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November 2001-Nine New Research Projects Funded in FY 2001

Nine new research applications reviewed by the MCHB Research Grants Review Committee in FY 2001 were recommended for approval and subsequently funded by MCHB. The first-year awards totaled $2,987,191. A short description of each of the nine new projects follows:

Improved Prenatal Down Syndrome Screening: PAIRED Testing. The current standard of care in the United States, the triple test (alpha fetoprotein [AFP], unconjugated estriol [uE3], and human chorionic gonadotrophin [hCG]), identi-fies 69 in every 1,000 women as being at high risk for having an infant with fetal Down syndrome. This demonstration project will develop, test, and validate an improved approach to serum screening for fetal Down syndrome. With this method, the best first- and second-trimester maternal serum biochemical markers are combined (PAIRED serum test) to identify women at sufficient risk in the second trimester to warrant amnio-centesis and karyotyping. If successful, the PAIRED test will provide a high-per-formance screening method that can be used in all types of primary care practices in rural and urban settings.
Principal Investigator: George J. Knight, Ph.D., Foundation for Blood Research, P.O. Box 190, 69 U.S. Route One, Scarborough, ME 04070-0190. Telephone: (207) 883-4131; e-mail: gknight@fbr.org.

PRWORA and Low-Income Women's Insurance and Prenatal Care Use. The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 has reduced welfare caseloads nation-wide. However, it may have also affected the financing of prenatal care and prenatal care use. This study proposes to use data from the Centers for Disease Control and Prevention's Pregnancy Risk Assessment Monitoring System from nine states for the years 1994 through 1999 to examine the impact of PRWORA on Medicaid and private insurance coverage as well as on the use of prenatal care by low-income women. Principal Investigator: Arden S. Handler, Dr.P.H., University of Illinois at Chicago, School of Public Health, 1603 West Taylor, Chicago, IL 60612. Telephone: (312) 996- 5954; e-mail: handler@uic.edu. Infant Functional Status and Discharge Management. Discharge algorithms for premature infants are controversial, in part because they determine the allocation of significant resources, in part because discharge decisions often place families and physicians at odds with insurers, and in part because of a lack of information about the relationship between infant physiologic status at discharge and subsequent resource use and outcomes. This study seeks to determine whether there are a range of discharge algorithms in which longer hospital stays may result in reduced overall resource use. Results from the study will ultimately provide important information relating physiologic status to outcomes and cost so that more rational discharge algorithms can be developed.
Principal Investigator: Jeffrey H. Silber, M.D., Ph.D., Children's Hospital of Philadelphia, Center for Outcomes Research, 3535 Market Street, Suite 1029, Philadelphia, PA 19104. Telephone: (215) 590-2540; e-mail: silberj@wharton.upenn.edu.

Growth and Development Longitudinal Follow-Up: Phase 2. Pediatric obesity is a serious public health problem that is increasing in prevalence, particularly among minority children from low-income families. The goals of this study are to prevent obesity rates from increasing by developing, implementing, and evaluating a health-promotion program that emphasizes diet and physical activity appropriate for low-income, urban, African-American adolescents ages 13 through 15. The study will (1) examine the ethnotheories of body size, diet, and physical activity and the opportunities to eat a healthy diet and engage in physical activity at home, in school, and in communities and (2) using gathered information, develop home-based intervention protocols. The study will employ a ran-domized controlled trial to implement and evaluate the health promotion interventions. Using longitudinal analytical strategies, the study will also examine changes in outcome measures in relation to genetic factors (e.g., parental weight and height) and environmental and psychological factors from constructs proposed by the underlying theories and ethnographic research. Principal Investigator: Maureen M. Black, Ph.D., University of Maryland School of Medicine, Department of Pediatrics, 655 W. Lombard Street, Room 311, Baltimore, MD 21201. Telephone: (410) 706-5289 or (410) 706-2136; e-mail: mblack@peds.umaryland.edu. Epidural and Intrapartum Fever: A Randomized Trial. While the association of epidural with fever has been reported in several studies, it remains controversial. This randomized trial will investigate the effects of epidural use on intraparturm temperature in low-risk women. Since epidural is such an integral part of practice, and since its benefits for pain relief are so clear, it is critical that the etiology, physiologic correlates, and clinical consequences of epidural-related fever be understood so that women can make informed decisions about pain relief. Findings may also suggest effective methods for prevention or treatment of epidural-related fever and its consequences.
Principal Investigator: Ellice Lieberman, M.D., Dr.P.H., Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115. Telephone: (617) 278-0700; e-mail: elieberman@partners.org.

