Welcome to the ECHO Connector! The Environmental influences on Child Health Outcomes (ECHO) Program is a research program at the NIH with the mission to enhance the health of children for generations to come. The ECHO Connector will keep you informed of program news and our latest research findings.
Message from Matt
A message from the ECHO Director, Matthew W. Gillman, MD
May 20 is Clinical Trials Day. This month, I’m pleased to be able to share important new findings from the ECHO IDeA States Pediatric Clinical Trials Network (ISPCTN), which helps address disparities in pediatric research by including children from rural or underserved populations in clinical trials, and by building pediatric research capacity in states with historically low NIH funding.
New ISPCTN research, titled “Eat, sleep, console approach versus usual care for neonatal opioid withdrawal,” was recently published in the New England Journal of Medicine. Researchers found that the “Eat, Sleep, Console” (ESC) care approach for treating newborns exposed to opioids during pregnancy substantially decreases the time until infants are medically ready for discharge and reduces use of opioid medications to treat these babies. Until now, there hasn’t been strong evidence to support a standard care approach for babies with neonatal opioid withdrawal syndrome (NOWS). Hospitals currently have widely different approaches. This clinical trial gives hospitals an evidence-based care approach for babies with NOWS. You can learn more about this study in the Research Spotlight below.
I’m also pleased to share that on March 16–17, 2023, ECHO hosted a virtual workshop on the Return of Individual Research Results to Participants to identify principles and best practices to ethically and feasibly return individual research results to participants in large-sample studies that include pregnant women and children. Over 500 registrants heard 16 expert speakers and discussants present their work on the history and principles of returning individual results, and the value of results to participants, in addition to a fruitful discussion on which results to return, and how to return individual results. More information and recordings of the presentations are available below.
—Matthew W. Gillman, MD, SM
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ECHO Data Available
ECHO Data are Available on DASH
The ECHO Program is excited to announce the continued availability of de-identified ECHO data through the Data and Specimen Hub (DASH). DASH is a centralized resource established by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) that allows researchers to share and access de-identified data from studies via a controlled-access mechanism.
Thus far the ECHO data in DASH include information collected on 41,299 participants and provide a valuable resource for the scientific community. This effort continues to advance a key strategic goal of the ECHO Program and an obligation to U.S. taxpayers for their investment in our research.
Researchers can request access to these data by creating a DASH account and submitting a Data Request Form. The NICHD DASH Data Access Committee will review the request and provide a response in about two to three weeks. Once granted access, researchers will be able to use the data for three years. See the DASH Tutorial for detailed information on the process.
NIH Virtual Symposium
NIH Obesity Research Task Force to Host Virtual Symposium: June 6, 2023
This virtual symposium will feature advances in childhood obesity research by the ECHO Program.
ECHO’s mission is to enhance the health of children for generations to come. The program consists of the ECHO-wide Cohort, which weaves together data from 69 ongoing longitudinal maternal-child observational studies, as well as a pediatric clinical trials network. The symposium will focus on findings from the ECHO-wide Cohort, which supports studies on how exposures from preconception to age 5 years may influence child health outcomes from the birth through adolescence. One of ECHO’s key outcome areas is childhood obesity.
The ECHO-wide Cohort currently includes more than 50,000 children plus family members, who come from racially, socioeconomically, and geographically diverse backgrounds across the United States. This seminar will cover several determinants of childhood obesity that take advantage of ECHO’s size and diversity, including natural experiments, community level factors, social and chemical stressors, and health behaviors.
Please visit the Symposium website for more details and registration information.
If you have questions, please contact S. Sonia Arteaga at sonia.arteaga@nih.gov.
Join Our Program Office Team
Environmental influences on Child Health Outcomes (ECHO) Program Office Seeking to Hire a Health Scientist Administrator (Program Officer) GS-601-12/13/14
The ECHO Program is an extramurally funded program within the Office of the Director, National Institutes of Health. ECHO capitalizes on existing and newly collected data from ongoing cohorts of mothers and children and promotes innovations and technological advances to enable research with impact on child health. ECHO supports multiple, synergistic, longitudinal cohorts to investigate the impact of a broad array of early environmental exposures—including physical, chemical, social, behavioral, and biological, as well as natural and built environments—on child health and development.
