ECHO Researchers Identify Gaps in Prenatal Opioid Exposure Research

Elisabeth Conradt, PhD

This week, Pediatrics published results from ECHO researcher Elisabeth Conradt and her team’s efforts to learn more about prenatal opioid exposure and its effects on child development. Conradt and her team reviewed 52 publications to summarize what is known and make suggestions on how to expand knowledge in this area. The resulting article includes perspectives on how the ECHO Program can help learn more about this important topic.

“The number one question mothers, fathers, and clinicians have when they see that a mother is using opioids while pregnant is ‘how will this opioid exposure affect the child’s health?’ We cannot answer that question right now with the existing data,” Conradt said.

The team analyzed existing publications on three age groups: birth, infancy, and 2 years and older. Because of inconsistent and limited data, Condradt’s team was not able to understand a connection between prenatal opioid exposure and how children’s minds develop throughout life. However, they predict that the effects of the exposure at birth and infancy are small and subtle, but may increase as children age and have more demands on their attention at home and school.

Current studies were limited because of small sample sizes and difficulty controlling for confounding factors such as where a person lives or how much money their family makes.

Moving forward, the team will use ECHO data to test how prenatal opioid exposure affects learning, understanding, behavior, and attention span in middle childhood. They will also consider other possible factors such as poverty. Conradt noted that the team will also look at whether newborns who have neonatal opioid withdrawal syndrome (NOWS) have worse effects compared with newborns exposed to opioids who do not have NAS/NOWS.

Read the study summary and full media release.

ECHO Program Activates First Sites under the ECHO-wide Cohort Data Collection Protocol

June 19, 2019

PASS Cohort Group Picture

The Environmental influences on Child Health Outcomes (ECHO) Program announced today that it has activated its first sites to begin data collection under the ECHO-wide Cohort Data Collection Protocol. Congratulations to the Safe Passage Study (PASS) Cohort, led by Principal Investigator Amy Elliott, sites at Avera Health – Rapid City and Avera Health – Sioux Falls.

“This site activation marks the beginning of ECHO’s next chapter, allowing us to begin collecting data that will enhance the health of children for generations to come,” said ECHO Program Director Matthew Gillman, NIH. “ECHO is uniquely positioned, through an innovative study design, to answer transdisciplinary research questions that have not been explored in observational research to date.”

The ECHO cohorts seek to improve the health of children and adolescents by conducting observational research that will inform high-impact programs, policies, and practices across the United States. ECHO uses information from existing longitudinal research projects (cohorts) that will include more than 50,000 children from diverse backgrounds across the United States. Together, these cohorts follow participants from before they are born, through childhood and adolescence.

The studies focus on five key pediatric outcomes that have a high public health impact:

  • Pre-, peri-, and postnatal
  • Upper and lower airways
  • Obesity
  • Neurodevelopment
  • Positive Health

To learn more about the ECHO Program, visit our About ECHO Page.

New ECHO-funded Research Shows Chronic Illnesses in Children Do Not Necessarily Lead to Dissatisfaction

The ECHO researchers’ findings suggest that children with chronic illnesses are just as happy as their peers who do not have chronic illnesses.

The May 2019 issue of Pediatrics published findings from a recent study by ECHO researchers Courtney Blackwell, Amy Elliott, Jody Ganiban, Julie Herbstman, Kelly Hunt, Chris Forrest, and Carlos Camargo. The publication, titled “General Health and Life Satisfaction in Children With Chronic Illness,” focuses on children’s general health and life satisfaction in the context of chronic illness.

The study found that while children with chronic illnesses have worse health overall, their life satisfaction was comparable with that of their peers without chronic illnesses, suggesting that children with chronic illnesses may still lead happy lives.

As reported by the American Academy of Pediatrics, the authors noted, “the current study suggests that having a chronic illness is certainly a health challenge (evidenced by lower parent-reported general health) but does not preclude these children from having happy and satisfying lives that are comparable with those of peers without illness.”

