News

Does Age Affect Susceptibility to Getting the Common Cold?

Posted on by Jodi Snare

Rhinovirus is a leading cause of the common cold and wheezing illnesses in young children and individuals with asthma. There are three species of rhinoviruses (A, B, and C), and the C viruses are often more likely to cause wheezing illnesses, especially in young children. Unfortunately, there are no treatments for these respiratory viruses.

To learn more about how age and other personal factors influence susceptibility to getting rhinovirus illnesses, ECHO researchers Timothy Choi, MS; James Gern, MD; and Yury Bochkov, PhD, of the University of Wisconsin School of Medicine and Public Health conducted a multi-year study with more than 4,000 children. This research, titled “Enhanced Neutralizing Antibody Responses to Rhinovirus C and Age-Dependent Patterns of Infection,” is now featured in the American Journal of Respiratory and Critical Care Medicine.

Children ages zero to 19 with illnesses of varying severity participated in 14 independent studies in the United States, Finland, and Australia. Between 2000 and 2019, each site collected and analyzed nasal samples for rhinovirus species and type. The investigators then tested whether characteristics such as age influenced which viruses were found.

“Our research shows that as children age, they are less likely to be infected with rhinovirus C,” said Choi. “This could be because the immune system has a stronger protective response to infection with rhinovirus C species compared to other species.” Other personal factors related to more frequent infections include wheezing respiratory illnesses and a genetic difference in a protein used by the viruses to enter cells.

The results of this study could help identify children at high risk for developing more severe illnesses with rhinovirus C based on young age and genetics. In addition, analyses of more than 10,000 mucus specimens identified viruses that were consistently more common and those more likely to be associated with illness.

“In the future, we want to focus on studying the magnitude and duration of immunity to rhinovirus C to determine why these viruses are able to produce such a strong immune response, and why rhinovirus C infections naturally decline with age,” said Dr. Gern. “This information may help researchers design a practical vaccine against rhinovirus C that could be used to protect high-risk children.”

Identifying and Addressing Limitations: The Effects of Air Pollution on Children’s Behavior and Brain Development

Posted on by Jodi Snare
Heather Volk, PhD
Johns Hopkins Bloomberg School of Public Health

In a recent article published in Environmental Research, ECHO researcher Heather Volk, PhD, of Johns Hopkins Bloomberg School of Public Health and her team summarized information on different ways to measure prenatal air pollution exposure. They also reviewed what scientists know about how air pollution affects children’s behavior and brain development.

To collect this information, the team reviewed previous publications on air pollution and child development and summarized the study results. They then took these findings and developed a plan to address shortcomings of the earlier work to advance children’s health.

The plan involves using advanced geographic models for common air pollutant exposures. Since more than 90% of ECHO cohorts have collected a physical address for their participants, ECHO has the ability to study pollutant exposures by geographic area. This has been a limitation commonly seen in this area of research. This summary data also allows researchers to determine if there may be enough ECHO participants in the future to study how air pollution can affect children’s brain development and behavior.

“This research confirms that ECHO provides a unique opportunity to study how air pollution can affect children’s brain development and behavior in a large, diverse study population,” Volk said. Given this information, the team hopes that future studies will examine prenatal air pollution exposure in ECHO participants to examine how it affects the brain.

Literature Review Finds Connection between Chemical Exposure and Time to Pregnancy

Posted on by Jodi Snare

Some human-made chemicals can cause problems with the reproductive system, and several studies have looked at whether these chemicals affect how long it takes to get pregnant.

Linda Kahn, PhD, MPH
NYU Langone Health

In a literature review recently published in Human Reproduction Update, ECHO researcher Linda Kahn, PhD, MPH, of NYU Langone Health, and her research team compared the results of past studies on human-made chemicals and their impact on pregnancy. The research found a connection between certain chemicals and time to pregnancy, and also identified chemicals that need further research.

To conduct this research, the team reviewed all papers published in English on this topic from January 1, 2007 to August 6, 2019. After searching five science libraries and finding more than 4,500 articles, they narrowed it down to 28 articles with information from 19 studies that took place in North America, Europe, and East Asia.

The review found a strong connection between a chemical group called polychlorinated biphenyls, formerly used in electrical and hydraulic equipment, and longer time to pregnancy. Even though production of these chemicals stopped in the late 1970s, individuals are still exposed to them through soil, water, and building materials. More research needs to be done on brominated flame retardants, found in furniture, clothing, and other household products, and per- and polyfluoroalkyl substances, found in non-stick cookware and stain-resistant fabrics, to determine their impact on time to pregnancy.