The incumbent will serve as a Health Scientist Administrator within the ECHO program and will be responsible for
- Leading ECHO’s efforts to promote equity in children’s health research
- Ensuring recruitment and retention of diverse participants
- Promoting inclusion in the child health workforce
- Increasing community and stakeholder engagement
- Managing a portfolio of cooperative agreements
- Serving on several working groups/committees
Candidates must be U.S. citizens or U.S. nationals. For additional information about and to express interest in a position, please reach out to Dr. S. Sonia Arteaga, PhD at sonia.arteaga@nih.gov. Interested individuals should also apply to an NIH global recruitment announcement through USAjobs.gov. Please prepare to apply to the upcoming health scientist administrator global announcement for GS-12/13/14, which will be open May 15-24, 2023. There will be two health scientist administrator vacancy announcements: one for federal employees and one for all other applicants.
ECHO Research Spotlight
“Eat, Sleep, Console” Care Approach Reduces Hospital Stay and Need for Medication Among Opioid-Exposed Infants
The ‘”Eat, Sleep, Console” (ESC) care approach approach is more effective than usual care for treating opioid-exposed infants, according to new research led by Dr. Leslie Young and Dr. Lori Devlin of ISPCTN in collaboration with Dr. Stephanie Merhar of NICHD. This clinical trial was funded by the NIH Helping to End Addiction Long-term® Initiative (NIH HEAL Initiative®).
The ESC approach substantially decreased the time that opioid-exposed infants spent in the hospital, without increasing adverse outcomes. ESC prioritizes nonpharmacologic care, including holding, swaddling, and rocking in low-stimulus environments, as first-line treatment for NOWS. Newborns cared for with ESC were able to leave the hospital approximately 6.7 days earlier and were 63% less likely to receive drug therapy, compared to newborns cared for under the traditional approach. Safety outcomes at three months of age were similar between both groups.
Establishing an evidence-based standard of care for babies with NOWS
Opioid-exposed newborns can develop symptoms of NOWS, which include tremors, excessive crying and irritability, and problems with sleeping and feeding. In the U.S., at least one newborn is diagnosed every 24 minutes with NOWS. Hospitals have widely different approaches for caring for these babies. They often use the Finnegan Neonatal Abstinence Scoring Tool (FNAST) to assess newborns with NOWS. The FNAST is an extensive scoring system that assesses signs of withdrawal in more than 20 areas. Concerns have been raised about its subjectivity and overestimation of the need for opioid medication.
“Prior to this trial, individual neonatologists were optimizing care in their local communities without strong evidence to support a standard approach to the assessment and management of infants with NOWS,” says Dr. Devlin. “The goal of our research was to build the evidence to identify a generalizable approach for the assessment and management of infants with NOWS. Strong evidence will lead to decreased variation in care and improve outcomes for affected infants.”
The ESC care approach
The ESC care approach was developed about eight years ago but before this trial it hadn’t yet been rigorously evaluated in a large and diverse population of infants with NOWS. ESC provides a function-based assessment of withdrawal severity centered around how well an infant can eat, sleep, and be consoled. “This approach really allows the families and care teams to focus on whether babies can do normal baby things, whereas previously we were focused on each potential symptom of withdrawal,” says Dr. Merhar.
To examine the extent to which ESC might be an optimal care approach for babies with NOWS, researchers in this study enrolled 1,305 infants across 26 U.S. hospitals. Infants cared for with ESC were medically ready for discharge after an average of 8.2 days, whereas infants cared for with FNAST were medically ready for discharge after 14.9 days.
The study also evaluated whether newborns received opioid therapy to manage their symptoms. Infants cared for with ESC were about 63% less likely to receive opioids (19.5% in the ESC group received opioid therapy, compared to 52% in the FNAST group).
These findings are based on three-month outcomes, and a two-year follow-up study of a subset of the infants is ongoing. This follow-up is critical to further inform the safety of the ESC care approach.
