Explaining State Variability in Pediatric Hospitalizations and Reported Child Maltreatment

Explaining State Variability in Pediatric Hospitalizations and Reported Child Maltreatment is sponsored by National Institutes of Health (NIH) - Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). This federal grant supports a collaborative research effort examining state safety net policies to identify whether they improve the health and well-being of children.

The mission of the _Eunice Kennedy Shriver_ National Institute of Child Health and Human Development (NICHD)is to lead research and training to understand human development, improve reproductive health, enhance the lives of children and adolescents, and optimize abilities for all. The institute's vision is: Healthy pregnancies. Healthy children.

Healthy and optimal lives. NICHD research programs incorporate the following concepts: * **Events that happen prior to and throughout pregnancy, as well as during childhood, have a great impact on the health and well-being of children and adults.

**The institute supports and conducts research to advance knowledge of pregnancy, fetal development, and birth and to develop strategies that prevent maternal, infant, and childhood mortality and morbidity; identify and promote the prerequisites of optimal physical, mental, and behavioral growth and development through infancy, childhood, and adolescence; and contribute to the prevention and amelioration of intellectual and developmental disabilities.

* **Human growth and development are life-long processes that have many phases and functions. **Much of the institute's research in this area focuses on cellular, molecular, and developmental biology to build understanding of the mechanisms and interactions that guide a single fertilized egg through its development into a multi-cellular, highly organized organism.

* **Learning about the reproductive health of women and men and educating people about reproductive practices is important to both individuals and societies.

**Institute-supported basic, clinical, and epidemiological research in the reproductive sciences seeks to develop knowledge that enables women and men to overcome problems of infertility, and to regulate their fertility in ways that are safe, effective, and acceptable for various population groups.

Institute-sponsored behavioral and social science research in the population field strives to understand the causes and consequences of reproductive behavior and population change. * **Developing medical rehabilitation interventions can improve the health and well-being of people with disabilities.

**Research in medical rehabilitation seeks to develop improved techniques and technologies, with respect to the rehabilitation of individuals with physical disabilities resulting from diseases, disorders, injuries, or birth defects. The institute also supports research training across all its programs, with the intent of adding to the cadre of trained professionals who conduct research in areas of critical public health concern.

In addition, an overarching responsibility of NICHD is to disseminate information from its programs to researchers, practitioners, other healthcare providers, and the public. To learn more about NICHD’s contributions to society, visithttps://www. nichd.

nih. gov/about/accomplishments/contributions. ## [](https://www.

nih. gov/about-nih/nih-almanac/eunice-kennedy-shriver-national-institute-child-health-human-development-nichd)Important Events in NICHD History **January 12, 1961**— The report of the Task Force on Health and Social Security calls for the establishment, by administrative action of the U.S. Surgeon General, of a National Institute of Child Health within the National Institutes of Health (NIH).

**January 30, 1961**— The U.S. Department of Health, Education, and Welfare (DHEW) general counsel declares that existing legislation (enacted in 1950) limited the creation of new institutes to those focusing on a disease or group of diseases, and that new legislation would be required to establish the institute called for in the Task Force report.

**February 17, 1961**— The Surgeon General establishes a Center for Research in Child Health in the Division of General Medical Sciences. **October 17, 1962**— Public Law (P. L.)

87-838 authorizes the establishment of NICHD. **January 30, 1963**— Secretary of DHEW Anthony J. Celebrezze approves the establishment of NICHD, with a provision that the Center for Research in Child Health and the Center for Research in Aging (established in 1956) be transferred from the Division of General Medical Sciences to the new institute.

**May 1963**— The Surgeon General appoints members of the National Advisory Child Health and Human Development (NACHHD) Council. **November 14, 1963**— NICHD holds the first meeting of the NACHHD Council. **1965**—States begin mandating the screening of all newborns for phenylketonuria (PKU), a rare disease that if left untreated causes intellectual disability (then called mental retardation), deafness, and seizures.

