Stepping Back to Look Forward

Investing in the next generation of researchers is essential, as recently highlighted in the 21st Century Cures Act. From its inception, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) has supported training and career development to ensure a robust pipeline of investigators who are prepared to lead their respective fields of inquiry. In recent years, the NICHD has emphasized institutional over individual training awards to a greater degree than many other National Institutes of Health institutes of similar size. To evaluate the success of individuals supported by NICHD career development and training awards, as measured by subsequent application and receipt of independent National Institutes of Health research project grant funding. This retrospective cohort study identified 417 physician-scholars who were supported by NICHD career development awards between October 1, 1999, and September 30, 2001. This period was selected to allow adequate follow-up of research project grant applications and funding. Among these physician-scholars, 355 met inclusion criteria. The primary outcomes were the numbers of research project grant applications submitted and, of these, the numbers that were successfully funded. Among 355 physician-scientists, scholars who had an MD degree only and received a K award or both an individual K award and institutional K12 support were more likely than those who received only K12 support (individual K only vs institutional K12 only: odds ratio [OR], 4.86; 95% CI, 1.83-13.62; both K and K12 vs K12 only: OR, 3.19; 95% CI, 1.46-7.10) to apply for subsequent project grant funding (88.0% vs 82.8% vs 60.1%, respectively; P < .001) and to receive it (60.0% vs 60.9% vs 32.9%, respectively; P < .001). For physicians with both MD and PhD degrees, neither application nor funding rates were statistically significantly different whether their career development was supported by individual or institutional awards. Physician-scholars are more likely to apply for and receive a National Institutes of Health research grant if they are trained on an individual career development award, with or without an institutional training award. Based on the data, the NICHD intends to provide a greater proportion of its career development fund allocation to individual awards. The NICHD recognizes the importance of institutional awards and will continue to support them. The NICHD remains committed to training and intends to maintain its investment in training and career development awards going forward.

AMSPDC: An overview of its history and evolving mission

Advancing the Health of Populations Across the Life Course: 50 Years of Discoveries in the Division of Intramural Population Health Research.

Comparing the Hadlock fetal growth standard to the Eunice Kennedy Shriver National Institute of Child Health and Human Development racial/ethnic standard for the prediction of neonatal morbidity and small for gestational age

When should we predict outcomes for extreme prematurity?

Nutrition during Pregnancy: Findings from the National Institute of Child Health and Human Development (NICHD) Fetal Growth Studies-Singleton Cohort.

Strip of the Month: November 2013

Electronic fetal monitoring (EFM) is a popular technology used to establish fetal well-being. Despite its widespread use, terminology used to describe patterns seen on the monitor has not been consistent until recently. In 1997, the National Institute of Child Health and Human Development (NICHD) Research Planning Workshop published guidelines for interpretation of fetal tracings. This publication was the culmination of 2 years of work by a panel of experts in the field of fetal monitoring and was endorsed in 2005 by both the American College of Obstetricians and Gynecologists (ACOG) and the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN). In 2008, ACOG, NICHD, and the Society for Maternal-Fetal Medicine reviewed and updated the definitions for fetal heart rate patterns, interpretation, and research recommendations. Following is a summary of the terminology definitions and assumptions found in the 2008 NICHD workshop report. Normal values for arterial umbilical cord gas values and indications of acidosis are defined in Table 1.A three-tier Fetal Heart Rate Interpretation system has been recommended as follows: Data from Macones GA, Hankins GDV, Spong CY, Hauth J, Moore T. The 2008 National Institute of Child Health and Human Development workshop report on electronic fetal monitoring. Obstet Gynecol. 2008;112:661–666.We encourage readers to examine each strip in the case presentation and make a personal interpretation of the findings before advancing to the expert interpretation provided.A 21-year-old primigravida at 32–6/7 weeks' gestation presents to labor and delivery with preterm labor. Cervical examination reveals 3 cm dilation. Her pregnancy has been complicated by maternal repaired transposition of the great vessels with ventricular inversion and first-trimester bleeding. The fetus had normal echocardiographic findings at 20 weeks' gestation. The patient has no evidence of infection, so she receives nifedipine tocolysis, betamethasone for fetal maturity, and penicillin for group B Streptococcus prophylaxis. The delivery plan is made for an assisted second stage of labor due to maternal cardiac disease. A fetal heart tracing is obtained upon admission (Fig. 1).Findings on EFT Strip #1 are: Tocolysis is discontinued after 48 hours. The woman remains stable for another 24 hours, when she begins having increased contractions and variable decelerations. On physical examination, she is 6 cm dilated, completely effaced, and −2 station. She is afebrile, and other examination findings are within normal parameters. A fetal heart tracing is obtained as her contractions begin to increase (Fig. 2).Findings on EFM Strip #2 are: The decision is made to proceed with augmentation of labor because she has completed her corticosteroid course, has advanced cervical dilation, and is having variable decelerations. Labor progresses rapidly after rupture of membranes and oxytocin augmentation, and her cervix is 9 cm dilated. An intrauterine pressure catheter (IUPC) is placed because of recurrent variable decelerations, but blood returns through the catheter, and it is removed. The fetal tracing is shown in Figure 3.Findings on EFM Strip #3 are: One hour later, the patient has a prolonged deceleration, and the decision is made to move to the operating room for further evaluation and possible operative delivery. The fetal tracing is shown in Figure 4.Findings on EFM Strip #4 are: In the operating room, the bradycardia resolves, but variable decelerations continue. Thirty minutes later, the patient is examined, and her cervix is still 9 cm dilated. A final fetal heart tracing is obtained (Fig. 5).Findings on EFM Strip #5 are: Fifteen minutes later, a primary cesarean delivery is performed. There is a single nuchal cord.A viable male infant is delivered by cesarean section. He weighs 4 lbs 4 oz and has Apgar scores of 5 at 1 minute and 7 at 5 minutes. The arterial blood gas findings are consistent with respiratory acidosis (Table 2). The baby receives continuous positive airway pressure. He is then taken to the neonatal intensive care unit, where he has a normal course for a preterm infant.This infant's FHR tracing could be explained by the presence of a nuchal cord. Single nuchal cords are seen in up to 30% of normal pregnancies. They are rarely associated with significant neonatal morbidity or mortality. Results are mixed on their association with abnormal FHR patterns, low birthweight, and umbilical artery pH of 7.10 or less. The poor sensitivity of ultrasonography in diagnosing nuchal cord and poor predictive value of adverse outcomes do not justify routine screening for its presence. (3)(4)

