Executive Director Letter July 2023
Hope on the Horizon: Six Trends Powering Child Health Research
For decades, child health research has received a fraction of the funding dedicated to adult research. The pervasive presumption was that children, being simply miniature adults, would benefit from a “trickle-down effect” of the research being done for adult diseases on adult populations. That presumption is unfounded and, frankly, dangerous.
Pediatricians and child health researchers understand and have advocated for children’s unique and specific healthcare needs. Our efforts have included a call-to-action to health research funding organizations, such as the National Institutes of Health, demanding equitable funding for pediatric-specific scientific research. As a result, we are increasingly able to develop tailored programs to advance important innovations in child health. This progress is encouraging, but we have only begun to close the gap in investing in child health.
As a society, we must prioritize spending to allow the scientific community to perform research to achieve optimal outcomes for children. Fortunately, pediatrics is replete with talented and well-positioned researchers innovating to solve our pediatric health challenges. With continued attention to funding and workforce development, I believe we are on the precipice of a groundbreaking period for child health research. As executive director of the Child Health Research Institute (CHRI) in Omaha, Neb., a partnership between Children’s Hospital & Medical Center and the University of Nebraska Medical Center’s Department of Pediatrics, I’m glad to share the six most exciting approaches that I think will significantly change health outcomes for children.
Looking at the Big Picture
Pediatric researchers are placing increased emphasis on the health patterns of populations as a whole. We know that climate, environment, diet and community impact our health and that children are very susceptible to these influences. Here at CHRI, investigators are looking at the association of heat and water exposures in relation to cancer and birth defects. We are evaluating how diet impacts pregnancy and neonatal outcomes and how a child’s address can leave them vulnerable to food deserts and insufficient food and transportation security. Others at CHRI are evaluating the impact of climate change and increasing temperatures on premature delivery. As a result of the COVID-19 pandemic, our investigators took on the challenge of understanding child health at a family, neighborhood, school and population level. Working with school districts, they were able to mobilize resources to families and community organizations through population, health-focused research platforms.
Going to the Source
As pediatric researchers gain a greater understanding of the origins of health problems, both scientifically and culturally, they develop research aimed toward prevention instead of treatment. I believe the next 20 years will be crucial in targeted prevention, helping children avoid health issues from before conception.
Whole exome sequencing, a technique for sequencing all of the protein-coding regions of genes in a genome, is an exciting tool, already helping clinicians with diagnosis on a daily basis. The next frontier of this innovation will be risk assessment and prevention. The addition of whole genome sequencing is close on the horizon, and we will need to develop even more expertise with big data processing to turn this personalized data into personalized and actionable information that can have meaningful impact. While there are serious questions that must be asked and answered with these tools, and assessing and mitigating risk as an iterative process is imperative, these advances will positively impact innumerable individuals before they have the first signs of illness. At CHRI, we are excited to have investigators who are on the leading edge of this research.
Reassess, Reassess, Reassess
Pediatric cancer is a great example of the trend to reevaluate previously established health solutions. Many treatments and medications successfully eradicate cancer in children only to cause health complications later in life. To combat this today, researchers at CHRI are developing targeted treatments and medications that will not only save the lives of children diagnosed with cancer but will also decrease short- and long-term side effects currently associated with many treatments. These advancements will result in decades of productive life for every childhood cancer survivor.
The Future is Here, and Collaboration is Essential
Children’s is equipped with some of the most advanced interventional pediatric neurosurgery equipment in the country. Surgeons are literally on the cutting edge of treatment and discovery for young patients with life-altering diagnoses. These same surgeons are working in our research labs, steadily pushing toward the next discovery for young children. Combined with advances from our oncologists, neonatologists and pediatric intensivists, our multidisciplinary research and care teams are removing boundaries and pushing treatments forward for pediatric brain and spine care with the expectation that our patients will have better outcomes with fewer complications because of our collaborative work.
Work Smarter, Faster and Bigger for True Impact
CHRI includes experts in biomedical informatics – the study of the organization and use of health information from large populations. Biomedical informatics empowers our scientists to use technology and data efficiently to get to solutions that clinical studies would take years to accumulate and that smaller studies may not be able to provide. With the ability to streamline data collection and analysis, while still ensuring ethical research practices, our investigators can ask and answer important questions about current delivery of care and the outcomes we achieve. This will lead to the rapid development of innovations impacting children in one to two years instead of a decade.
We must train a highly skilled workforce to unlock the power of massive amounts of data and translate it into the information that our clinicians, public health professionals and policymakers need to improve health outcomes for our children. An additional important consideration is how we harness artificial or augmented intelligence to enhance the speed and impact of our work in child health research while maintaining clear control surrounding the work in this arena.
What and Who are We Missing?
Performing quality child health research is only possible if we continue to examine how we can serve at-risk populations in a more comprehensive manner. Setting an expectation of community-engaged research is a critical step to employ if we want to maximize the impact of our research and study interventions that are meaningful and accepted by the target populations. Forming connections with a community early in the research process can help us understand child health problems from a different lens, allowing for more innovative hypotheses and study designs.
Importantly, meaningful engagement with minority populations, who we know bear a larger proportional burden of child health morbidity and mortality, can allow us to integrate diversity, equity and inclusion best practices into our research. This is not just an important trend in pediatric research, but I would put forth that it is an essential component of how we expend our research efforts and the limited dollars that are invested in child health research. Our field must come to terms with its historical research transgressions and the impact they have had on groups outside the majority population. We must build back the trust that was broken over decades if we are going to meaningfully serve and impact these important stakeholders and improve child health.
With the preceding six trends promising a brighter future for the health outcomes of children, there is no better time to be engaged with and supporting pediatric research, whether inside or outside the medical community. In my role steering CHRI, my guiding principle is that every expenditure of time, talent and treasure must matter because today’s children can’t wait for tomorrow’s innovations. Our impact is needed now.
Interested to learn more? The CHRI website is a great resource to learn about our life-changing work. Just this year, we introduced a Community Membership level for those outside the medical/research field who are interested in supporting and being part of the conversation around child health research. We’d love to have you engaged in child health through CHRI.