These mandates come after NICHD research confirms the safety and effectiveness of a simple blood test to screen for and a special diet to treat PKU. By 1990, routine newborn screening can detect up to 10 conditions, including PKU and congenital hypothyroidism (CH). Early detection and immediate initiation of treatment made possible by newborn screening save lives and virtually eliminate PKU and CH as causes of intellectual disability.

**December 1965**— A major NICHD reorganization, approved by the Surgeon General, emphasizes four program areas: reproduction, growth and development, aging, and mental retardation. NICHD creates the Mental Retardation Research Centers to help develop research infrastructure at universities throughout the country(These centers are now called the Eunice Kennedy Shriver Intellectual and Developmental Disabilities Research Centers).

**April 1967**— A second reorganization of NICHD, approved by the Surgeon General, acknowledges the institute's intramural research programs by separating responsibility for intramural and extramural research and creating seven intramural laboratories. The reorganization brings NICHD's administrative structure into line with that of other NIH institutes.

**August 9, 1968**— The DHEW Secretary establishes the Center for Population Research within NICHD. The Center is responsible for contract and grant programs in population and reproduction research and is designated by the President as the federal agency primarily responsible for population research and training.

**May 27, 1975**— The federal government establishes the Center for Research for Mothers and Children within NICHD as the focal point for research and research training on the special health problems of mothers and children. The Center also has responsibility for increasing knowledge about pregnancy, infancy, childhood, adolescence, and adulthood, and for administering grant and contract programs related to these areas.

**June 30, 1975**— The Adult Development and Aging Branch and the Gerontology Research Center, with their programs for support and conduct of research in the field of aging, are transferred from NICHD to the newly established National Institute on Aging (NIA). **October 1977**— Roger Guillemin, M. D.

, Ph. D. , and Andrew Schally, Ph.

D. , MDHC, DScHC—leaders of two independent teams of researchers funded by NICHD and other organizations—win the Nobel Prize in Physiology or Medicine for their work in identifying luteinizing hormone releasing factor (now called gonadotropin-releasing hormone) and other releasing hormones produced by the hypothalamus.

This discovery leads to new understanding and treatments for thyroid diseases, infertility, diabetes, types of tumors, and other disorders. **1977**— The U.S. Food and Drug Administration (FDA) approves the home pregnancy test, developed as a direct result of work conducted by NICHD intramural researcher Judith Vaitukaitis, M. D.

She identifies the beta subunit of human chorionic gonadotropin as the earliest marker of pregnancy, which leads to the development of the first standard home pregnancy test and a monitor for response to cancer treatment. **1978 —**NICHD intramural researchers become the first to successfully clone a mammalian gene, a critical first step in obtaining large amounts of medically important proteins.

**December 1983 —**NICHD grantees Ralph Brinster and Richard Palmiter become the first to transplant human genes into animals. Their accomplishment, transplanting the gene for human growth hormone into mice, provides an important new means to study the function of human genes, as well as the foundation of the new biotechnology industry.

**1985**— NICHD forms research networks of Neonatal Intensive Care Units and Maternal-Fetal Medicine Units. The networks, which perform large clinical trials, provide the institute with a faster, more effective system of evaluating neonatal intensive care and maternal-fetal treatments.

**December 1989**— NICHD announces the establishment of the country's first research centers that combine the biomedical and behavioral sciences to focus specifically on learning disabilities. **September 1990**— The institute begins a congressionally initiated national program of Child Health Research Centers. The program’s goal is to expedite the application of findings from basic research to the care of sick children.

**November 16, 1990**— Congress establishes the National Center for Medical Rehabilitation Research within NICHD to conduct and support programs for the rehabilitation, health, and well-being of individuals with physical disabilities. **1991 —**NICHD expands its Epidemiology and Biometry Research Program to create the Division of Epidemiology, Statistics, and Prevention Research, part of its intramural research component.

The division's portfolio includes research in the fields of reproduction and maternal and child health. **1994**— NICHD launches the Back to Sleep campaign, a program designed to teach parents and caregivers the importance of putting babies on their backs to sleep, to help reduce the risk of sudden infant death syndrome (SIDS).