Strip of the Month: May 2011

In 1974, a six-center* cooperative clinical trial of photo-therapy for the treatment of neonatal hyperbilirubinemia was initiated by the National Institute of Child Health and Human Development (NICHHD), National Institutes of Health (NIH). Infants were randomized into control or phototherapy groups by a code established by the Biometry Branch of the NICHHD. Randomization was applied to each of the birth-weight groups, <2000 g, 2000–2499 g, and 2500 g or greater. Sex and race were also used in cohorting for randomization. Infants entered the study according to the following criteria: 1) All infants with birth weights <2000 g were entered at 24 ± 12 hours of age (922 infants). 2) Infants with birth weights 2000–2499 g were entered if the serum bilirubin reached 10 mg/dL within the first 96 hours after birth (141 infants). 3) Infants with birth weights <2499 g were entered if the serum bilirubin reached 13 mg/dL in the first 96 hours after birth. Before October 1974, the level of bilirubin for accession in this weight group was 15 mg/dL (276 infants).

This article comments on the discussion of S. A. Storch and G. J. Whitehurst's literacy development model in the article by the National Institute of Child Health and Human Development (NICHD) Early Child Care Research Network (ECCRN). Specifically, this comment focuses on concerns raised by the NICHD ECCRN that Storch and Whitehurst's model does not afford an important role to oral language in the development of early reading skill. Four important issues are presented that provide a serious and careful challenge to the model and conclusions of the NICHD ECCRN's report.

Electronic fetal monitoring alone is a poor screening test for detecting fetuses at risk of acidemia or asphyxia. We aimed to evaluation of predictive ability of the National Institute of Child Health and Human Development (NICHD) 3-tier fetal heart rate (FHR) system combined with the maternal, obstetric, and fetal risk factors for predicting perinatal acidemia, and to compare this with the predictive of the NICHD 3-tier system alone, and the Fetal Reserve Index (FRI). A retrospective cohort study was conducted among singleton term pregnant women. Fetal heart rate tracings of the last two hours before delivery were interpreted into the NICHD 3-tier FHR classification system by two experienced obstetricians. Demographic data were compared using the χ2 or Fisher's exact test for categorical variables and the Student's t test for continuous variables. Logistic regression model was used to identify factors associated with perinatal acidemia in neonates. The Odds ratios (OR) and probabilities with 95% confidence intervals (CI) were calculated. A total of 674 pregnant women were enrolled in this study. Using the NICHD 3-tier FHR categories I and II combined with the selected risk factors (AUC 0.62) had a better performance for perinatal acidemia prediction than the NICHD 3-tier FHR alone (AUC 0.55) and the FRI (AUC 0.52), (P<0.01). Improvement of predicting perinatal acidemia was found when NICHD category I was combined with preeclampsia or arrest disorders of labor (OR 3.2, 95% CI 1.30‒7.82) or combined with abnormal second stage of labor (OR 6.19, 95% CI 1.07‒36.06) and when NICHD category II was combined with meconium-stained amniotic fluid (OR 4.73, 95% CI 2.17‒10.31). The NICHD 3-tier FHR categories I or II combined with selected risk factors can improve the predictive ability of perinatal acidemia in neonates compared with the NICHD 3-tier system alone or the FRI.