This multi-cohort study evaluated results from questionnaires completed by 1113 caregivers completed on behalf of 1253 children aged 5-9 years with illnesses such as asthma, attention deficit hyperactivity disorder (ADHD), and digestive disorders. The study used the Patient-Reported Outcomes Measurement Information System Parent-Proxy measures for Global Health and Life Satisfaction.

Consistent with one of the primary goals of ECHO to leverage existing cohorts through harmonization of extant data and standardization of newly collected data, this study evaluated data from existing cohorts associated with the ECHO Program, with a specific focus on ECHO’s Positive Health outcome area.

“Overall, this work highlights clinical opportunities to broaden the perspective of health beyond the absence of disease to one in which all children, regardless of illness or impairment, can have well-being,” the authors said.

Read the full article to learn more.

Related links:

Link to AAP story

NIH, ECHO, and the Navajo Nation Make History with New Data-Sharing and Use Agreement

This landmark agreement enables the Navajo Birth Cohort Study (NBCS) to continue as part of the ECHO Program.

A Mother’s Love. Mallery Quetawki (Zuni Pueblo). University of New Mexico College of Pharmacy-Community Environmental Health Program

May 8, 2019

The National Institutes of Health (NIH) facilitated a data-sharing and use agreement between the Navajo Nation and NIH grantees of the Environmental influences on Child Health Outcomes (ECHO) Program at the Navajo Nation Head Start Center in Leupp, Arizona. This agreement, signed by the Navajo Nation, Johns Hopkins University, and RTI International, enables the Navajo Birth Cohort Study to continue participating in the ECHO Program while maintaining respect for Navajo Nation cultural beliefs, Tribal sovereignty, and community values. Additionally, the agreement serves as the first Tribal data-sharing agreement for a nationwide research consortium creating a large-scale database.

“Through this agreement I am confident that data sharing will benefit our Navajo people and allow us to further understand the relationship between uranium exposure, birth effects and childhood development,” said Navajo Nation President Jonathan Nez. “I am optimistic that through this partnership, the Navajo Birth Cohort Study will continue to progress and clarify the environmental impacts on our children’s health.”

The landmark agreement is the culmination of two years of discussion facilitated by NIH, and lays the groundwork for discussions with other Tribal Nations considering participation in biomedical research programs. Most importantly, the study is poised to benefit Navajo mothers and children as well as mothers and children everywhere. More information about the agreement can be found in the NIH news release here.

ECHO Leaders Spotlight Child Health Research at Pediatric Academic Societies Annual Meeting

ECHO will have a strong presence at the 2019 Pediatric Academic Societies (PAS) Annual Meeting in Baltimore, MD.

The ECHO Program will spotlight its advancement of child health research through three special ECHO-wide sessions at this year’s PAS Meeting in Baltimore, MD. These sessions are in addition to numerous abstracts that ECHO investigators are presenting in oral or poster sessions. You may find a list of all presentations by ECHO investigators here.

In the 3 special sessions, NIH Program Director Matt Gillman and several ECHO Investigators will present various perspectives on ECHO science, both from ECHO’s Cohorts and its IDeA States Pediatric Clinical Trials Network.  One is a state-of-the-art plenary session devoted to outlining the goals and early findings of the ECHO Program.

“The mission of ECHO to enhance the health of children for generations to come will resonate with the PAS community,” said Gillman. “We are looking forward to sharing our early findings with the larger pediatrics community. We hope that these presentations will generate excitement around ECHO as we forge the next steps of the Program, both on the observational side, where we are building the ECHO-wide Cohort of more than 50,000 children, and on the intervention side, where the IDeA States Network is providing access for children from rural and underserved backgrounds to participate in state-of-the-art clinical trials.”

Descriptions of each ECHO-related special session:

Precision Pediatrics: The Promise of Integrating Advanced Science and Technology with Prospective Birth Cohort Studies

Saturday, April 27th, 2:45 PM – 4:15 PM, Convention Center 301-302

This 90-minute session will focus on the impact that population-based cohort studies can have on advancing knowledge in child health. The session will feature overviews of the NIH All of Us Program, the Boston Birth Cohort Study, and the ECHO Program. Dr. Gillman will present an overview of ECHO, titled Environmental Influences on Child Health Outcomes: Leveraging Multiple Cohort Studies.

