Perinatal and Pediatric Division
The mission of the Perinatal and Pediatric Research is to conduct epidemiologic research on causes of neurodevelopmental conditions of early childhood and on prenatal and perinatal risks to the developing fetus and infant that may affect later health. Core members of the division are investigating a diverse range of topics related to this theme within the broader topic of maternal and child health, including cognitive development in children, causes and consequences of preterm birth, inherited neurodevelopmental conditions, and aspects of the HIV/AIDS epidemic related to pregnancy and children. The division strives to be at the interface between science uncovering molecular foundations of disease and translation to effective interventions.
Ongoing work in Duchenne muscular dystrophy (DMD) provides a translational model of molecular influences on cognition. Detailed neuropsychological assessments of children with DMD, a single-gene disorder, have shown selective cognitive deficits related to the absence of a single protein during brain development. Children with DMD have difficulty mastering the phonetic basis of reading and present similarly to children with developmental dyslexia. Unlike most cases of dyslexia, however, the genetic basis of their learning disabilities is established. Thus, the work provides a model for study of the neural basis of this common and serious developmental disorder.
The division supports a number of studies in low resource settings in sub-Saharan Africa related to mother-to-child transmission of HIV. The primary focus of these studies is transmission of HIV to the child, but new findings suggest that a mother being HIV-positive may have other serious adverse consequences for newborns. It was observed that infants who escape HIV-infection despite their mothers being HIV-positive were more likely to die during the neonatal period, to be hospitalized, and to have poor growth during infancy if their mothers had more advanced HIV disease. This vulnerability was not explained by low birth weight or by maternal death. Rather, an excess of these two additional risks compounded their vulnerability to poor outcomes. These results draw our attention to a neglected and growing population of children who, although not infected with HIV, are affected by their mother's HIV status—not only socially, but also biologically. These results offer a window to expand scientific understanding of the impact of intrauterine viral infections on the developing human, as well as raising immediate public health challenges to develop and test interventions to complement existing programs to ameliorate these risks.