“This review is especially important because it shows that certain long-lasting chemicals may increase the time it takes for couples to become pregnant, which can be stressful and lead couples to seek expensive fertility treatment,” Dr. Kahn said. “Although many of the chemicals covered in the review are no longer produced or used in the United States, they can last for years—even decades—in the environment and our bodies, affecting our health.”

The team believes we need more research on newer chemicals that have been invented to replace dangerous ones to figure out exactly how these chemicals interfere with healthy reproduction. For example, there may be certain life stages such as puberty when being exposed to them may be especially damaging.

ECHO Researchers Explore Validity of Shortened Social Communication Questionnaire

Posted on by Jodi Snare

Are short questionnaires as valid as longer versions when identifying autism spectrum disorder (ASD) and other social communication behaviors?

Kristen Lyall, Sc. D.

ECHO researchers Kristen Lyall, Craig Newschaffer, and others hoped to answer this question in their research titled, “Distributional properties and criterion validity of a shortened version of the Social Responsiveness Scale: Results from the ECHO program and implications for social communication research.” This publication, featured in Journal of Autism and Developmental Disorders, examines how well a shortened version of a social communication questionnaire identified behaviors related to ASD and social communication compared to the longer, established version.

More than 3,000 parents from across the United States participated in this study, nearly 200 of which had a child with ASD.

In all, the team found that the short form did well predicting ASD diagnosis and measuring social communication behaviors. These results suggest that shorter surveys can provide correct information about ASD, which would be quicker and easier for the participant to complete. However, more research is needed to see how the short questionnaire compares in other ways to the longer version.

This work is especially important because it may help address the needs of people who do not have autism but face challenges in social communication and could benefit from help. Additionally, it may help reduce the time it takes to complete surveys while still accurately capturing and addressing social communication challenges in those with and without ASD.

For more information, read the study summary.

Establishing a Standard of Care for Babies Born Dependent on Opioids

Posted on by Jodi Snare

Lead Investigators: Leslie Young, University of Vermont, Lori Devlin, University of Louisville, Stephanie Merhar, University of Cincinnati

As the opioid epidemic continues to affect families across the United States, opioid exposure in the womb has attracted more attention. When a woman uses opioids while she is pregnant, her newborn baby can have symptoms of withdrawal such as intense fussiness, inability to eat well, and poor sleep. Neonatal Opioid Withdrawal Syndrome, or NOWS, has increased five-fold over the last decade, but evidence as to the best approach for assessing and treating these infants is lacking.

That’s why ECHO—in partnership with the NIH Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)—is launching the Advancing Clinical Trials in Neonatal Opioid Withdrawal (ACT NOW) initiative. One intervention trial slated to begin in late summer 2020 is Eating, Sleeping, and Consoling for Neonatal Opioid Withdrawal (ESC-NOW). In this study, researchers will test the effectiveness of ESC, a new method that nurseries can adopt for assessing and treating infants with NOWS. Comparing ESC to the usual care NOWS babies receive, they’ll evaluate how the ESC approach affects the short term—being ready for discharge from the hospital–as well as longer-term: how this approach affects family and infant well-being, as well as how well the baby’s brain is developing, during the first 2 years of life.

The ESC approach engages parents and other primary caregivers in the treatment of NOWS. It emphasizes tactics like holding, swaddling, and rocking in low stimulus environments, thus potentially lowering the need for medication.

Up to 3,000 infants and their primary caregivers will be included in this clinical trial across 26 sites in the United States. By filling gaps in our knowledge of how to take care of these babies, the results of this study may very well set a standard for improving the care of infants with NOWS.

ESC-NOW is one of several ACT NOW studies funded through the National Institutes of Health Helping to End Addiction Long-term (HEAL) Initiative.

ECHO Researchers Learn How Children’s Sleep Quality Is Associated With Overall Life Satisfaction

Posted on by Jodi Snare

Updated July 21, 2020

Most sleep research focuses on how poor sleep may cause health problems. Taking a different approach, ECHO researcher Courtney Blackwell and her team recently conducted a study to determine how better sleep quality may lead to positive health outcomes. In an article published in Quality of Life Research, Blackwell and team found that better sleep quality in school-age children was associated with lower psychological stress and better general health status, which in turn, predicted better life satisfaction

“Existing literature primarily focuses on the negative impacts of sleep. Our team is excited to contribute to the growing body of research on associations of sleep quality on children’s positive well-being,” said Blackwell.

To conduct this study, ECHO researchers asked parents and caregivers to complete surveys about their children’s sleep quality, general health, stress, and life satisfaction. More than 1,000 caregivers of 5- to 9-year-old children from three ECHO Cohorts participated in this study, creating a diverse population that none of the Cohorts offered individually.

Overall, this study suggests that children whose sleep quality is better experience higher levels of life satisfaction.

For more information, read the study summary.

