LAUSR

This issue of Pediatric Research highlights the importance of pediatric research in optimizing health in childhood and setting the foundation for health into adulthood. Three articles demonstrate life course and intergenerational influences starting early. Two of these focus on preterm infants and later outcomes. Globally, preterm birth rates have increased in the past two decades and make up one in ten births in the US. Woodward et al. explore the visuospatial working memory of children who were born very preterm and/or very low birth weight in two prospective cohort studies. They found that both children and adults had difficulties that appear to persist into adulthood, continuing to impact everyday functioning, educational and occupational/socioeconomic achievement. Camerota et al. identified four discrete neurodevelopmental profiles of infants born <30 weeks of gestation at 2 years of age that could facilitate the development of targeted intervention strategies for high-risk children. Finally, in a multi-center cohort of infants born extremely preterm, Jackson et al. found differential placental methylation within genes involved in fetal lung development that likely reflects signaling between the placenta and fetus mediating later health outcomes. Growing research demonstrates that there are developmental origins of health and disease and intergenerational transmission of disadvantage. In summary, these and other studies confirm that maternal and child health research is critical to life course health. While it is often stated that children are not simply “little adults,” these studies strongly suggest that to prevent disease in childhood and adulthood, research on mechanisms and early antecedents requires prioritizing pediatric research. Structurally, pediatric research is often at a disadvantage. Because of the proportion of children to adults, pediatric departments within universities are usually smaller than internal medicine departments serving adults. Requests for proposals that allow one applicant per institution often result in little attention to pediatric issues. Free-standing children’s hospitals may be excluded from federal requests for proposals that allow eligibility only for institutions of higher education. In addition, funding of pediatric care increasingly relies on Medicaid and the Children’s Health Insurance Program that are siloed by state and have low payment rates that strain health care system investment in pediatric research. From a biopharma standpoint, the size of pediatric markets, most of which entail rare disease diagnoses and are perceived to entail increased liability risks, makes research and development investments less appealing. In addition, the pipeline of pediatric researchers is endangered by inadequate recruitment, funding limitations and attrition. While these are challenges for all physician researchers, pediatrician investigators have been disproportionately affected. Diversity in the research pipeline, including women and those underrepresented in medicine, is also sorely lacking. What are some legislative policy solutions to support pediatric research? We focus on three federal legislative initiatives, the PACT Act, Pediatric subspecialty loan repayment, and National Institutes of Health (NIH) Inclusion of Children in Research.