"What makes our work really important in my mind is the emphasis this care approach places on empowering moms and families in the care of their babies.” says Dr. Young. “This matters because too often, moms feel marginalized and face stigma that can create barriers to them participating in their babies' care. Our research reinforces the value of having moms at the center of their babies’ care teams—where they belong."
Read the research summary.
Learn more about this research on the NIH HEAL Initiative® website.
Learn more about language to help reduce stigma and bias toward moms, families, and communities affected by substance use disorder.
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News You Can Use
ECHO Researchers Compare Thousands of Prenatal Vitamins to Help Pregnant People Get the Nutrients They Need
Collaborative ECHO research led by Katherine Sauder, PhD of the University of Colorado, Anschutz Medical Campus, highlights six key nutrients essential for healthy pregnancies and identifies the best prenatal dietary supplements available in the United States to help pregnant people get the right amounts of these nutrients. Out of over 20,000 choices, the researchers found one prenatal dietary supplement that may potentially provide the right amounts of the most important nutrients needed during pregnancy: vitamin A, vitamin D, folic acid, calcium, iron, and omega-3 fatty acids. However, the supplement costs $200 per month and requires the patient to take seven pills a day. The researchers then identified other, more accessible supplement options that provide as close a match to the needed amounts of nutrients as possible. This research, titled “Selecting a dietary supplement with appropriate dosing for six key nutrients in pregnancy,” is published in The American Journal of Clinical Nutrition.
It is important for pregnant people to get optimal amounts of the right nutrients. There are thousands of options for prenatal vitamins in the U.S., so ECHO researchers designed this study to help pregnant people and doctors select the ones that contain optimal doses of key micronutrients to support a healthy pregnancy.
This study included 2,450 pregnant participants from six ECHO cohorts across the U.S. ECHO researchers first analyzed data about what participants ate and drank during their pregnancies. Then, they calculated how much of the six key nutrients (vitamin A, vitamin D, folic acid, calcium, iron, and omega-3 fatty acids) mothers were getting in their regular diet. The researchers compared the participants’ diets to nutrition recommendations for pregnancy to determine the amount of nutrients the participants would need from prenatal vitamins to supplement their diet.
The results of this study highlight the ongoing need for prenatal vitamin options that are low-cost and convenient, while still containing the optimal amounts of key nutrients. More research on nutrients in foods will also be needed to help pregnant people get more of these key nutrients in their daily diets.
ECHO Researchers Investigate the Effect of Prenatal PFAS Exposure on Birthweight
In a study investigating how per- and polyfluoroalkyl substances (PFAS) exposures affected pregnant mothers and their babies, ECHO researchers Amy Padula, PhD, MSc and Tracey Woodruff, PhD, MPH, from the University of California, San Francisco, found that higher levels of prenatal exposure to PFAS are associated with lower birthweights.
PFAS are widely used, long-lasting chemicals that break down very slowly over time and are found in drinking water, food, household products, personal care products, manufacturing facilities, and other sources. The PFAS were detected in all participating mothers, suggesting some level of PFAS exposure from the environment.
This research, titled “Birth Outcomes in Relation to Prenatal Exposure to Per- and Polyfluoroalkyl Substances and Stress in the Environmental influences on Child Health Outcomes (ECHO) Program,” is published in Environmental Health Perspectives.
For this study, the researchers collected blood samples and pregnancy data from more than 3,000 pregnant women in 11 different ECHO cohorts. They then measured PFAS levels in the mothers’ blood samples and asked them about their stress levels during pregnancy. The team found that mothers who had higher levels of PFAS chemicals in their bodies were more likely to give birth to a baby of low birthweight than mothers with lower levels of PFAS. Previous studies have found that psychosocial stress may affect PFAS exposures and birthweight, but the team did not find that relationship in the study group.
This research suggests that PFAS exposures during pregnancy can affect infant birthweight, demonstrating the importance of efforts to reduce sources of environmental PFAS exposure.
“Outside of research studies, pregnant people are not tested for PFAS and are uncertain of the potential harms PFAS cause,” said Dr. Padula. “We need to better understand where people are most likely to be exposed to these substances given the number of sources, from drinking water to consumer products.”
