• ​Upwards of one-third of infants born <30 weeks postmenstrual age suffer long term neurodevelopmental deficits.
  
• The prevalence rate of Autism Spectrum Disorders (ASDs) is approximately 5 times higher in these infants than in the general population
  
• Neurodevelopmental impairments are not the only health consequences in these children
  

We are working with Dr. Barry Lester and his team at the Brown Center for the Study of Children at Risk and their cohort of infants born <30 weeks of postmenstrual age, the Neonatal Neurobehavior and Outcomes in Very Preterm Infants (NOVI) study, to discern which of these infants are most likely to become developmentally impaired. We are taking a personalized medicine approach and attempting to integrate information from a medical risk score, a neurobehavioral risk assessment during the newborn period (the NICU Network Neurobehavioral Scales, NNNS) and the profiling of DNA methylation in accessible samples taken at multiple ages starting in the newborn period and through age 7.​

We will follow these children and determine potential mechanisms that lead to developmental outcomes. Our hypothesis is that environmental exposures, behavioral, genetic variation and epigenetic factors are required to understand the mechanisms involved. We plan to determine how prenatal, perinatal and postnatal environmental exposures (e.g., physical, demographic, maternal psychological, medical, chemical), DNA methylation, and infant neurobehavior at NICU discharge) will be related to child measures of attention, cognition, emotion, social, language, behavioral and motor development at ages 5, 6, and 7 and ASD diagnosis. We expect genetic variation to modify the effects of environmental exposures on these child outcomes and plan to develop an algorithm to identify which individual infants will be developmentally impaired at ages 5-7. Uniquely, we also plan to determine the trajectories of DNA methylation and neurodevelopmental measures to determine how neurodevelopmental trajectories “track” the trajectory of DNA methylation and determine how these trajectories are modified by environmental exposures and genetic variation.

This cohort is part of the NIH Environmental influences on Child Health Outcomes (ECHO) program. ECHO is supporting multiple, synergistic, longitudinal cohorts of children at various ages in order to address how the environment, taken broadly, impacts children’s health, including pregnancy and newborn health, upper and lower airway disease, obesity, neurodevelopment, and overall wellness. NOVI provides a unique opportunity to examine a highly susceptible, and growing, population of children, those born preterm, to understand the unique vulnerabilities these children face.  Our work will contribute to improved understanding of how the environment programs long term health outcomes in these children and can provide opportunities for early identification of those most at-risk, in order to intercede when interventional efforts can be most valuable.