Applying Team Science to Building Research Collaboratives

Saturday, April 27th, 3:00 – 6:00 PM, Convention Center 313

This 3-hour workshop will focus on empowering residents, fellows, faculty, program directors, and departmental leadership with the tools to successfully build research collaboratives through team science. IDeA States Pediatric Clinical Trials Network PI Jessica Snowden will introduce and close the workshop as one of the session chairs.

The NIH Environmental Influences on Child Health Outcomes (ECHO) Program: Goals and Early Findings

Tuesday, April 30th, 9:45 AM – 11:45 AM, Convention Center 316

This 2-hour State of the Art Plenary session will focus solely on the ECHO Program, featuring an introduction by Dr. Gillman. ECHO PIs Drs. Nigel Paneth and Robert Wright will moderate the session, and three ECHO investigators will present current findings from their ECHO-funded projects. Presentations within this session include:

  • Leslie Young MD, FAAP, University of Vermont, will describe how ECHO addresses the Neonatal Opioid Abstinence Syndrome
  • Anne Dunlop MD, MPH, Emory University, will present a paper entitled: Geographic and Temporal Variation in the Effects of Socio-demographic Factors on Risk of Preterm Birth in the US.
  • Aruna Chandran MD, MPH, FAAP, Johns Hopkins University, will present a paper entitled: Epidemiology of Incident Asthma in Children across the US: Unique insights from the ECHO multi-cohort consortium.

In preparation for these talks, we sat down with a few ECHO presenters to learn more about what they planned to cover. Watch our videos below.


The ECHO Program looks forward to sharing its learnings with PAS attendees at this year’s meeting. To learn more about PAS presentations, or to add these presentations to your PAS schedule, visit the PAS website here.

ECHO Program Receives Green Light to Begin Expansive Child Health Research

Single institutional review board approves the NIH’s ECHO cohort research to proceed, which promises answers to high-impact research questions related to early influences on child health outcomes.

February 1, 2019

The Environmental influences on Child Health Outcomes (ECHO) Program today announced it has received single institutional review board (sIRB) approval to begin its research under the ECHO-wide Cohort Data Collection Protocol. The purpose of the sIRB is to ensure that research follows guidelines to protect participants. ECHO research will investigate the effects of a broad range of early exposures—including physical, chemical, biological, social, behavioral, natural, and built environments—on child health and development.

“The sIRB approval of the ECHO-wide Cohort Data Collection Protocol gives us the green light to start finding answers to important questions that will enhance the health of children for generations to come,” said ECHO Program Director Matthew Gillman. “We know that a child’s exposures from before birth through the first few years of life are tremendously formative, and yet, until now, child health research in this area has been limited, leaving us with lots of questions. We look forward to turning that tide.”

The ECHO-wide Cohort is made up of more than 70 individual cohorts, or groups, of mothers and children from ongoing research projects. Researchers follow participants through different life stages, some starting before birth and through adolescence. Together, they form a massive virtual “cohort of cohorts” that includes more than 50,000 children from diverse backgrounds across the United States. By bringing together data collected under a single protocol, ECHO researchers can answer high-impact, complex research questions.

Looking at the whole child

ECHO’s promise is not only in its breadth of data, but also its approach, which brings together multiple disciplines to address child health. Historically, many research projects have looked at children through a single, narrow lens. However, the body’s development process includes millions of interacting factors that all play a part in a child’s overall health. Researchers from 44 states, Puerto Rico, and the District of Columbia are involved in the ECHO-wide Cohort Data Collection Protocol. These researchers bring expertise from hundreds of disciplines. As a result, knowledge from ECHO research can offer a richer understanding of child health and development to help guide a healthier, happier childhood for our nation’s children.

