Message from Alan

A guest message from ECHO Medical Officer, Alan Simon, MD

In light of National Childhood Obesity Awareness Month this month, our second edition of the ECHO Connector will focus on obesity—its role in the ECHO Program, the work our community is doing to promote and expand obesity research, and a spotlight on a member of the ECHO community who is helping facilitate this research.

ECHO’s unique structure allows our researchers to collect data through both observational and interventional research. When conducting and analyzing this research, ECHO focuses on five key pediatric outcomes:

1. Pre-, peri-, and postnatal (pregnancy and birth)
2. Upper and lower airway (breathing)
3. Obesity (body weight)
4. Neurodevelopment (brain development)
5. Positive health (well-being)

ECHO identified obesity as an important outcome to study because of its many predictors, whether prenatally, early in infancy, or across other life stages. A mother’s weight prior to pregnancy, weight gained during pregnancy, and behavioral changes such as early introduction of solid foods within the first six months of life, may all contribute to the likelihood of obesity. This can also become a generational issue as pregnant mothers pass down traits to their daughters, who are likely to engage in similar behaviors during their own pregnancies.

By design, ECHO is well-poised to address the intersection between pediatric outcome areas that contribute to children’s health. For example, the Vitamin D Oral Replacement in Asthma (VDORA) clinical trial, featured in this issue, investigates the relationship between obesity and asthma, which falls under the “upper and lower airway” outcome. Complexities such as this, among a range of other societal structures and individual behaviors, reveal the benefits of ECHO’s collaborative approach, engaging experts in these outcome areas to combat the obesity epidemic. ECHO aims to understand the underlying causes of issues within these outcome areas so that we can identify how and when to intervene. Understanding these factors will help us in our mission to enhance the health of children for generations to come.

—Alan E. Simon, M.D.

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ECHO by the Numbers

ECHO’s Five Outcome Areas

As mentioned in the message from Alan, the ECHO Program focuses its research on five specific child health outcome areas. These outcome areas serve as ECHO’s overarching research topics, which allow ECHO to conduct research in more specific areas within each outcome. For example, asthma is a topic area that falls under upper and lower airways. All ECHO research pertains to one of these outcome areas, and some spans multiple outcomes.

Learn More about ECHO Research

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ECHO Program Spotlight

Understanding Childhood Obesity in the US

While many programs have addressed childhood obesity over the years, ECHO has a unique opportunity to utilize its large and diverse population to answer questions that may be more difficult to answer in smaller populations. An ECHO-wide research article on childhood obesity in the United States, published in the International Journal of Obesity last fall, utilizes this unique population and shows ECHO’s valuable contributions to obesity research.

Understanding childhood obesity in the US: the NIH Environmental influences on Child Health Outcomes (ECHO) program explores the correlation between weight and age in children, as well as obesity rates in Hispanic and black children. When comparing older children to younger children, the study found the older children to have a greater percentage of being overweight and obese – this also varied by 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.

With a population of more than 37,000 children and infants, the study provides significant data to support answered questions in obesity research. ECHO researchers use statistical power from the program’s large cohort size to investigate the influences of environmental exposures on child health and development. Findings from this study and ECHO’s population may be useful for future research relevant to broad populations.

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.”

ECHO looks forward to utilizing its unique platform to continue learning about childhood obesity in the United States.

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News You Can Use

Awards Announced for Cycle 2 of IDeA States Pediatric Trials Network

All 17 existing clinical sites within the IDeA States Pediatric Clinical Trials Network (ISPCTN), along with the Data Coordinating and Operations Center (DCOC), will continue to the Network’s second cycle. In addition, the Network is adding one clinical site, South Dakota Pediatric Clinical Trials Network, led by MPIs Dr. Amy Elliott and Dr. Katherine Wang.

The purposes of the ISPCTN are 1) to conduct clinical trials among children from rural or underserved populations, and 2) to build pediatric research capacity in historically low-resource institutions to conduct these trials. In this next cycle, ISPCTN will continue its four ongoing trials, including two trials to address care of newborns exposed to opioids in utero. The Network will also stand up at least three new trials. Opportunities to address the COVID-19 pandemic are of particular interest. Learn more about two of the ISPCTN’s current trials below.    

