for bacterial diseases, especially those found in children.
DIR investigators study, uncover, and reevaluate clinical, epidemiologic, and immunologic data. They evaluate investigational vaccines suitable for clinical study in experimental animals and then submit them to the appropriate institutional review board and the U.S. Food and Drug Administration for evaluation of their safety and immunogenicity in adults, children, and infants, and, finally, for their efficacy. Surface polysaccharides of gram-negative pathogens, capsules, or lipopolysaccharides are essential virulence factors (factors that enable the development of disease within the host) and protective antigens. The immunogenicity of polysaccharides can be improved by binding to carrier proteins. Bacterial toxins or toxoids and viral capsid proteins may be protective antigens and may serve as carrier proteins.
Division of Intramural Population Health Research (DIPHR)
The mission of the DIPHR includes the design and conduct of original and collaborative research in reproductive, perinatal, and pediatric health; the determinants of health behavior; and statistical theory and methodology relevant to these problems.
The Upstate New York Infant Development Screening Program aims to determine whether infertility treatments, such as ovulation-stimulating medications and various assisted reproductive technologies, adversely affect the growth and motor and social development of children from birth through age 3 years. The study is also addressing the question of whether these technologies are associated with differences in the timing or rates of infant and child development, including motor and social development; the development of major and, especially; and minor neurodevelopmental impairments, and with physical growth patterns (e.g., length, weight, head circumference) and proportionality (weight for length).
Other Activities and Advances
- The Best Pharmaceuticals for Children Act (BPCA) Program, which dates from 2002, focuses on the drugs used for children. The goal of BPCA activities at the NICHD, which are conducted through the Obstetric and Pediatric Pharmacology and Therapeutics Branch, is to improve pediatric therapeutics through preclinical and clinical drug trials that lead to changes in drug labeling.
- In 1994, the NICHD and its partners, including the American Academy of Pediatrics, launched the Safe to Sleep® Campaign (formerly the Back to Sleep campaign) to raise awareness about SIDS and to educate parents, caregivers, and health care providers on ways to reduce the risk of SIDS. Since then, the U.S. SIDS rate has declined by 50%, and the percentage of infants placed on their backs to sleep has more than tripled.
In addition, the NICHD supports the two networks described below with the aim of increasing our understanding of preterm labor and birth and identifying their causes as well as improving treatment for preterm infants.
- The Neonatal Research Network (NRN), funded by the PPB, was initiated in 1986 to conduct multicenter clinical trials and observational studies in neonatal medicine to reduce infant morbidity and mortality and promote healthy outcomes. Several important studies are under way at NRN centers, including a trial called "Optimizing hypothermia as neuroprotection at <6 hours of age for neonatal hypoxic ischemic encephalopathy."
- The Newborn Screening Translational Research Network (NBSTRN) , funded through the IDDB, seeks to improve the health outcomes of newborns with genetic or congenital disorders through an infrastructure that provides the research community with access to robust resources for newborn screening.