**January 1994**— In response to the need for appropriate drug therapy for pediatric patients, NICHD establishes the Pediatric Pharmacology Research Unit Network. The network's mission is to facilitate and promote pediatric labeling of new drugs or drugs already on the market to ensure the safe and effective use of drugs in children. **September 1996**— Two NICHD scientists, Drs.

John Robbins and Rachel Schneerson, receive the 1996 Albert Lasker Clinical Medical Research Award for the landmark development of a polysaccharide-protein conjugate vaccine for _Hemophilus influenzae_ type b (Hib). Robbins and Schneerson also receive the World Health Organization Children's Vaccine Initiative Pasteur Award for Recent Contributions in Vaccine Development for their Hib vaccine breakthrough.

**April 1997**—NICHD establishes the Specialized Cooperative Centers Program in Reproduction and Infertility Research to provide high-quality translational research programs in reproduction and infertility and to serve as national resources for the training and career development of new scientists conducting translational research in high-priority areas of reproduction and infertility.

**June 1997**—NICHD and the National Institute on Deafness and Other Communication Disorders (NIDCD) establish the Network on the Neurobiology and Genetics of Autism, composed of 10 Collaborative Programs of Excellence in Autism (CPEAs). The CPEA Network is an international effort that seeks to solve the puzzle of autism through research.

**September 1997**— NICHD initiates the first phase of its National Longitudinal Study of Adolescent Health (later renamed the National Longitudinal Study of Adolescent to Adult Health).

The study's main premise is that social context — such as relationships with families, friends, and peers — influences the health-related behaviors of young people, and that understanding this context is essential to guide efforts to modify health behaviors. **March 1998**— Using sophisticated brain imaging technology, NICHD-funded researchers reveal a brain map of the physical basis of dyslexia.

This finding may provide the basis for screening techniques that will help identify dyslexia, allowing treatment to start earlier in a person's development.

**June 1998**— In the largest, most comprehensive analysis of its kind, NICHD-funded research finds that pregnant women with HIV can reduce the risk of transmitting the virus to their infants by about 50% if they deliver by elective Cesarean section before they have gone into labor and before their membranes have ruptured.

**July 1998**— The FDA approves an NICHD-developed DTaP (diphtheria-tetanus-acellular pertussis) vaccine for use in immunization against these diseases. **September 1999**— NICHD-funded researchers announce the discovery of the gene for Rett syndrome, a disorder in which healthy infants (mostly girls) gradually lose their language capabilities, mental functioning, and ability to interact with others.

**2000 —**NICHD researchers demonstrate that inhaled nitric oxide is an effective therapy for respiratory failure in critically ill term infants in whom aggressive conventional therapy had failed.

The findings, which resulted from the first definitive, randomized clinical trial of nitric oxide use in human neonates, may further reduce the long-term costs of caring for such children and improve their quality of life by reducing their risk for chronic respiratory insufficiency and central nervous system ischemia.

**2000 —**NICHD researchers evaluating data from the Fels Longitudinal Study, the oldest and largest growth study in the world, find that obesity in childhood tracks from age three years onward, into adulthood, and that obesity in adolescence is more likely to lead to adult obesity than obesity earlier in childhood.

Data from the study, supported by NICHD since 1974, may allow researchers to ascertain the segregation of growth patterns over three generations, detect linkage of candidate genes to various phenotypes of growth, and permit the discovery of new descriptors of normal growth and underlying genetic mechanisms.

**January 2000**— The Bill & Melinda Gates Foundation joins NICHD in developing and supporting an international research network to improve the health of women and children throughout the world. NICHD commits to match the Foundation's $15 million to help the network establish self-sustaining, international, and medical research institutions.

**April 2000 —**The National Reading Panel, established by NICHD, releases findings of the largest, most comprehensive, evidence-based review ever conducted of research related to how children learn to read.

The independent panel concludes that the most effective way to teach children to read is through instruction that includes a combination of methods and addresses alphabetics (phonemic awareness and instruction), reading fluency, reading comprehension, teacher education, and computer technology.

