Improving Newborn Outcomes

A smiling father gently cradles a sleeping newborn baby in his hands.

NICHD’s commitment to improving the health of infants includes studies of how pregnancy and post-delivery treatments affect overall health.

Researchers at NICHD identified placental-related genes that regulate birthweight. A baby’s birthweight can have long-term consequences—low birthweight affects survival during the newborn period, and high birthweight can elevate a person’s future risk for cardiovascular and metabolic diseases. The team’s analyses identified functional gene pathways in the placenta, often excluded from tissue-specific gene expression resources. The target genes were broadly enriched in cardiometabolic, immune response, and hormonal pathways. Follow-up studies could help identify therapeutic targets to improve fetal growth outcomes and future heath.

In another study, NICHD-supported scientists developed a noninvasive method to predict congenital cytomegalovirus (CMV) infection. Approximately five out of every 1,000 infants in the United States are born with CMV. Although most babies with congenital CMV do not develop long-term health problems, the infection can cause hearing loss and other neurologic effects that can lead to lifelong disabilities. The study team’s “calculator” can help estimate the risk that a CMV infection will pass to a fetus during pregnancy. Personalized estimates of risk for congenital CMV infection can help pregnant people and their healthcare providers make decisions about whether to undergo more invasive testing, such as amniocentesis to detect fetal CMV infection, or to consider antiviral therapy. 

Research on extremely preterm infants can help optimize their survival and long-term health. One study reported improved survival rates of extremely preterm infants born within the NICHD Neonatal Research Network, which includes 19 centers across the United States. The team found that the survival rate had increased from 76% to 78.3%. Nearly 49% of surviving infants had no or only mild neurodevelopmental impairment, 29% had moderate impairment, and 21% had severe impairment. Another research team found that hydrocortisone did not prevent lung complications in extremely preterm infants. They found that hydrocortisone was no more effective than placebo at preventing damage from oxygen and ventilator therapy, necessary to keep preterm infants alive.

NICHD investigators also found that development scores were higher for infants born later in term pregnancies. On average, scores on development tests were lower for infants born earlier in the range of a term pregnancy—from 37 to 41 weeks—than for those born later in the range. The slight difference in scores, first apparent at 8 months of age, persisted through age 7. The findings may have implications for current practice guidelines that encourage doctors to avoid induction of labor for non-medical reasons before the 39th week of pregnancy. Developmental outcomes may be further improved by waiting for spontaneous labor.

NICHD-funded investigators surveyed healthcare providers to determine the extent to which the providers discuss transition-to-adulthood topics with ASD patients who do not have intellectual disabilities. On average, healthcare providers began these conversations when patients were around 16 years old, but more than half were only “somewhat” or “a little” comfortable with the discussions. Nearly all providers discussed at least one healthcare, well-being, and mental health topic, while basic need-related discussions were limited. The findings suggest that poor preparation for these conversations among healthcare providers may delay or limit these much-needed discussions. To remedy this deficiency, healthcare providers need better resources and training to meet their patients’ needs.

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