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NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT STATEMENT OF DUANE F. ALEXANDER, DIRECTOR

BUDGET REQUEST Senator HARKIN. Dr. Alexander, welcome back to the subcommittee. I look forward to hearing your plans for the Institute because the research programs are targeted on some of the most urgent public health issues in the United States today. I believe the work done by your Institute is critical to improving the health and well-being of our children in the future. And when we talk about prevention and early intervention, that is your backyard.

Doctor, we have your request for $520.6 million, an increase of about 8.1 percent from last year. Would you begin by highlighting the major programs included in your budget request?

Dr. ALEXANDER. Thank you, Mr. Chairman.

In 1989, more than 4 million babies were born in the United States, but of these almost 39,000 died before their first birthday. Although our infant mortality rate is at an all-time low, the pace of our progress in reducing it has slowed. Our scientists are trying to determine why the Nation's rate of low birth weight has remained constant and why low birthweight is twice as prevalent among black women as compared to white women.

An important advance was made this year in the treatment of children infected with the AIDS virus. NICHD-supported investigators found that monthly administration of intravenous immunoglobulin, a solution that contains concentrated antibodies, significantly reduces the number of serious bacterial infections, reduces the number of hospitalizations required, and prolongs by as much as 1 year the time free from serious bacterial infections in children who are afflicted with symptoms of HIV infection.

In other research related to pediatric AIDS, the NICHD, in a joint effort with the National Institute of Allergy and Infectious Diseases, is beginning clinical trials in pregnant women to attempt to reduce transmission of the virus from mother to fetus.

Sudden Infant Death Syndrome continues to resist revealing its causes. Now, new technologies are allowing us to investigate factors that may hold the key to our being able to predict or prevent apnea or SIDS.

The Food and Drug Administration recently licensed the first vaccine effective in infants against Haemophilus influenzae type b. As Dr. Fauci indicated, this conjugate vaccine is based on the work of Dr. John Robbins in the NICHD intramural research program and was further developed with both NIAID and NICHD support. This vaccine, once it is widely used, should nearly eliminate H. flu meningitis as a cause of mental retardation and deafness.

Assuring that research advances are transferred from the laboratory bench to the health-care system is an Institute priority. Evidence of this commitment is NICHD's recent establishment of a national program of child health research centers. We also plan to fund several new centers over the next year related to women's health issues. At least one center will focus on infertility research and as many as three will concentrate on contraceptive development. These centers will become part of the Institute's historically strong research centers program.

PREPARED STATEMENT Millions of Americans are encumbered by physical disability resulting from birth defects, injuries, or diseases. Helping these individuals regain their physical or functional ability to the fullest ex. tent possible is the objective of a new National Center for Medical Rehabilitation Research established within NICHD. The new center will conduct and coordinate research and research training related to rehabilitation of individuals with physical disabilities.

Mr. Chairman, our fiscal year 1992 budget request is $520,584,000.

I will be pleased to answer any questions. [The statement follows:)

STATEMENT OF DUANE F. ALEXANDER

The United States is a nation that holds its children in high esteem. A

child who dies prematurely or who fails to develop to its full human potential

represents a societal as well as a personal tragedy.

The research programs of the National Institute of Child Health and Human

Development (NICHD) are designed to ensure the health and well-being of

American children and their families.

That goal is pursued through the

support and conduct of research addressing some of the urgent public health

problems facing our nation.

These problems include a high national Infant

mortality rate; maternal, pediatric and adolescent AIDS; unintended pregnancy,

a large portion of which is teenage childbearing; Sudden Infant Death

Syndrome; factors that inhibit the physical or behavioral development of

children; and the physical disabilities that result from impaired development,

accidents or disease.

The NICHD supports a broad range of biomedical and behavioral research on

such challenges as birth defects, mental retardation or other developmental

disabilities, learning disabilities, medical rehabilitation and the

development of better, more effective fertility regulation, including

contraceptive choices.

Improving the health status of mothers and infants remains a national

challenge.

In 1989, more than 4,000,000 babies were born in the United

States.

of these, almost 39,000 died before their first birthday, with black

babies dying at twice the rate of white babies.

Although the nation's infant

mortality rate is at an all-time low, the pace of progress has slowed.