**October 2000 —**An NICHD-funded study, conducted by researchers from Thailand, France, and the United States, shows that transmission of HIV from a mother to her child can be reduced nearly as effectively with shorter treatments of the drug AZT, as with longer AZT treatments. The findings may allow women in developing countries to better afford the treatment that can reduce their babies' chances of contracting AIDS.

**October 2000 —**An NICHD grantee, Dr. James J. Heckman of the University of Chicago, is 1 of 2 NIH researchers to receive the Bank of Sweden Prize in Economic Sciences in memory of Alfred Nobel. Dr. Heckman is awarded the Nobel Prize in Economics for his pioneering work in accounting for unknown factors affecting statistical samples.

Much of his work has been applied to understanding how early life events contribute to individuals' later earning potential and economic standing. **February 2001 —**NICHD establishes three Fragile X Research Centers to conduct and support research related to improving the diagnosis and treatment of Fragile X syndrome. This initiative is mandated under public law 106-310, the Children's Health Act, which passed in October 2000.

**June 2002 —**Findings from NICHD's Women's Contraceptive and Reproductive Experiences Study (Women's CARE) reveal no association between oral contraception use and an increased risk of breast cancer.

The study, which focuses on women ages 35 to 64 because they are more likely to develop breast cancer than younger women, provides scientific evidence that past or present oral contraception use does not significantly increase breast cancer risk.

**2003 —**In a first-of-its-kind collaboration, NICHD, National Coalition of 100 Black Women, the Women in the NAACP, and Alpha Kappa Alpha Sorority, Inc., embark on a year-long program to spread the safe sleep message in African American communities.

At regional summits held in Tuskegee, Los Angeles, and Detroit, the partners conduct SIDS risk-reduction training and activities to equip members and community leaders with educational techniques, strategies, and promotional materials so they can conduct outreach activities to reduce the risk of SIDS among African American infants. **June 2003 —**NICHD establishes the Center for Developmental Biology and Perinatal Medicine.

The center strives to advance fundamental and clinical knowledge about maternal health and problems of child development, such as preterm birth, intellectual and developmental disabilities, congenital defects and genetic disorders, fetal growth restriction, and other conditions.

**April 2004 —**NICHD-supported researchers demonstrate that effective reading instruction not only improves reading ability, but also changes the functioning of the brain so that it reads more efficiently. The scientists used functional magnetic resonance imaging (fMRI) to observe brain functions in children during reading.

With fMRI, the researchers could see that the brains of once-poor readers, as they overcame their reading disabilities, began to function like the brains of good readers. The findings show that the brain systems involved in reading respond to effective reading instruction and show increased activity in a part of the brain that recognizes words.

**June 2004 —**Reorganization within NICHD's Center for Research for Mothers and Children establishes the Obstetric and Pediatric Pharmacology Branch to meet the increased demand for research leadership and support of legislation passed to ensure the safety of drugs used to treat children.

The new Branch includes the NICHD Pediatric Pharmacology Research Units Network, the Obstetric-Fetal Pharmacology Research Network, and NICHD Best Pharmaceuticals for Children Act activities. The Branch provides a focus for managing efforts across the U.S. Department of Health and Human Services (HHS) to address this important topic.

**November 2004 —**NICHD and its partner agencies announce the 96 recruitment locations for the National Children's Study, a national, longitudinal study of environmental influences on child health mandated in the Children's Health Act of 2000.

The study is led by a consortium of federal agencies, including HHS (NICHD and the National Institute of Environmental Health Sciences (NIEHS) within NIH, as well as the Centers for Disease Control and Prevention) and the Environmental Protection Agency.

**December 2004 —**Researchers in NICHD's Maternal-Fetal Medicine Units (MFMU) Network find that the risks from vaginal delivery after a prior Cesarean delivery are low, and are only slightly higher than for a repeat Cesarean delivery, thus clarifying the safety of vaginal birth after Cesarean.

The largest, most comprehensive study of its kind indicated that, although complications (such as rupture of the uterus and infection of the uterine lining) were possible, the risk of these complications was very low. Further, the researchers noted that repeat Cesarean carries its own risks, including infection and surgical complications, and that the procedure may complicate future births.