ECHO Program’s Response to COVID-19

Posted on by Jodi Snare

Updated January 25, 2021

ECHO’s approach to innovative research practices in the era of COVID-19

As the novel coronavirus pandemic continues to affect communities across the world, ECHO is committed to protecting the health and safety of its staff and participants while advancing our research mission of enhancing the health of children for generations to come. In addition to following guidance from our national and local governments, many of our studies have, at least temporarily, limited activities to those they can do at a distance.

In response, ECHO researchers are working together to find innovative approaches to keep research going remotely.

Many ECHO Cohorts are moving toward collecting data from a distance. Fortunately, the ECHO-wide Cohort Data Collection Protocol includes online, mail, and phone surveys, as well as remote sample collection. Like the ECHO Cohorts, the ECHO IDeA States Pediatric Clinical Trials Network (ISPCTN) paused ongoing clinical trials in early Spring 2020, but has resumed with a shift toward remote research tools for informed consent, interventions, and data and sample collection.

In these ways, ECHO is responding to the ongoing pandemic by introducing new ways of conducting research, some of which may continue once the pandemic subsides.

ECHO’s contribution to COVID-19 research

ECHO is also joining with researchers around the world to contribute to understanding how COVID-19 affects pregnant women and children.

ECHO researchers are working together in record time to incorporate COVID-19 research in ongoing and new studies. This work is being led by a COVID-19 task force for ECHO ISPCTN and a COVID-19 working group for ECHO Cohorts.

The ISPCTN task force, chaired by Paul Palumbo, MD, includes eight members with a range of expertise such as pediatric infectious diseases, perinatal transmission of disease, and vaccine delivery. The task force is identifying specific COVID-19-related intervention trials that this network of rural and underserved children could mount.

The ECHO Cohorts rapidly produced COVID-19-specific questions that are now part of the ECHO-wide Cohort Data Collection Protocol.  To be maximally useful for other researchers, two public NIH websites feature these questionnaires: https://dr2.nlm.nih.gov and https://www.phenxtoolkit.org/covid19.

During the summer of 2020, the NIH Program Office issued a Notice of Special Interest to encourage and foster time-sensitive ECHO-wide Cohort science related to the COVID-19 pandemic. In September, NIH funded six projects, which include participation from 24 ECHO Pediatric Cohorts or Centers. Co-chaired by Kaja LeWinn, ScD and Leonardo Trasande, MD, MPP, the ECHO Cohorts COVID-19 Working Group continues to facilitate implementation of these new projects, and to foster other COVID-19 related research questions that the ECHO cohorts are uniquely suited to address.

ECHO COVID-19 Projects

  • Amplification of racial and social inequalities in response to the COVID-19 pandemic: Impacts on child positive health outcomes
    • Aim 1: Examine if long term racial/ethnic inequities in sociodemographic resources contribute to more COVID-19 hardships and higher levels of school and social disruptions within communities of color.
    • Aim 2: Examine independent and joint impacts of COVID-19 hardships, school practices, and children’s emotional support on 4-18-year-old’s positive health, as measured by academic competence and well-being.
  • Microbial Mediators of the Impact of Maternal Psychosocial Stress on Perinatal and Neurodevelopmental Outcomes
    • Aim 1: Determine the impact of a) maternal SARS-CoV-2 infection and b) psycho-social stress during the COVID-19 pandemic on length of gestation. We will also consider whether the maternal vaginal or fecal microbiomes in pregnancy mediate this relationship using whole shotgun metagenomic sequencing.
    • Aim 2: Determine the impact of maternal psychosocial stress on infant neurodevelopment and if alterations in infant gut microbiota during the first nine months of life mediate this association.
  • Examining the impact of societal changes during the COVID-19 pandemic on obesity related behaviors
    • Aim 1: Compare diet, physical activity, screen time and sleep prior to versus during the pandemic, with a focus on identifying children at high risk for adverse changes.
    • Aim 2: Using a mixed method approach, examine families’ daily routines during the pandemic, and parent perceptions of how societal changes influence children’s behaviors.
  • Changes in environmental exposures resulting from the COVID-19 pandemic and impacts on child health outcomes
    • Aim 1: Environmental exposures and levels of stress have dramatically changed since March 2020 consequent to the COVID-19 pandemic.
    • Aim 2: These changes have influenced birth outcomes (e.g., birthweight, gestational age) and child respiratory outcomes (wheeze, asthma diagnoses).
    • Aim 3: Exposures and their associations with the outcomes of interest vary by: a) measures of familial stress; b) urban/rural residential location; and c) race/ethnicity. Changes in environmental exposures will be assessed using a questionnaire (all cohorts); silicon wristbands (subset of cohorts); and using urinary biomarkers (subset of cohorts).
  • Impact of COVID-19 and associated stressors on neurodevelopment in marginalized populations
    • Aim 1: Collect time-sensitive responses on stress and parenting in the participating cohorts.
    • Aim 2: Create an efficient remote data collection system and build capacity by expanding the range and quality of developmental screening and assessment conducted by community staff.
    • Aim 3: Optimize a system for routine, timely, and efficient transfer of data collected in the field to the NBCS/ECHO data portal.
  • SARS-CoV-2 stress, infection and immunity: associations with birth outcomes in three ECHO cohorts
    • Aim 1: Study associations of COVID-19 symptomatology, salivary RNA, and SARS-CoV-2 seropositivity with birth outcomes among pregnancies newly enrolled into ECHO.
      • Hypothesis 1. Symptoms consistent with the WHO probable case definition and SARS-CoV-2 seropositivity are associated with shortened gestation, consistent with possible hypercoagulability identified in COVID-19 cases.
    • Aim 2: Examine whether stress (assessed via questionnaire and cortisol measured in hair) modifies associations of COVID-19 case definition, salivary RNA, and SARS-CoV-2 seropositivity with birth.
      • Hypothesis 2. Stress augments effects of SARS-CoV-2 on birth outcomes.

