The Brown Center for the Study of Children at Risk was established at the Warren Alpert Medical School of Brown University and Women & Infants Hospital in 2005. The mission of the Center is to stimulate outstanding interdisciplinary research, education and clinical services on the biological and social factors that determine the developmental outcome of at-risk children.
Read Dr. Lester's Q&A in The Boston Globe's weekly Ocean State Innovators column about using cry analysis with infants with Neonatal Abstinence Syndrome.
New NIH Study on Early Signs of Risk for Autism
Autism Spectrum Disorder is a group of conditions that can have a devastating and significant impact on the lives of children and their families. Unfortunately, although developmental problems in children with autism emerge in the second year of life, reliable diagnosis is challenging until children are 2 to 3 years of age or later. This leaves many families “in limbo” as they seek diagnostic clarification. Moreover, indicators of risk for autism in infancy are very limited, and there are no formal screening tools for this development period. The development of very early screening for autism would open new doors for treatment and prevention, with the potential to improve long-term outcomes. There are significant challenges for the validation of early infant indicators of autism risk, including questions of which risk markers are most promising as well significant logistical hurdles for sample ascertainment and follow up. This study, “Neonatal cry acoustics and neurobehavioral characteristics as early markers of risk for autism spectrum disorder,” funded by a grant from the NIH National Institute of Mental Health (Dr. Sheinkopf, Principle Investigator) addresses these challenges by using a novel set of biobehavioral measures including the NICU Network Neurobehavioral Scales and infant cry acoustics as predictors of later autism status is being conducted in collaboration with the Hassenfeld Child Health Innovation Institute birth cohort with diagnostic outcomes assessed at 36 months. The aim of this study is to determine the unique and combined utility of neurobehavioral functioning and infant cry acoustics as predictors of later autism diagnosis in combination with genetic/familial risk and later developmental screening and surveillance.
Two New NIH Studies of Opioid Exposed Babies
The number of infants exposed to opioids during pregnancy in the United States has increased by 333% in the past two decades. Every 15 minutes, a baby is born exposed to opioids or one newborn every 15 minutes. These infants are at high risk for developing Neonatal Opioid Withdrawal Syndrome (NOWS) - the drug withdrawal syndrome that occurs due to the abrupt discontinuation of prenatal opioids following delivery. These infants can be difficult to manage, are often kept in the hospital for prolonged periods of time, separated from their mothers with an annual cost of $2.5 billion.
In one study, “Clinical markers of neonatal opioid withdrawal syndrome: onset, severity and longitudinal neurodevelopmental outcome” funded by a grant from the NIH National Institute on Drug Abuse (Dr. Lester, Principle Investigator) the objective is to identify predictors of NOWS and chart the neurodevelopmental outcome of newborns with NOWS. We will study over 300 infants at Women and Infants Hospital and at the University of Utah in the newborn period and at 6 and 18 months. Using measures of neurobehavior, cry analysis, analysis of hair for prenatal drug use, epigenetics and sociodemographic characteristics we will develop algorithms to predict which individual infants will develop NOWS and the severity of NOWS. Our goal is to detect which individual newborns could be discharged early and which newborns to target for treatment to reduce NOWS severity. This could lead to the development of tools that will allow clinicians to intervene early, improve care for these infants and improve their long-term developmental outcomes.
The second study is “Monitoring newborn sleep to improve treatment and outcomes from opioid exposure” funded by an NIH COBRE (Center of Biomedical Research and Excellence) grant (Dr. Salisbury, Principle Investigator). In this study we will measure newborn sleep state and respiration patterns before, during and after withdrawal (NOWS) in opioid exposed newborns. Poor sleep is used in the diagnosis of NOWS. Measurement of sleep state organization is also a biomarker of brain function and a predictor of long-term outcomes. The goals of this study are to: 1). improve the accuracy of the measurement of NOWS that will lead to a more accurate diagnosis as well as indicators for treatment initiation, 2) understand the relative effects of treatments for maternal opioid use disorders in pregnancy, and 3) understand the relative effects of NOWS treatment on brain development.
New Follow-up Clinic for Infants with Prenatal Opioid Exposure
The national epidemic in opioid exposed infants in the U.S. has shined the spotlight on services for these infants. Follow-up clinics for opioid exposed infants are rare and the long-term outcome of these infants is virtually unknown. At Women and Infants Hospital, the Brown Center for the Study of Children at Risk has established the Family Care Follow-up Clinic which provides services and evaluation of all infants with opiate exposure during pregnancy from hospital discharge into childhood. We serve graduates from the Family Care Unit at Women & Infants Hospital and infants born at other hospitals across the region. Our mission is to support optimal growth, development, and behavior for all children, and to provide support services for families, including individual and family therapy. Follow-up will include medical, developmental and psychosocial follow-up to monitor both concerns and responses to treatments. This clinic not only provides services for these patients but also enable us to study their development.
Revision of NICU Network Neurobehavioral Scale (NNNS-II)
Our ability to accurately assess and evaluate the neurobehavioral integrity of the newborn and young infant is of critical importance for research and clinical practice. It also has social policy implications because of the number of infants at risk born every year that need services. The NICU Network Neurobehavioral Scale (NNNS) was originally developed for the NIH as a research tool to measure the neurobehavior of high-risk newborn infants (e.g. infants with prenatal drug exposure and preterm infants). The NNNS has become the “go to” research exam for these infants and is increasingly being used clinically as part of standard care to help with the management and treatment of these infants before hospital discharge. With several hundred publications, an extensive database and a wealth of clinical experience we developed a revision of the NNNS, the NNNS-II. The NNNS-II continues to provide a comprehensive and integrated view of the infant’s neurological, behavioral and stress functions as well as a rich base for individualized clinical intervention that has implications for infant behavior and caretaking. The NNNS-II has a shorter administration time and improved psychometric properties. The empirical summary scales were refined and items were retained that statistically contributed to the sensitivity and specificity of the exam. You can find more information on the NNNS-II here.
Privacy for preemies: R.I. hospital at forefront of transforming neonatal intensive-care wards
Please read the news article on the Providence Journal on how our single-family room-neonatal intensive care unit and improved 18-month neurodevelopmental outcome have sparked the interest in other neonatal intensive-care wards across the country to follow the same model.
18-Month Follow-Up of Infants Cared for in a Single-Family Room Neonatal Intensive Care Unit
Please read our recent publication, "18-Month Follow-Up of Infants Cared for in a Single-Family Room Neonatal Intensive Care Unit," where we found that the single greatest contributor to long-term neurobehavioral development in preterm infants is maternal involvement— and that a single-family room NICU allows for the greatest and most immediate opportunities for maternal involvement resulting in improvements in neurodevelopmental outcomes at 18 months.
Dr. Lester and Dr. Czynski talk about the "Establishing Risk in Neonatal Abstinence Syndrome Study" on WPRI 12.
Learn more about the new program that focuses on the future of babies born with opioid dependence.
Please read the New York Times Magazine cover story for Mother's Day by Pulitzer Prize winning author Jennifer Egan on "Children of the Opioid Epidemic."
$4.9 Million ECHO Grant Award
Epigenetics at the Policy Level
Epigenetic Changes in Children
The Care New England's Psychiatry Research Division at Butler Hospital and its Autism Research Unit at Women and Infants Hospital have joined forces with the state's leading neuroscience research institutions to significantly advance the understanding and treatment of such brain-centered disorders and diseases as autism, epilepsy, stroke, Alzheimer's disease and traumatic brain injury. To read more about this promising collaboration, click on the PDF