Emily Oken, of Harvard University and the principal investigator for an ECHO Pediatric Cohort Award, and David Cella, of Northwestern University and one of the principal investigators for the ECHO Person-Reported Outcomes Core, led the trans-disciplinary development of the ECHO-wide Cohort Data Collection Protocol. They worked collaboratively with all ECHO components and gathered input through a public comment period. The research will include participants that are often excluded from traditional research, such as pregnant women, children, and caregivers. ECHO’s researchers hope that this wide view of the child will shed light on important patterns and trends in child health that have not been captured to date.

“It was a Herculean effort to develop a protocol of this scale with so many interacting variables,” said Gillman. “Through collaboration and a shared passion to enhance the health of all children, we are now positioned to begin this important work. Our team is energized and ready to go, and our nation’s children are waiting.”

ECHO-funded study sheds light on second- and third-hand smoke exposure in kids

A recent study funded by the ECHO Program, National Institute of Child Health and Human Development (NICHD), and National Institute on Drug Abuse, shows that infants and toddlers in low-income, rural areas may be at higher risk for second- and third-hand smoke than previously reported in the National Health and Nutrition Examination Survey. Findings were dependent on the detectable presence of cotinine – the byproduct formed when the body breaks down nicotine – in the children’s systems.

Based on an analysis of saliva samples collected from 1,218 children, 15 percent were in the high exposure group when tested for cotinine, demonstrating levels that are comparable to active adult smokers. Forty-eight percent of the children classified as moderate exposure and 37 percent fell in the low exposure group.

Other key findings from the study include lower smoke exposure for children in center-based daycare facilities and higher smoke exposure for infants, compared with toddlers. This is partially attributed to crawling and infants’ tendencies to put objects into their mouths. Additionally, according to the study, “lower income, less education, frequent residential moves and fluctuations in the number of adults within the home were associated with high smoke exposure.”

“Our results, if supported by future studies, can help educate parents and caregivers, as well as improve prevention programs that seek to reduce children’s smoke exposure,” said Clancy Blair, Ph.D., M.P.H., a professor at New York University’s Steinhardt School of Culture, Education and Human Development, and the senior author of the study.

The study was published in Nicotine & Tobacco Research December 5, 2018.

‘Current Opinion in Pediatrics’ Publishes Seven Manuscripts from ECHO Program

The April 2018 issue of Current Opinion in Pediatrics features seven manuscripts authored by and about the Environmental influences on Child Health Outcomes (ECHO) research program, supported by the National Institutes of Health. Readers can find each of the manuscripts, one from each active ECHO Program Component, in the journal’s “Therapeutics and Toxicology” section. Together, they offer readers a glimpse into ECHO’s mission and progress from diverse vantage points.

Current Opinion in Pediatrics gives us a forum to showcase how each of ECHO’s Components is working collectively toward the ECHO mission to enhance the health of children for generations to come,” said Matthew Gillman, ECHO program director, National Institutes of Health. “We developed ECHO on the premise that the whole is greater than the sum of its parts. That premise applies equally to the ECHO Cohorts and the IDeA States Pediatric Clinical Trials Network. Their combined intellectual capital, disciplines, innovation, and analyses will bring us closer to our mission than individual cohorts or clinical trial sites could ever reach alone. I am inspired by the work across all ECHO Components to bring this premise to life.”

Current Opinion in Pediatrics is a great platform for ECHO. As a publication that spans all the subspecialties and primary care, it represents a product that is more than the sum of its parts, just like ECHO,” said Robert Wright, the publication’s editor. “It is critical for the pediatric health care community to learn about ECHO and the exciting work that will one day change the way pediatrics is practiced.”

Readers can access all seven articles electronically in the journal’s April 2018 (volume 30, issue 2) publication or via the links below:


NIH Releases Report Summary of ECHO-wide Cohort Data Collection Protocol Request for Information (RFI) Responses

On August 11th, 2017 the NIH published an RFI seeking feedback from stakeholders and the general public on the ECHO-wide Cohort Data Collection Protocol. The RFI specifically requested feedback and recommendations on the data element concepts, types of biospecimens, and innovative data collection methodology. The NIH received a number of responses from researchers, professional organizations, nonprofit organizations, and research foundations. View the responses to this RFI here. The NIH thanks all responders for their input.