The MFMU Network allows researchers to conduct large clinical trials quickly, by recruiting from multiple sites and using one protocol, providing a faster, more effective system of evaluating maternal-fetal treatments.

**April 7, 2005 —**World Health Day — the Global Network for Women's and Children's Health Research, funded by NICHD and the Bill & Melinda Gates Foundation, initiates the First Breath Project to treat newborn asphyxia, a major cause of infant death, in resource-poor settings.

The new project seeks to determine if training midwives and other traditional birth attendants in standard infant resuscitation practices commonly used in the United States can reduce the death and disability from newborn asphyxia in seven Global Network sites located in South Asia, Africa, and Latin America.

**October 2006 —**As part of a decades-long research effort on SIDS, NICHD-funded researchers announce findings that infants who died of SIDS had abnormalities in the brainstem, a part of the brain that helps control heart rate, breathing, blood pressure, temperature, and arousal.

The finding supports the concept that SIDS risk may greatly increase when an underlying predisposition combines with an environmental risk at a developmentally sensitive time in early life. Modifiable factors, such as sleep position, may provide the greatest protection against SIDS for infants with the brain abnormality.

**December 2006/February 2007 —**NICHD researchers discover two genetic defects that lead to forms of Osteogenesis Imperfecta (OI), a disorder that weakens bones and may cause frequent fractures.

The first gene discovery — a recessive form that requires two copies of the affected gene to show the trait — was implicated in a previously unexplained but fatal form of OI; the second was related to other previously unexplained forms of the disorder. Although there is no treatment for the disorder, the finding allows clinicians to test families who have lost a child to OI for the presence of the defective gene.

**August 2007**— NIH initiates the Autism Centers of Excellence (ACE) Program, a consolidation of two existing programs, the Studies to Advance Autism Research and Treatment (STAART) and Collaborative Programs of Excellence in Autism (CPEA), into a single research effort. The ACE Program seeks to expand on earlier discoveries made by research previously supported by the NIH.

Funding and resources for the program are provided by NICHD, along with NIDCD, NIEHS, the National Institute of Mental Health, and the National Institute of Neurological Disorders and Stroke. **December 2007 —**The President signs the bill renaming NICHD as the "_Eunice Kennedy Shriver_ National Institute of Child Health and Human Development."

**January 2008 —**NIH, led by NICHD, releases a research plan to advance understanding of Down syndrome and speed development of new treatments for the condition, which is the most frequent genetic cause of mild to moderate intellectual disability and associated medical problems. The plan sets research goals for the next 10 years that build upon earlier research advances fostered by NIH.

Among the plan elements are the need for increased research on the medical, cognitive, and behavioral conditions that occur in people with Down syndrome and the need to study whether aging has a greater impact on mental processes in people with Down syndrome than in people who do not have the condition. **June 2008 —**NICHD serves as the scientific lead for the Surgeon General's Conference on the Prevention of Preterm Birth _.

_ The aim of the conference is to establish an agenda for activities in both the public and private sectors to speed the identification of, and treatments for, the causes of and risk factors for preterm labor and delivery. The agenda calls for a national system to better understand the occurrence of preterm birth and a national education program to help women reduce their chances of giving birth prematurely.

The agenda also calls for improved methods for estimating the age of the fetus, and studies to identify biomarkers which would signal the beginning of preterm labor. **July 2009**— NIH, led by NICHD, releases a research plan to advance understanding of Fragile X syndrome and its associated conditions, Fragile X-associated Tremor/Ataxia Syndrome and Fragile X-associated Primary Ovarian Insufficiency.

The plan sets research priorities for each condition and includes investigating the biological processes underlying all three disorders and how to better diagnose and treat them. Other priorities include studying how widespread the gene variations are in the population and how the three conditions affect families.

**October 2009**— NICHD and NIH join members of the newborn screening research community andHunter's Hope(link is external)— the foundation started by former National Football League quarterback Jim Kelly and his wife Jill after their son Hunter was diagnosed with a rare, degenerative, fatal genetic disease — to launch the Hunter Kelly Newborn Screening Research Program.