Important determinants of infant mortality such as the incidence of low birth

weight and early prenatal care show no recent improvements.

NICHD scientists are trying to determine why the nation's rate of low

birth weight has remained constant and why low birth weight is twice as

prevalent among black women as compared to white women.

Socioeconomic factors

alone do not explain the disparity, and researchers are currently

investigating the effect of social support, level of work and other physical

activity, nutrition, stress, health behaviors and other factors on the

occurrence of low birth weight among various ethnic groups including blacks

and Hispanics.

Sudden Infant Death Syndrome (SIDS), which claims the lives of 6.000 to

7,000 infants each year, continues to resist revealing its causes.

.

However,

research is making some inroads.

Differences in the number of short pauses in

breathing during sleep may be a clue as to why apparently healthy infants die.

During the second month of life, babies who die of SIDS appear to have a

decrease in the number of normal pauses in breathing.

This decrease occurs

just prior to the age at which most SIDS deaths occur, leading Investigators

to conclude that this change may be related to factors in the Infant's

respiratory control system.

A prospective study being developed by NICHD will

use the new technology of event recorders with apnea monitors to determine

whether this decrease in breathing pauses or other factors may be able to

predict, detect, or prevent apnea and SIDS.

The improvement in infant mortality that has been noted is largely

attributable to advances in the technology of caring for 111 or premature

newborns.

Assuring that these advances are transferred from the laboratory

bench to the health care system is an Institute prio

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commitment is the NICHD's' recent establishment of a national program of Child

Health Research Centers.

Seven Centers were funded last year in response to

Congressional interest.

This program is designed to foster the development of

improved treatment techniques, expedite the transfer of these findings from

basic research to the care of sick children, and encourage the development of

a new generation of highly trained research clinicians specializing in

pediatric research.

Survival of premature or low birth weight infants is not the only issue.

The future Intellectual and behavioral functioning of these children is also

at stake.

Low birth weight or premature infants often suffer developmental

disabilities ranging from mild learning problems to severe mental retardation.

The results from a large-scale study jointly supported by the Robert Wood

Johnson Foundation and the NICHD demonstrated that early intervention can

prevent many behavioral problems and raise I.Q. scores in at-risk children.

The low birth weight children in the study began receiving weekly visits soon

after birth from health care professionals who taught parents not only how to

take care of their children's physical needs but also how to play with their

children in ways that would stimulate their minds.

At one year of age, the

children were enrolled in special child development centers.

I.Q. scores at

age 3 were significantly improved for infants of all birth weights who

received the services.

In contrast, nearly half of the at-risk children who

did not receive the intervention program had 1.Q. scores below 85, a level

associated with significant learning problems.

The Institute hopes to

reassess these children at age 6 to ascertain if they have maintained the

gains achieved.

It is intriguing to note that this research reinforces observations made

in the laboratory that fetal mouse nerve cells respond to stimulation by

increasing their connections to other cells. Using a unique apparatus, NICHD

intramural scientists are able to study the effects of electrical impulses on

sensory neurons.

One group of neurons are stimulated while another group are

not.

The stimulated neurons respond with an overall increase in the

efficiency with which nerve impulses are conducted.

By contrast,

the

efficiency of the unstimulated neurons decreases.

This research enhances our

understanding of the formation of orderly connections between nerve cells

during normal development.

Scientists believe that disturbances in these

connections may be related to mental retardation or some forms of mental

illness.

Studies such as this demonstrate the vulnerability of the brain to

disruption of its biochemical and electrical interactions.

Tangible evidence

of this is provided by the damaged babies being born to cocaine-dependent

mothers.

It is estimated that as many as 375,000 infants may be affected by

in utero exposure to illicit drugs in the U.S. each year.

In Fiscal Year

1991, the NICHD will start two projects related to this problem.

The

Institute is conducting a comprehensive review of current information about

the adverse effects of prenatal illicit drug use on fetal health, including

possible long term effects, and, through its network of neonatal intensive

care units, is leading a study involving several agencies to assess the impact

of prenatal drug use on the development of the fetus's central nervous system.

Infants in this study will be followed from birth until they enter school to

monitor their progress.

In another longitudinal study involving children, NICHD-supported

scientists at 10 centers around the country are assessing the effects of day

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