When children are sick, clinicians can consult a known standard for how their heart, lungs and kidneys should be growing and working. But no such rubric exists for something as complex as brain development. As part of a nationwide consortium, the HEALthy Brain and Child Development Study (HBCD) is set to provide a comprehensive picture of healthy development. This longitudinal study of infants and children, unprecedented in scope and in aim, will provide information that will impact medical care for decades to come.
A child's environment can affect his or her brain development in countless ways, even before birth. From medications and drug use by a pregnant mother to nutrition and environmental toxins, babies are exposed to thousands of influences. These variables have made it difficult for clinicians to establish what normal variability in brain development should look like-;until now.
Three principal investigators at Children's Hospital Los Angeles have been awarded funding from the National Institutes of Health to help lead the HBCD study, which spans 25 institutions across the United States. The study will follow approximately 7,500 pregnant women and their infants, and investigators will collect a wealth of information including: brain images and activity data, wearable sensor data to monitor infant movement development, developmental assessments, and biological samples. Children will be followed before birth and through the first several years of life. The participants will span a variety of regions and demographics, ensuring the model of healthy development will be representative of children across the country.
Pat Levitt, PhD, Chief Scientific Officer at CHLA, will serve as Associate Director of the national study, overseeing the efforts of all institutions involved. He will also lead the portion of the study measuring biochemical factors that are informative about child development, such as markers of stress.
"We know that the environment can impact neurodevelopment in many ways," says Dr. Levitt, who is also the Simms/Mann Chair in Developmental Neurogenetics at CHLA. "These studies will help define the factors that pose the greatest risk, and those that build resilience for children and their families when confronted with challenges."
Children's Hospital Los Angeles is uniquely suited to help lead efforts to better understand the developing brain. One of the hospital's new research themes-;Best Starts to Life-;focuses the talents and expertise of dozens of researchers working toward a better understanding of infant and childhood development.
Within this theme, Jessica L. Wisnowski, PhD, investigates new MRI methods and techniques to better assess brain injury in infants. As one of CHLA's principal investigators in the HBCD study, she will play a leadership role in the consortium's MRI work groups, overseeing the planning, execution and analysis of MR spectroscopy data in infants and young children.
"This is a groundbreaking study-;in scale, in scope and in ambition of what we will be able to measure," says Dr. Wisnowski. She adds that the data gathered will be referenced by the research community and impact clinical practice for years to come.
Indeed, the HBCD study stems from a clinical need to better understand healthy brain development. But research also feeds into shaping clinical care.
Being at CHLA, we are well-positioned to not only have a voice in the design and execution of the study, but also to really take this information and use it as an institution to better understand the needs and outcomes of our families."
Dr. Jessica L. Wisnowski, PhD
To truly understand how the brain develops, CHLA investigators also look beyond the organ itself to study how it co-develops with major systems of the body. Beth A. Smith, DPT, PhD, studies infant movement behavior. Through the use of wearable sensors and other technologies, her research aims to capture how motor, cognitive and social development interact as infants learn and grow. As a principal investigator in the HBCD study, she will lead efforts to measure and describe development of infant behavior and movement.
That these three investigators are assuming important roles in the HBCD study is no coincidence. The team has been working together for several years. Dr. Smith explains that their individual research interests are like circles in a Venn diagram. "Part of the beauty of this group-;Dr. Levitt, Dr. Wisnowski and myself-;is that we have overlapping interests and experience, but also unique expertise," she says. "I think this is important and prepares us to be successful." Indeed, she adds, no one person can have expertise in all areas. "But together, and with a remarkable group of co-investigators," she says, "we bring the strength of shared research goals and the diversity of our specific research experience."
He went in for a colonoscopy. The hospital charged $19,000 for two.