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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
Improving the health status of mothers and infants remains a national
In 1989, more than 4,000,000 babies were born in the United
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.
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
Sudden Infant Death Syndrome (SIDS), which claims the lives of 6.000 to
7,000 infants each year, continues to resist revealing its causes.
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
Assuring that these advances are transferred from the laboratory
bench to the health care system is an Institute prio
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
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
Survival of premature or low birth weight infants is not the only issue.
The future Intellectual and behavioral functioning of these children is also
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
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
One group of neurons are stimulated while another group are
The stimulated neurons respond with an overall increase in the
efficiency with which nerve impulses are conducted.
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
Studies such as this demonstrate the vulnerability of the brain to
disruption of its biochemical and electrical interactions.
of this is provided by the damaged babies being born to cocaine-dependent
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.
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
care on social, emotional, and Intellectual development. Since approximately three-fourths of U.S. children under the age of two whose mothers are employed
are cared for by someone other than a parent, it is important to ascertain the long-term effects of different types of day-care situations on children and
At least 1,200 children will be monitored at regular
intervals from the time they are one month old through age three.
Science is in the very earliest moments of being able to apply what has
been learned about genes and their control to the anelioration or prevention of disease or disability. Researchers supported by the NICHD recently
developed a mouse model for sickle cell anemia, an incurable genetic disorder
afflicting about 50,000 black Americans. The availability of an animal model should prove valuable for testing new drugs and gene therapies to treat the
To facilitate access to this new technology, the NICHD has established a
National Transgenic Development Facility for the generation of "custom made"
This facility will make the technology of gene transfer more accessible
to the basic research community at an affordable price.
It is anticipated
that as many as 100 animal models a year will be developed at this facility,
accelerating research on many genetic disorders.
Just as basic research is beginning to yield results in gene therapy, it
is paying off in other areas as well. Recently, the Food and Drug
Administration licensed the first vaccine effective in infants against
Haemophilus influenzae type b. This vaccine is based upon the work of NICHD
This vaccine, once it is widely used, should nearly
eliminate H. flu meningitis as a cause of mental retardation and deafness,
Other vaccines are being developed against pertussis; salmonella;
streptococcus Group B, associated with sepsis in the newborn; Shigella
dysenteriae, the cause of epidemic diarrhea; and Staphylococcus aureus, often
the source of life-threatening infection in burn patients and prenature
The number of women and children with HIV infection is increasing.
Approximately 6,000 HIV-infected women gave birth last year, and about one out that contains concentrated antibodies, significantly reduces the number of
of three of these babies will be infected.
NICHD-supported investigators have
found that monthly administration of intravenous immunoglobulin, a solution
serious bacterial infections, reduces the number of hospitalizations required,
and prolongs by. as much as a year the time free from serious bacterial
Infections in children who are afflicted with symptoms of HIV infection. results of this clinical trial were so compelling, it was terminated a year
early so that the benefit of its findings could be made available immediately
to all symptomatic HIV infected children.
In a joint effort with the National Institute of Allergy and Infectious
Diseases, we are enrolling children with AIDS in other clinical trials, and
beginning clinical trials in pregnancy to attempt to reduce transmission of
the virus from mother to fetus.
Women's health has been a long-standing priority area of the NICHD, but
the recent increase of HIV infection among women; the small but troubling
upturn in the number of births to unmarried women, primarily teenagers; and
the number of women encountering difficulties in achieving pregnancy have
provided impetus for increased emphasis in this area.
The NICHD intramural
research program plans to expand significantly its research in gynecology to
Investigate hormonal, immunologic, genetic, and anatomic processes which lead
to illness or infertility.
In addition, the NICHD plans to fund several new
centers over the next year.
At least one center will focus on Infertility
research and as many as three will concentrate on contraceptive development.
Millions of Americans are encumbered by physical disability resulting from
injuries or diseases.
Helping these individuals regain their physical or
functional ability to the fullest extent possible is consistent with the
Institute's Interest in human development and the maximization of potential.
To help achieve this objective, a National Center for Medical Rehabilitation
Research has been established within the NICHD.
The new Center will conduct
and coordinate research and research training related to the rehabilitation of
Individuals with physical disabilities resulting from problems such as
arthritis, head or spinal cord injury, stroke, burns, birth defects, cerebral
palsy, or genetic disorders.
This first year of a new decade has set the tone for the years ahead--the
Institute has seen the maturation and fruition of research efforts of past
years result in the availability of new products such as vaccines; the