IDeA States Pediatric Trials Network Update on VDORA and iAmHealthy

Infants and children living in rural parts of the United States are less likely than children in urban centers to have a chance to enroll in clinical trials. In 2016, the NIH started the ISPCTN to bring research to children in rural and underserved parts of the country. This group of pediatric researchers from 18 states is working to make sure that children in states with historically low funding for research have access to clinical trials as part of ECHO.

Asthma is one of the most common illnesses in children and impacts families across the country. Children with higher body mass index or BMI can have more severe asthma symptoms than other asthmatic children with lower BMI. Vitamin D is a vitamin that helps many parts of the body, including bones and the immune system. Because vitamin D is stored in fat, doctors do not currently know the ideal amount of vitamin D that children with higher levels of body fat and a BMI greater than or equal to 85% for their age and sex, should take in order to get the most health benefits. Vitamin D Oral Replacement in Asthma (VDORA) is a study that ECHO ISPCTN is currently running to begin to answer this question.

The focus of the VDORA1 study is to help determine what dose of vitamin D would work best for children with higher BMI than other children their age with asthma, and low vitamin D levels in their blood. The children in the study will take vitamin D at different doses and have their blood-levels of vitamin D measured at regular times. The study team will also ask about asthma symptoms, to see if these symptoms change while the child is taking vitamin D. Over 70 children have participated in this study so far and the study will continue through spring 2021.

Childhood obesity is an increasing problem throughout the country and is an important outcome that the ECHO Program studies. It can be hard for families in rural areas to work with health care providers to learn healthy food and activity habits. Over 100 children and their families from four states are now participating in the iAmHealthy feasibility study. This is a 6-month trial, studying the best ways to teach children who live in rural areas how to eat and exercise daily to create a healthier mind and body. Half of the children and families will receive a monthly newsletter in the mail with healthy diet, activity, and lifestyle tips. The other half will have individual and group sessions with health care coaches via video conferences.

Importantly, this trial is also studying the best ways to recruit children and families into research studies, which may be harder in rural and other areas with little research experience. The study is being done virtually without any face-to-face visits required, using electronic communication for consenting, measuring height, weight, and activity, and delivering all the other parts of the study. The lessons learned about research in rural areas and without face-to-face visits will help other studies reach a larger number of children.

Trials Aim to Find Out How Best to Care for Infants Exposed to Opioids in Utero

The ISPCTN is collaborating with the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Neonatal Research Network on Advancing Clinical Trials in Neonatal Opioid Withdrawal Syndrome (ACT NOW). ACT NOW consists of two multi-center clinical trials to find out how nurseries could best care for newborns who are very fussy and have a hard time sleeping and eating because they were exposed to opioid drugs before they were born.

One of these trials, called Eating, Sleeping, and Consoling for Neonatal Opioid Withdrawal (ESC), launched September 8. ACT NOW ESC will compare a new approach that hospital nurseries can use to assess and care for infants with Neonatal Opioid Withdrawal Syndrome (NOWS), with the usual care these newborns get. The main idea is that parents hold, swaddle, and rock their babies in quiet, low-light rooms. This approach may very well lower the need for medication. ACT NOW ESC will include up to 3,000 infants and their primary caregivers across nurseries in 18 states.

The second clinical trial, named the Trial to Shorten Pharmacologic Treatment of Newborns with Neonatal Opioid Withdrawal Syndrome, compares two approaches for weaning infants from morphine or methadone. Clinicians often prescribe these drugs for several days to calm babies who have NOWS.

ECHO Hosts Child Health Webinar

The ECHO Program recently hosted a Child Health Webinar for program stakeholders on July 30. The one-hour webinar, featuring a conversation with ECHO Director Dr. Matt Gillman, focused on sharing important updates about the program and discussing ways to continue the conversation with ECHO’s stakeholders.

Dr. Gillman shared the latest information on ECHO’s child health research, as well as an overview of the ECHO mission, research updates, and new efforts regarding the effects of COVID-19 on pregnant women and children. Dr. Gillman also covered ECHO’s commitment to health equity and its work with diverse, rural, and underserved populations. The webinar concluded with a Q&A for participants.

The goal of ECHO webinars is to highlight research plans and results and how they aid in achieving the program’s mission. We plan to make this a webinar series that will keep stakeholders informed and engaged in ECHO news and plans.

View the resources and materials for this webinar, and keep an eye out for other webinar opportunities in future editions of this newsletter.
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