The program aims to identify new screening technologies and research management strategies for screened conditions. **August 2010**— NICHD-supported researchers are the first to activate dormant mouse egg cells at the earliest stage of their development and bring them to full maturity within the laboratory. Researchers then fertilize and transfer the eggs into female mice, resulting in the birth of healthy offspring.

**February 9, 2011**— Results from an NICHD-funded study show the benefits and risks of prenatal surgery to repair myelomeningocele, the primary defect in the most severe form of spina bifida. Researchers in the Management of Myelomeningocele Study compared outcomes from the standard postnatal surgery treatment to outcomes from surgery done while the baby is still in the womb.

The study shows that, despite a slight increase in risk for preterm delivery, mother and baby have better overall outcomes if the surgery is done before birth. **December 13, 2011**— NICHD’s National Center for Medical Rehabilitation Research (NCMRR) marks its 20th anniversary with a scientific symposium.

The event provides a forum for discussions of the center’s founding and history, early years, and scientific accomplishments in rehabilitation research. **September 2012**— NICHD and its collaborators expand the Back to Sleep campaign, which focused on SIDS, into the Safe to Sleep®campaign, with a broader emphasis on SIDS, safe sleep environments, infant health, and other sleep-related causes of infant death.

**December 5, 2012**— The institute commemorates the 50th anniversary of its founding with a series of volunteer activities and events related to NICHD’s mission. These activities culminate with a scientific colloquium that features NIH and NICHD Directors, renowned researchers, Nobel laureates, and former NICHD leadership.

At the same time, the institute releases a Scientific Vision Statement, which identifies the most promising scientific opportunities of the next decade. **December 2012**— NICHD reorganizes its extramural research program, consolidating the former Center for Population Research, Center for Research for Mothers and Children, and Center for Developmental Biology and Perinatal Medicine into the Division of Extramural Research.

Two new branches – Gynecologic Health and Disease, and Pediatric Trauma and Critical Illness – are added to the 12 that existed in the three separate centers. **September 2013**— NICHD launches DS-Connect®, an online health registry and national health resource for people with Down syndrome, researchers, and health care providers.

**September 2013**— The Division of Epidemiology, Statistics, and Prevention Research changes its name to the Division of Intramural Population Health Research to reflect its renewed focus on population health.

**May 2014**— NICHD launches the Human Placenta Project to advance technologies that can assess placental structure, function, and development in real time over the course of a human pregnancy, with the ultimate goal of improving lifelong health of mothers and children. **December 12, 2014**— NIH ends the National Children’s Study, following reviews by external advisory groups.

NIH considers new research plans to explore the links between the environment and child health and development. **October 1, 2015**— Informed by input from a Blue Ribbon Panel, NICHD reorganizes its Division of Intramural Research into 14 affinity groups. The groups are designed to serve as intellectual hubs for investigators and to facilitate sharing of ideas and collaboration around common themes.

**August 2015**— NICHD launches theNICHD Data and Specimen Hub (DASH), a centralized online resource for researchers to store and access de-identified data from NICHD-funded research studies for secondary research use.

**November 2015**— NIH launches a new research effort, the NIH Biomarkers of Alzheimer’s Disease in Adults with Down Syndrome Initiative, to identify biomarkers that signal the onset and progression of Alzheimer’s in people with Down syndrome. NICHD and NIA provide joint funding support.

**December 2015**— NIH launches a new multi-year initiative, the Environmental influences on Child Health Outcomes (ECHO) program, to understand the effects of environmental exposures on child health and development.

Consistent with the goals of the former National Children’s Study, the program is designed to capitalize on existing pediatric research participants while taking advantage of new clinical networks and technological advances.

Included within the ECHO program is the Institutional Development Award (IDeA) States Pediatric Clinical Trials Network, which will create teams of pediatric clinical trial specialists at IDeA state institutions to study diseases or conditions relevant to the pediatric population.

**February 2016**— After the World Health Organization declares the association between Zika virus infection and microcephaly and other neurological disorders as a Public Health Emergency of International Concern, NIH announces its research priorities related to understanding the virus and its effects.