Enhancing Breastfeeding Duration in Premature Infants. Preliminary findings suggest that the neonatal intensive care unit (NICU) environment exacerbates all problems associated with low breastfeeding rates among underprivileged groups. Research shows that peer counselors increase breastfeeding duration in a population of low-income full-term infants, but counselors have not been used in the NICU setting. This randomized clinical trial will determine whether peer counselors increase breastfeeding duration among low-income women with premature infants.
Principal Investigator: Barbara L. Philipp, M.D., Boston Medical Center Corporation, Boston University School of Medicine, Division of General Pediatrics, Maternity Building, Fourth Floor, 91 East Concord Street, Boston, MA 02118. Telephone: (617) 414-5202; e-mail: bobbi.philipp@ bmc.org.

Intergenerational Pathways to Competence in Minority Families. Data currently exist across the early childhood and elementary school years of the adults who participated in the randomized trials of two early childhood intervention projects, Abecedarian and CARE. The study's goal is to determine the extent to which early childhood intervention is associated with better adult adaptation for those individuals who participated in either of the two intervention projects. A second goal is to explore intergenerational effects in relation to children born to individuals who participated in the early intervention projects.
Principal Investigator: Frances A. Camp-bell, Ph.D., University of North Carolina at Chapel Hill, Frank Porter Graham Child Development Center, UNC-CH, CB #8180, 105 Smith Level Road, Chapel Hill, NC 27599-8180. Telephone: (919) 966-4529; e-mail: campbell@mail.fpg.unc. edu.

Prehospital Arrest Survival Evaluation: Pediatric PHASE. Information is needed to better define the causes, processes, and outcomes of pediatric resuscitation and to allow for the planning of interventions and for new research to improve the outcomes of pediatric resuscitation. This population-based, prospective, observational study aims to determine the incidence of interventions and complications, and the outcome of all children under age 18 years of age receiving resuscitation (assisted ventilation or cardiopulmonary rescuscitation [CPR]) in New York City by New York City Fire Emergency Medical Services personnel over a 12-month period. The project will add a large, prospective, population-based cohort study with "the Pediatric Utstein" uniform-data reporting style to the limit-ed literature on resuscitation of children (an area in which there is a great need for investigation) and will generate more hypotheses for further research.
Principal Investigator: George L. Foltin, M.D., New York University School of Medicine, 550 First Avenue, New York, NY 10016. Telephone: (212) 562-3161; e-mail: gf16@nyu.edu.

Early Detection of Autism: Comparison of Three Screening Instruments. Autism and other pervasive developmental disorders (PDDs) are severe disorders of development that often lead to lifelong disability. Early detection and intervention can substantially improve the prognosis for individuals with PDDs; however, with available screening instruments, early detection is difficult. Diagnosis and intervention often follow initial suspicion by 3 years or more. The proposed study involves the comparison of five parent-checklist screening instruments for 24- month-olds. The study should greatly advance the development of an effective early screening tool for autism and related PDDs. Planned future studies include replication in other states and cross-cultural comparisons in countries other than the United States (e.g., Japan).
Principal Investigator: Deborah A. Fein, Ph.D., University of Connecticut, Department of Psychology, Unit 1020, 406 Babbidge Road, New Haven, CT 06269-1020. Telephone: (860) 486-3518; e-mail: deborah.fein@uconn.edu.

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