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DR. ALAN GUTTMACHER: I think the significance of any anniversary, certainly one like the
50th anniversary, is both to have a celebration of what we've accomplished, to think about
what we've accomplished, to think about who we are as an institution, and how did
we get here. But I think even more importantly than thinking about the past, thinking about
the future. So, how has what we've done in the past prepared us for the future? How
do we perhaps need to refine some of our approaches, some of our emphases to make sure that we
are productive, or even more productive over the next 50 years as we've been over the
past 50 years?
[MUSIC OUT] DR. LORETTE JAVOIS: So in terms of birth defects research, every organ system, every major
organ system that develops in a human baby also develops in the zebrafish.
DR. BRANT WEINSTEIN: We've actually found that a number of genes that are known to cause
defects in humans, cause hemorrhagic stroke defects in humans similarly cause fish to
have hemorrhages in their heads when you knock these genes out in fish. We've gone and
tried to understand more about this gene pathway and about how these genes work with an eye
toward potentially helping people that have defects in these genes or that have hemorrhagic
stroke defects to better understand what we can do to help those people.
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[MUSIC OUT] DR. MARIAN WILLINGER: There are several negative outcomes for infants who are born preterm.
For example, they are at greater risk of dying 18,000 infant deaths each year are to babies
born preterm. There is a treatment for women who have recurring spontaneous preterm birth
and we did a study and found that if these women are treated at 16 to 20 weeks with a
hormone, progesterone, we can reduce the chance that these women will have a preterm birth by one third.
Myelomeningocele is a birth defect in which the spinal column doesn't
close properly over the spinal cord. Traditionally babies who have myelomeningocele are, their
spinal cord is repaired after birth. But we had reason to believe that if we repaired
the spinal column in utero, then the brain and the spinal cord would have a better chance
of developing normally, and, the baby would do better. And what we found was the babies
who were repaired in the womb had much better outcomes. They were less likely to die or
have shunt placement after birth and they had less motor disability, and at 30 months
twice as many of those babies were able to walk than the babies who had repair after birth.
DR. LYNNE MOFENSON: HIV infection in children was basically a fatal disease and 60 percent
of children died by the time they were aged two years and we first found that using one
drug reduced the risk of disease progression and currently we use three or more drugs in
these children and we're seeing increased survival into young adulthood. There's been
a complete paradigm shift in HIV from a fatal disease to currently a chronic disease like diabetes.
Because HIV was a fatal disease in infants, we really needed to find a way
to prevent mother to child transmission and in the early 1990s, the only drug available
was zidovudine or AZT. And we gave that drug to the pregnant woman during pregnancy, during
labor, and to the infant for six weeks, hoping that that would be effective. And I'll never
forget, it was Presidents' Day weekend, 1994, when the Data and Safety Monitoring Board
came back to us and said, you should stop the trial, this is 67 percent effective in
reducing mother to child transmission, and you should let everyone know that this is
an effective therapy.
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[MUSIC OUT] DR. MELISSA PARISI: Newborn screening is a nationwide screening program with well over
99 percent of children being screened. So that represents 4.3 million infants per year.
Now most of those infants are perfectly normal and don't have any abnormalities detected
by newborn screening but for those that do have an abnormality, you can institute treatments
that can help prevent very severe complications, including intellectual disability, severe disabilities, or even death.
The first condition screened for in most newborn screening programs
was PKU or phenylkentonuria. In fact, in most newborn screening programs, even worldwide,
that's one of the first tests that they usually start. It is remarkable to realize that in
the past 50 years we've actually been able to expand newborn screening from that single
test for PKU, to now 30 different conditions, and that's largely due to all the research
that's been done to help us understand these conditions so much better.
DR. GILMAN GRAVE: So, the newest and youngest of our longitudinal cohort studies is Project
Viva to look, again, at precursors of childhood obesity, childhood hypertension, and early
indications of the metabolic syndrome in children. We've learned, for instance, that leptin
levels in utero determine obesity later in life -- that the lower the leptin levels
the more likely by age three a child will be significantly obese.
That babies who are born by cesarean section have twice the rate of obesity at age three than babies who are
born vaginally and we've also learned that very early introduction of solid food before
four months of age leads to a very surprising six times increase in the rate of childhood
obesity by age three.