Background Accurate assessment of fetal size is essential in providing optimal prenatal care. National Institute of Child Health and Human Development (NICHD) study from 2015 demonstrated that estimated fetal weight (EFW) differed significantly by race/ethnicity after 20 weeks. There is a large Somali population residing in Minnesota, many of whom are cared for at our maternal fetal medicine practice at the University of Minnesota. Anecdotally, we noticed an increased proportion of small-for-gestational age diagnoses within this population. We sought to use our ultrasound data to create a reference standard specific for this population and compare to currently applied references. Purpose We aimed to model fetal growth standards within a healthy Somali population between 16 and 40 weeks gestation, and address possible differences in the growth patterns compared with standards for non-Hispanic White, non-Hispanic Black, Hispanic, and Asian singleton fetuses published by the NICHD in the Fetal Growth Study. Materials and methods This is a retrospective cohort study using ultrasound data from 527 low risk pregnancies of Somali ethnicity at single tertiary care center between 2011 and 2017. A total of 1107 scans were identified for these pregnancies and maternal and obstetrical data were reviewed. Women 18–40 years of age with low-risk pregnancies and established dating consistent with first trimester ultrasound scan were included. Exclusion criteria were any maternal, fetal or obstetrical conditions known to affect fetal growth. Results Estimated fetal weight among Somali pregnancies differed significantly at some time points from the NICHD four ethnic groups, but generally the EFW graph curves crossed over at most time points between the study groups. At week 18, EFW was significantly larger than all other four ethnic groups (all p<.001), it was also significantly larger from the Hispanic, Black, and Asian ethnic groups at some time points between 18 and 27 weeks gestation (p < .05). Additionally, EFW among Somali pregnancies was significantly smaller than the Black and Asian ethnicity at 32 and 35–36 weeks and smaller than the White ethnicity at 30 and 38–39 weeks (p < .05). Abdominal circumference (AC) for the Somali population was significantly smaller than the other ethnic groups, especially than the White ethnicity at various time points across 16–40 weeks (p < .05). Femur and humerus length were significantly longer when compared to all other ethnic groups at most time points from 16 to 40 weeks of gestation (p < .05). Biparietal diameter (BPD) was significantly smaller than all other ethnic groups specifically at time of fetal survey (18 weeks) and at time of fetal growth assessment (32 weeks) (p < .05). Conclusions Significant differences in fetal growth standards were found between the Somali ethnicity and other ethnic groups (White, Black, Asian, and Hispanic) at various time points from 16 to 40 weeks of gestation. Racial/ethnic-specific standards improve the precision for evaluating fetal growth and may decrease the proportion of fetuses of Somali ethnicity labeled as small-for-gestational age.

ObjectiveThe incidence of bronchopulmonary dysplasia (BPD) is increasing, but data on its prevalence and management variations remain insufficient in China. The study aims to investigate its point prevalence and variations...

BackgroundLithium is a benchmark treatment for bipolar illness in adults. However, there has been relatively little methodologically stringent research regarding the use of lithium in youth suffering from bipolarity.MethodsUnder the auspices of the Best Pharmaceuticals for Children Act (BPCA), a Written Request (WR) pertaining to the study of lithium in pediatric mania was issued by the United States Food and Drug Administration (FDA) to the National Institute of Child Health and Human Development (NICHD) in 2004. Accordingly, the NICHD issued a Request for Proposals (RFP) soliciting submissions to pursue this research. Subsequently, the NICHD awarded a contract to a group of investigators in order to conduct these studies.ResultsThe Collaborative Lithium Trials (CoLT) investigators, the BPCA-Coordinating Center, and the NICHD developed protocols to provide data that will: (1) establish evidence-based dosing strategies for lithium; (2) characterize the pharmacokinetics and biodisposition of lithium; (3) examine the acute efficacy of lithium in pediatric bipolarity; (4) investigate the long-term effectiveness of lithium treatment; and (5) characterize the short- and long-term safety of lithium. By undertaking two multi-phase trials rather than multiple single-phase studies (as was described in the WR), the feasibility of the research to be undertaken was enhanced while ensuring all the data outlined in the WR would be obtained. The first study consists of: (1) an 8-week open-label, randomized, escalating dose Pharmacokinetic Phase; (2) a 16-week Long-Term Effectiveness Phase; (3) a 28-week double-blind Discontinuation Phase; and (4) an 8-week open-label Restabilization Phase. The second study consists of: (1) an 8-week, double-blind, parallel-group, placebo-controlled Efficacy Phase; (2) an open-label Long-Term Effectiveness lasting either 16 or 24 weeks (depending upon blinded treatment assignment during the Efficacy Phase); (3) a 28-week double-blind Discontinuation Phase; and (4) an 8-week open-label Restabilization Phase. In December of 2006, enrollment into the first of these studies began across seven sites.ConclusionThese innovative studies will not only provide data to inform the labeling of lithium in children and adolescents with bipolar disorder, but will also enhance clinical decision-making regarding the use of lithium treatment in pediatric bipolar illness.Trial RegistrationNCT00442039