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.
We are pleased to announce the appointment of Dr. David Savitz as Associate Director of the Brown Center for the Study of Children at Risk and the Center for Children and Families, Brown Alpert Medical School and Women and Infants Hospital. Dr. Savitz is Professor of Epidemiology, Professor of Obstetrics and Gynecology and Professor of Pediatrics. Dr. Savitz will provide leadership for research in perinatal epidemiology and share responsibility for overseeing the administration, programs and strategic plan of the Centers.
Dr. Levine was mentioned in the story "After Other Options Fail, A Family Tries Medical Marijuana For Son With Autism" in the National Public Radio.
Breastfeeding Changes Gene Activity That May Make Babies Less Reactive To Stress
Please read Dr. Lester and his colleagues' recent publicantion, "Epigenetic Programming by Maternal Behavior in the Human Infant." They looked at more than 40 full-term, healthy infants and their mothers, one-half of whom breastfed for the first five months and one-half of whom did not. They measured the cortisol stress reactivity in infant saliva using a mother-infant interaction procedure and the DNA methylation (changing the activity of the DNA segment without changing its sequence) of an important regulatory region of the glucocorticoid receptor gene which regulates development, metabolism, and immune response. According to Dr. Lester, "Breastfeeding was associated with decreased DNA methylation and decreased cortisol reactivity in the infants. In other words, there was an epigenetic change in the babies who were breastfed, resulting in reduced stress than those who were not breastfed."
Margaret Jordan, Health and Human Biology. Sponsor: Cynthia Miller-Loncar, PhD Pediatrics & Psychiatry & Human Behavior. "Early Infant Regulatory Problems, Maternal Depression and Later Socioemotional Outcomes."
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."
Study of kids with autism identifies hospitalization risk factors
Children or teens with autism spectrum disorders often come to hospitals when behavioral episodes overwhelm the support that caregivers can provide at home — but resources at hospitals are sometimes limited, too, says clinical psychologist and researcher Giulia Righi. With that reality in mind, Righi led a new study to identify which factors put young people with autism at especially high risk of seeking inpatient psychiatric care. Read about the study of kids with autism identifies hospitalization risk factors.
$4.9 Million ECHO Grant Award
Read the Redbook's article on Dr. Hawes's Social Emotional Factors Increase Risk of Postpartum Depression in Mothers of Preterm Infants publication.
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.
10th Anniversary Celebration
From Mark Marcantano, President and COO, Women and Infants Hospital:
Exactly 10 years ago today, a large group of dignitaries, staff, physicians and other representatives from Women & Infants Hospital and Brown University gathered together at 50 Holden Street to celebrate the official opening of the Brown Center for the Study of Children at Risk. At that time, the Center boasted nearly $18 million in federal funding to study a myriad of behavior and development issues that face children, including such issues as infant drug exposure, autism, developmental delays, colic and crying.
The past decade at the Brown Center has seen growth and continued excellence in coordinated research, training, education and clinical services in child and family development, including the introduction of the Center for Children and Families to provide clinical services to complement the research being done at the Brown Center.
Under the direction of Dr. Barry Lester at the Brown Center, the multidisciplinary research team of psychologists, pediatricians, psychiatrists, nurses, occupational therapists, social workers, and substance abuse and public health specialists, come together each and every day to broaden our understanding of the influence of biological and social factors to best support the care of newborns, children and their families.
The Center for Children and Families, under the leadership of Dr. Cindy Loncar, provides exceptional inpatient and outpatient clinical care at Women & Infants. Inpatient services include the Occupational Therapy Consult Service, the Neonatal Intensive Care Unit (NICU) Family Psychosocial Health Service, and the NICU Network Neurobehavioral Scale (NNNS) Service. Outpatient services encompass the areas of infancy/early childhood assessment and treatment as well as child and family therapy. The Center for Children and Families has one-of-a-kind clinical services for infants with crying, colic, sleep and feeding concerns.
The Center is also well-regarded as a state and regional leader for comprehensive outpatient services for children with autism with RI-CART (Rhode Island Consortium for Autism Research and Treatment) affiliated staff.
Please join me in congratulating Drs. Lester and Loncar and all of the staff at the Brown Center for the Study of Children at Risk and the Center for Children and Families on being true vanguards in caring for the families of our community through research and clinical practice.
Please sign up at EpigenomicsNet to watch Dr. Lester's interview on the "Role of epigenetics in neurodevelopment and neurobehavior insights on the in utero environment and DNA methylation."
Dr. Stephen Sheinkopf has been awarded a $1,528,896 grant from the Simons Foundation entitled "The Rhode Island Consortium for Autism Research and Treatment (RI-CART) - Phase II." Read about it in the Providence Journal.