NICHD leads the NIH focus onstudying Zika infection and exposure during pregnancy(link is external), how Zika affects sperm function and fertility, andchild development outcomes after Zika.

**July 2016**— Findings from the Promoting Maternal and Infant Survival Everywhere (PROMISE) study, funded by the National Institute of Allergy and Infectious Diseases and NICHD, indicate that for mothers with HIV who have healthy immune systems, taking a three-drug antiretroviral regimen during breastfeeding essentially eliminates HIV transmission to their infants.

The treatment makes breastfeeding a safe option for mothers with HIV in low- and middle-income countries, who may not have access to alternative feeding methods. **August 2016**— NIH Director, Francis Collins, M. D.

, Ph. D. , appoints Diana W.

Bianchi, M. D. , as Director of NICHD.

Dr. Bianchi, a practicing medical geneticist with special expertise in reproductive genetics, joins NICHD from the Floating Hospital for Children and Tufts Medical Center in Boston, where she served as the founding executive director of the Mother Infant Research Institute and vice chair for pediatric research. She also served as the Natalie V.

Zucker Professor of Pediatrics and a professor of Obstetrics and Gynecology at Tufts University School of Medicine and was a member of the NICHD’s federal advisory committee from 2011 to 2015. NICHD is a long-term primary funder of Dr. Bianchi’s research on prenatal diagnosis and treatment of intellectual and developmental disabilities.

**August 2016**— NICHD-funded researchers announce a new way to diagnose bacterial infections in infants 2 months of age or younger who present with fevers of unknown cause. The technology, once refined, could provide a time-saving alternative to the standard method, which requires several days and sometimes invasive procedures to complete.

Having a fast, accurate, and non-invasive way to diagnose the causes of fevers in young children could reduce unnecessary drug regimens and hospital admissions. **September 2016**— A new analysis by NICHD researchers provides the strongest evidence to date that nausea and vomiting during pregnancy are associated with a lower risk of miscarriage in pregnant women.

**September 2016**— NICHD's National Center for Medical Rehabilitation Research (NCMRR) releases theNIH Plan on Rehabilitation Research, which identifies current medical rehabilitation research activities at NIH, opportunities and needs for additional research, and priorities for this research.

NCMRR will coordinate NIH-wide activities related to plan objectives and areas of high priority for the benefit of those with temporary or chronic limitations in physical, cognitive, or sensory function that require rehabilitation. **October 2016**— NICHD joins other NIH institutes in launching a study that will collect brain imaging and other data to better understand teen behavior.

The Adolescent Brain Cognitive Development study will follow 10,000 children, from age 9 years through early adulthood, to gather information during the pivotal teen years, including—for the first time in a study of this size—brain images. **January 2017**— NICHD leads activities related to structural birth defects for the Gabriella Miller Kids First Pediatric Research Program, an NIH-wide effort supported through the NIH Common Fund.

The program focuses on developing tools and resources to better understand the relationship between specific structural birth defects, such as neural tube defects, and childhood cancers. Its first project is the creation of a large data bank that will enable researchers to better study children with birth defects, cancer, or both.

**March 2017**— The NICHD-funded Maternal Fetal Medicine Units Network releases findings that treating mildly low thyroid function during pregnancy shows no benefit for pregnancy outcomes. The findings—from a large, long-term study—bolster results from earlier studies.

The American College of Obstetricians and Gynecologists recommends against universal screening for low thyroid function in pregnant women based, in part, on these findings. **June 2017**— With opioid use and deaths in the United States reaching their highest numbers ever, NICHD convenes experts to review evidence on how best to recognize, treat, and manage newborns at risk for drug withdrawal, or neonatal abstinence syndrome (NAS).

NAS infants experience a range of symptoms, including tremors, incessant crying and irritability, and problems sleeping, feeding, and breathing. Later in the year, NICHD announces a new study—Advancing Clinical trials in Neonatal Opioid Withdrawal Syndrome (ACT NOW)—to help inform clinical