The next steps for this research include examining potential sources of PFAS exposure. Additional studies may examine how factors like body mass index and other health conditions in pregnancy might also affect the relationship between PFAS exposure and infant birthweight.
The U.S. Environmental Protection Agency has created a Roadmap to address PFAS as part of the White House plan to accelerate efforts to better protect Americans from PFAS exposure.
Read the Inside Climate News article featuring ECHO researchers.
ECHO Researchers Investigate Link Between Mental Health and Pregnancy During the COVID-19 Pandemic
Collaborative ECHO research led by Alison Hipwell, PhD, ClinPsyD, of the University of Pittsburgh; and Irene Tung, PhD, of California State University Dominguez Hills, found that being pregnant during the COVID-19 pandemic was associated with higher levels of stress and depression symptoms.
The researchers found that participants who reported more emotional support and engaged in physical activity before and during the pandemic had less stress and fewer symptoms of depression. The results also showed that pregnancies during the pandemic were slightly shorter on average, but there was no impact on infant birthweight. This study highlights the importance of providing access to emotional support and mental health care during pregnancy and identifying ways to promote physical activity to help improve maternal health and well-being, regardless of external conditions like the pandemic. This research, titled “Impact of Sedentary Behavior and Emotional Support on Prenatal Psychological Distress and Birth Outcomes During the COVID-19 Pandemic,” is published in Psychological Medicine.
The study included 501 pregnant participants who gave birth during the COVID-19 pandemic (between March 12, 2020 and May 30, 2021) and 501 pregnant participants who gave birth before the pandemic (prior to March 11, 2020). Participants were 31 years old on average and enrolled in one of 16 ECHO research sites across the U.S. Participants answered questions about their experiences with stress and depression, reported on their physical activity, and described the emotional support they received during pregnancy. The researchers also collected information on participants’ birth outcomes from medical records and maternal reports.
“More research is needed to understand how social support and physical activity may protect pregnant people during difficult times,” said Dr. Hipwell. “Future research may look at what types of experiences during the pandemic had the most influence on pregnancy health and well-being.”
ECHO Program Hosts Return of Individual Research Results to Participants Virtual Workshop
On March 16-17, 2023, ECHO hosted a virtual workshop on the Return of Individual Research Results to Participants. Over 500 registrants heard 16 expert speakers and discussants present their work on the history and principles of returning individual results, the value of results to participants, the selection of which results to return, and how to return individual results. The workshop highlighted a panel of four current ECHO participants who shared their own perspectives on the value and meaning of receiving their results from ECHO. The information provided by the participants, speakers, discussants, and moderators has provided a strong foundation for further planning about returning individual results in the ECHO Program.
ECHO leadership would like to thank everyone involved in making this event a success.
Additional information about the speakers and presentations is available on the workshop webpage.
Recordings of the workshop sessions can be viewed here:
NIH ECHO Return of Individual Research Results to Participants Workshop – Day 1
NIH ECHO Return of Individual Research Results to Participants Workshop – Day 2
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ECHO Discovery
ECHO Discovery is a monthly webinar series with educational presentations for the ECHO community, stakeholders, and the public.
April ECHO Discovery
Prenatal Origins of Child Neurodevelopmental Outcomes: From Exposures to Mechanisms
On April 12, Thomas G. O’Connor, PhD of the University of Rochester Medical Center, presented for ECHO Discovery on how a variety of prenatal factors can affect neurodevelopmental outcomes during childhood.
Many common exposures during pregnancy have been associated with neurodevelopmental outcomes in children. During his presentation, Dr. O’Connor emphasized the importance of expanding the evaluation of prenatal exposures beyond traditional chemical exposures (e.g., lead, tobacco) to include the effects of stress, mood disorders, and illness on childhood cognitive development. Broadening this focus allows researchers to expand their understanding of what defines a “healthy pregnancy” and identify the biological mechanisms underpinning the complex relationship between prenatal exposures and childhood cognitive development. Understanding these mechanisms will help researchers and clinicians develop assessments and screening tools that facilitate early interventions or treatments.
Learn More about ECHO Discovery
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Contact the ECHO Program Office.