Dr. Lester talks about babies with Neonatal Abstinence Syndrome (NAS) for WPRI 12.
Learn more about the number of drug-dependent babies in Rhode Island.
Epigenetics at the Policy Level
Dr. Barry Lester was interviewed by Daniel Keating of the Child and Family Blog and featured in their blog. The interviewed discussed how parenthood policies could prevent early stress from causing epigenetic changes in children. To read this interview visit the Child and Family Blog or view this PDF.
Update On White House Briefing at the ONDCP
On November 25, 2015, President Obama signed bipartisan legislation:
"The Protecting Our Infants Act of 2015"
This law will help identify evidence-based approaches to care for infants with Neonatal Abstinence Syndrome (NAS) and their mothers. In addition, this law requires the Department of Health and Human Services to conduct a study and develop recommendations for preventing and treating prenatal opioid use disorders and NAS throughout the United States. The Centers for Disease Control and Prevention will also continue to assist states in improving the availability and quality of data collection related to NAS, and encourage public health measures aimed at decreasing its prevalence. Read more about the The Protecting Our Infants Act. PDF of bill
White House Briefing at the Office of National Drug Control Policy (ONDCP)
On October, 22 2015, Dr. Barry Lester and Dr. Jonathan Davis (Tufts University) presented a White House Briefing for Michael Botticelli, Director of the Office of National Controlled Drug Policy about use and abuse of prescription pain medication (opioids) during pregnancy and the acute opioid withdrawal syndrome (NAS or Neonatal Abstinence Syndrome) suffered by the newborn infant. To read more about this briefing, click on the PDF
Dr. Barry Lester, Dr. Elizabeth Conradt and Dr. Carmen Marsit were Guest Editors of a Special Section of the journal Child Development (volume 87, Issue 1, January/February, 2016) entitled: Epigenetics, Child Behavior and Development: Unraveling the Gene-Environment Interaction.
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
Dr. Amy Salisbury published an article on the American Journal of Psychiatry (Am J Psychiatry 173:2, February 2016) entitled "The Roles of Maternal Depression, Serotonin Reuptake Inhibitor Treatment, and Concomitant Benzodiazepine Use on Infant Neurobehavioral Functioning Over the First Postnatal Month." The article was on the cover of the Journal and was accompanied by an editorial.
Dr. Amy Salisbury was interviewed by Psychiatry Weekly on her study, "Newborn Infant Behaviors Following In Utero Exposure to SSRIs and Maternal Depression." To read this interview, click on the PDF
Dr. Jean Twomey was elected vice president of the Rhode Island Association for Infant Mental Health in October, 2015. She has also served on the Rhode Island Association for Infant Mental Health Board of Directors since February 2009.
Dr. Elisabeth Conradt has been awarded the Society for Research in Child Development's 2015 Victoria S. Levin Award for Early Career Success in Young Children's Mental Health Research for her research on targeting epigenetic processes in prenatal programming research to support healthy newborns.
Dr. Amy Salisbury’s recent study, “The roles of maternal depression, serotonin reuptake inhibitor treatment, and concomitant benzodiazepine use on infant neurobehavioral functioning over the first postnatal month," has been cited in the Care New England’s newsletter. To read this article, click on the PDF
Dr. Stephen Sheinkopf has been awarded a grant from Simons Foundation on "Biomarkers of Emotion Regulation, Social Response & Social Attention in ASD."
Dr. Katheleen Hawes' study, "Neuroendocrine Correlates of Empathy and Stress Reactivity in Registered Nurses," has been cited in the University of Rhode Island's newsletter, Momentum: Research & Innovation (page 26). To read this article, click on the PDF
Dr. Amy Salisbury has been appointed as a member of the Child Psychopathology and Developmental Disabilities (CPDD) Study Section at the National Institutes of Health (NIH).
Rosemarie Bigsby Honored for Contributions to Neonatal Care
Dr. Rosemarie Bigsby, ScD, OTR/L, FAOTA, has been elected as a recipient of the National Association of Neonatal Therapists (NANT) for the inaugural Pioneer Award for Neonatal Therapy. Bigsby is a clinical professor of pediatrics, psychiatry and human behavior at The Warren Alpert Medical School of Brown University and coordinator of neonatal intensive care unit (NICU) services at the Brown Center for the Study of Children at Risk/Center for Children and Families of Women & Infants Hospital of Rhode Island, a Care New England hospital. Bigsby was honored with the award at the 5th Annual NANT Conference this month in Phoenix, AZ.