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Release Date: 09/22/2016

The National Institutes of Health (NIH) this week announced $157 million in awards in fiscal year 2016 to launch a seven-year initiative called Environmental Influences on Child Health Outcomes (ECHO) – a program that will investigate how exposure to a range of environmental factors in early development influences the health of children and adolescents.

Two Care New England hospitals – Memorial Hospital and Women & Infants Hospital of Rhode Island – were among the 35 pediatric cohorts who will together enroll more than 50,000 children to study the early environmental origins of health outcomes. The initial award to Memorial is a two-year grant of $6.2 million, and $4.9 million over two years to Women & Infants. Pending successful completion of this “feasibility phase,” an additional five years of funding is expected to be available.

The principal investigator at Memorial is Viren D’Sa, MD, the hospital’s pediatrician-in-chief, director of the New England Pediatric Institute of Neurodevelopment (NEPIN) and associate professor of pediatrics at The Warren Alpert Medical School of Brown University, who is working with Sean Deoni, PhD, a neuroimaging physicist at the University of Colorado and adjunct professor at the School of Engineering at Brown University.

They will draw on information gleaned from about 1,100 children enrolled in two ongoing studies – one based at Memorial Hospital and Brown University, which has followed children from as young as three months of age since 2010 under a previous NIH grant, and a second based in Colorado, which has enrolled pregnant mothers. Combined, these studies sought to examine pre and postnatal influences that shape pediatric development.

“We are looking to better understand how the various environmental, genetic and nutritional influences interact to shape early brain development from the prenatal stage through childhood and to puberty,” Dr. Deoni said. “We will investigate how factors such as the in utero environment, starting as early as 22 weeks gestation, breastfeeding and early nutrition, lead exposure, parent interaction, sleep and daytime activity, pollution, and specific genes influence brain structure and function.”

The research will track the children’s performance in many functional domains including academic progress as well, according to Dr. D’Sa.  

“By understanding how and when this diverse array of influences impact brain growth and ultimately affect childhood outcomes such as their performance in school or their chance of developing a medical, developmental or behavioral disorder, we hope to identify predictors of such outcomes and learn how interventions can be optimized for a particular child to maximize their individual potential,” he said.  

Women & Infants
Principal investigators at Women & Infants are Barry M. Lester, PhD, director of the hospital’s Brown Center for the Study of Children at Risk and professor of psychiatry and pediatrics at the Alpert Medical School, and Carmen Marsit, PhD, formerly of Women & Infants/Brown and now a professor at Emory University in Atlanta. The project is entitled “Environmental Influences of Neurodevelopmental Outcome in Infants Born Very Preterm.”

This grant will enable Dr. Lester and his colleagues to enhance the work they are doing through an existing study – the Neonatal Neurobehavior and Outcomes in Very Preterm Infants (NOVI) Study. Sponsored by the National Institute of Child Health and Human Development, the primary goal of the NOVI study is to learn about how early detection of neurobehavior can identify which individual infants are most likely to suffer later developmental impairment and advance interventions to combat those developmental deficits.

“ECHO will enable us to study the development of these infants in the broader environmental context in which they develop, including a range of exposures from air pollution and chemicals in our neighborhoods to societal factors such as stress and parenting,” Dr. Lester said. “At the same time, NOVI will contribute a unique population of very low birthweight infants to the pooled ECHO sample and study how the effects of the kind and timing of early exposures can be detected amongst these diverse populations. This is a win-win study, with children and their families as the ultimate winners.”

Wide-reaching impact
This translational research project has real-life implications for children and families, including helping to shape national policy, health care trends and educational policy.

“Every baby should have the best opportunity to remain healthy and thrive throughout childhood,” said NIH Director Francis S. Collins, MD, PhD. “ECHO will help us better understand the factors that contribute to optimal health in children.”

Said Dr. Deoni, “With the data of all the ECHO cohorts, the sky is really the limit of what we can do for advancing child health. This is an exciting and unprecedented opportunity to make a major and lasting impact.”

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About Women & Infants Hospital

Women & Infants Hospital of Rhode Island, a Care New England hospital, is one of the nation’s leading specialty hospitals for women and newborns. A major teaching affiliate of The Warren Alpert Medical School of Brown University for obstetrics, gynecology and newborn pediatrics, as well as a number of specialized programs in women’s medicine, Women & Infants is the 9th largest stand-alone obstetrical service in the country and the largest in New England with approximately 8,500 deliveries per year. A Designated Baby-Friendly® USA hospital, U.S.News & World Report 2014-15 Best Children’s Hospital in Neonatology and a 2014 Leapfrog Top Hospital, in 2009 Women & Infants opened what was at the time the country’s largest, single-family room neonatal intensive care unit.

Women & Infants and Brown offer fellowship programs in gynecologic oncology, maternal-fetal medicine, urogynecology and reconstructive pelvic surgery, neonatal-perinatal medicine, pediatric and perinatal pathology, gynecologic pathology and cytopathology, and reproductive endocrinology and infertility. It is home to the nation’s first mother-baby perinatal psychiatric partial hospital, as well as the nation’s only fellowship program in obstetric medicine.

Women & Infants has been designated as a Breast Imaging Center of Excellence by the American College of Radiography; a Center of Excellence in Minimally Invasive Gynecology; a Center of Biomedical Research Excellence by the National Institutes of Health (NIH); and a Neonatal Resource Services Center of Excellence. It is one of the largest and most prestigious research facilities in high risk and normal obstetrics, gynecology and newborn pediatrics in the nation, and is a member of the National Cancer Institute’s Gynecologic Oncology Group and the Pelvic Floor Disorders Network.
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