Developmental Impact of NICU Exposures (DINE) phase II

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Project Summary/Abstract The Environmental Influences on Child Health Outcomes (ECHO) program capitalizes on diverse pregnancy and pediatric cohorts to investigate the impact of a broad array of environmental influences on child health and development. Since 2016, the Developmental Impact of NICU Exposures (DINE) study has significant contribution of the to the ECHO mandate is a large, exquisitely phenotyped preterm birth cohort - a unique and sensitive population with a demonstrated large burden of adverse health outcomes. The DINE cohort readily combines rich existing clinical and research datasets and biospecimen repositories, existing infrastructure for long-term follow up and assessments of multiple ECHO exposure and outcome specialization areas, and a novel exposure and outcome profile that will continue high-yield contribution to ECHO program scientific goals. In this second phase of the ECHO program, we will continue to focus on the scientific premise that early life physical and chemical exposures, notably phthalates and air pollution, have long-lasting harmful effects on child health and development, and that these harmful effects are magnified in children born preterm. DINE contributes a unique and critically important population to ECHO in that preterm infants face significant dermal, inhalational and intravenous exposures to phthalates, ubiquitous organic endocrine disrupting chemicals, while hospitalized the neonatal intensive care unit (NICU). Premature infants experience a high prevalence of the adverse health effects that are associated with early life exposure to phthalates in term-born children, particularly abnormalities of pulmonary function. The contribution of environmental influences on adverse outcomes of preterm children is poorly understood. One additional central tenet of our work is that preterm infants can be studied to identify exposure-outcome links that may be more subtle in the general population. Large clinical studies like ECHO that enroll participants born over the entire preterm-to-term continuum allow rigorously study of this premise. Through the next phase of the ECHO program, we pursue the following Specific Aims in DINE: Aim 1. Leverage ECHO Cohort Protocol core data elements to compare exposure-outcome relationships in preterm compared to term populations. Aim 2. Leverage specialized data elements to address critical questions about the impact of early life chemical exposures on pulmonary development in a sensitive population, preterm infants. Aim 3. Implement procedures to maximize retention of existing participants with an emphasis on maintaining cohort diversity and protocol fidelity. Continued involvement of preterm infants in ECHO is critical not only to our cohort’s scientific imperatives, but also to the entire ECHO program as preterm infants constitute more than 10% of the United States population.