DR. VALERIE MAHOLMES: With some of our basic foundational research, we're able
to assess the prevalence and incidence of abuse and neglect and other kinds of relational
issues that might occur within a home so, looking at the family dynamics, how mom and
dad interact with each other, how the parents interact with the children, and how the siblings
interact with us with each other, helps us to really understand what that dynamic is in the family
because we start with our basic foundational questions. What is the prevalence
and incidence of abuse and neglect, let's say for example, in families that are experiencing
poverty, who are at or below the poverty level. What are the underlying mechanisms of poor
child outcomes, especially children who might grow up in these kinds of contexts. So, having
descriptive studies or studies, epidemiological studies, or basic behavioral and biobehavioral
research studies that give us answers to those questions, then gives rise to the array of
intervention possibilities.
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[MUSIC OUT] DR. ALICIA ARMSTRONG: It's estimated that approximately 80% of African-American women
and 70% of Caucasian women will have fibroids by the age of 50. Of those only about a quarter
or 25% have symptoms. The work that we're doing here at NICHD I think will have innumerable
effects on the reproductive health of women not just in the United States but throughout
the world. One of my colleagues Doctor James Segars, for example, has a fibroid tissue
bank and he offers tissue specimens to researchers across the globe and so supports the research
of investigators not only the United States but throughout the world.
DR. MICHAEL WEINRICH: So the overall goals of rehabilitation research at the NICHD are
to improve the function and quality of life for individuals who have suffered illness
or injury of all kinds, including traumatic brain injury.
BrainGate is a multi-electrode array of tiny microelectrodes which are directly implanted into the cerebral cortex, to the
outer layer of the brain. These electrodes can record signals from individual nerve cells,
and they are processed by some very sophisticated computer algorithms to allow patients to actually
control external devices by using the signals from the brain, by actually thinking about
doing something.
DR. PETER BASSER: DT-MRI provides information about, primarily about wiring in the brain,
the white matter, the nerves that traverse the brain. It can provide information about
the clinical conditions, such as autism or schizophrenia -- things that have been very difficult
to analyze or describe using conventional imaging methods, or even genetics. It provides
information about the viability of the fetus in utero and the health of the mother and
allows us to look at the brain structure from womb to tomb.
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[MUSIC OUT] DR. CONSTANTINE STRATAKIS: What makes our intramural research program unique is that
it doesn't necessarily focus on a single disease or on a single system. It is focusing on human
development. We are uniquely positioned within one of the largest research campuses in the
world, next to a wonderful clinical research center where we can see this basic science
being conducted right next to where the patients are and, so, we can translate these findings
immediately to clinical applications.
DR. CATHERINE SPONG: Now, the NICHD mission is broad. It encompasses all of development,
from basic biology, through translation medicine, through clinical trials. It includes pediatrics,
obstetrics, rehabilitative medicine, as well as basic science research and demography and behavioral research.
NICHD actively works with cross collaboration both within the Institute
across different branches as well as outside the Institute to other institutes, agencies,
and other professional societies and organizations.
DR. YVONNE MADDOX: One of the many areas about the NICHD that I am particularly proud of is our commitment to health equity.
We know that there are health inequities in terms
of length of life, the quality of life, the different rates of infant mortality and preterm
birth, childhood obesity and diabetes, to name a few. But our research is peeling away, layer
by layer, some of the underlying biological and behavioral reasons for these health inequities.
And as the research looks more closely at the concept of developmental origins of health
and disease, with an emphasis on the role of environment, we're likely to have great
success against these health inequities and move towards an optimum health for all Americans.
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[MUSIC OUT] GUTTMACHER: Well the possibilities are great, across all of the areas of our mission. They
are different kinds of possibilities. What they have in common is that we have some new
scientific research tools and they're just opening new doors of exploration for us and
doors of exploration that we think will be satisfying to walk through but also in doing
that, really will give us new tools to prevent disease, to be able to look at, using the
developmental lens we always have, to be able for instance to get real with the idea that
the child is father of the man and mother of the woman, to really understand how early
life influences -- even back in pregnancy -- have a lifelong impact on people's health
and wellbeing, and to use that knowledge in a way to really improve not just health of
children but health of all individuals.
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