ECHO Researchers Analyze Potential Toxicity of Chemicals, Discover Gaps in Chemical Research

Posted on by Jodi Snare
link to articles byEdo Pellizzari
Edo Pellizzari, PhD, RTI International, ECHO Researcher

In a recent article in Environmental Health Perspectives, ECHO researchers discuss their work on identifying and ranking chemicals that have not been biomonitored nationally but may negatively affect child health. Biomonitoring is a process that detects chemicals that people are exposed to and measures how much of those chemicals get into the body.

To collect information, researchers examined different environmental elements (i.e., food, water, air, house dust) and household products that may contain toxic chemicals. Among other tasks, they put the chemicals into three groups:

  1. Chemicals recommended for biomonitoring
  2. Chemicals that need more information
  3. Chemicals that are a low priority for biomonitoring

Of the identified 720 chemicals, 155 were selected for prioritization, and of these, 36 were recommended for biomonitoring, 108 need additional research, and 11 were considered low priority. The chemicals recommended for biomonitoring add to the list of those currently studied by the ECHO Program. The chemicals that did not meet the three criteria – prevalence in environmental media or biospecimens, toxicity and a biomarker for its measurement – show the gap in current chemical research.

“There is a large opportunity to expand our ability to measure and evaluate chemicals to which the public is likely exposed,” the authors note. “These opportunities include performing exposure measurements, developing methods for biomonitoring, and toxicity testing of chemicals.”

While several thousand chemicals are approved for use in the United States, there is little information on biomonitoring of exposures in pregnant women, babies, and children. This limits the ability to evaluate the potential health impact of a variety of chemicals.

Through this study, the research team hopes others in the science community will be encouraged to study the identified chemicals and improve understanding of the potential health consequences they present in pregnant women, infants, and young kids.

International Journal Highlights ECHO’s Novelty and Necessity in Obesity Research

Posted on by Jodi Snare

A recent article on childhood obesity in the US, published in the International Journal of Obesity, details results from an ECHO study of more than 37,000 babies and kids and describes the unique features that make the ECHO Program exceptionally valuable for obesity research.

The authors note that ECHO “holds promise to provide insight into the mechanisms that promote overweight and obesity in US children and provides rigorous data for novel programs to lessen the burden on individuals, families, and society.”

The study found that overweight and obesity were more common in older children than in younger children and varied with race/ethnicity. About 1 in 10 children age 1 to <2 years had a high BMI, and about 1 in 3 adolescents age 12 to <18 years was overweight or obese. Hispanic and black children had the highest rates of both overweight and obesity.

The results were similar to those from the large National Health and Nutrition Examination Survey (NHANES), pointing to the generalizability of ECHO’s population for further obesity research.

Despite the growing obesity epidemic, few programs provide an accurate insight into the many factors that promote overweight and obesity in children in the United States. However, due to the diversity and size of the ECHO Program’s population, it is well positioned to provide a comprehensive view of the impact of various environmental influences on childhood obesity.

“ECHO has assembled a large racially/ethnically diverse US cohort poised to provide much-needed answers to important questions regarding the early life determinants of childhood obesity risk,” the article states.

Because of the program’s size, it will have the statistical power to answer questions about environmental and preventable causes of childhood obesity even for less common exposures. Through the collection of existing and forthcoming data, ECHO also has the ability to examine genetic modifications and unravel the complexity of gene-environment interactions as contributors to obesity.

Find more information on ECHO research at echochildren.org/about.

ECHO Researchers Identify Gaps in Prenatal Opioid Exposure Research

Posted on by Jodi Snare
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.