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To view previously submitted comments that cut across multiple scientific Vision themes or that relate to the Vision process overall, please see below.


Created on February 28, 2011



24 Submitted Comments on General Vision Comments

 


 

I feel Dr Alan Guttmacher's talk at Children's National Medical Center today (April 15th, 2011) on the vision of NICHD helped replace a burgeoning sense of frustration with an inkling of hope. So thank you for that, Dr Guttmacher. My comment lies in the area of improvement in mentoring/training of young investigators, which is one of the targets in NICHD?s vision and white paper. I would like to draw your attention to this grass-root need in the scientific community, without which all the visions for the next decade that NICHD purports to address and achieve will most definitely fall short of fruition. We must make good mentorship of young scientists a priority in our research goals. It is just as important as addressing the needs of the research regulatory boards, writing grants, publishing your data and dreaming up the visions and policies that will push the frontiers of science. I urge you to implement and not merely strategize the need for good mentoring of young investigators ? and by that I mean the entire spectrum from graduate students, the invisible population of postdoctoral researchers and scientific faculty. Inter-disciplinary science ? the beacon of the future - requires a harmonization of multiple mentorship. Tools and platforms must be developed for this goal to be realized. As for now, I must inform you that my experience shows me that mentoring a budding scientist takes a back-seat on most scientific discussion panels and in the scientific life. We must call for enhanced participation and creative improvisation in the art of mentoring and reward it when it is well done. If neglected, this may be the death knell for many individual lives in science and the promise of truly good science and scientists.


Submitted by Anjali Sarkar on April 15, 2011 at 2:47 PM


I would like to see more attention paid to measurements and the development of innovative sensor technology. Many critical physiological parameters require monitoring and approaches used for adults are not suitable for infants. For example, arterial blood gases are much harder to measure in neonates than in adults.It would be great to see more engineers connecting with clinicians to come up with innovations to serve unmet needs.


Submitted by Govind Rao on May 17, 2011 at 1:02 PM


The maternal brain, via both cognitive processes and neuroendocrine regulation, is a crucial interface between the mother's external environment and her offspring. Yet the maternal brain is conspicuously absent from the Visioning white papers.

In utero, a mother's decisions with respect to diet, physical activity and substance use are key determinants of fetal exposures. Moreover, neuroendocrine mechanisms governing stress reactivity and autonomic regulation impact such critical mechanisms as uterine blood flow and fetal cortisol exposure. After birth, the maternal brain remains a key mediator of infant development, through the effects of stress, anxiety and mood on breastfeeding, mother-infant interaction and attachment. Behavioral constructs such as maternal self-efficacy impact breastfeeding and postpartum weight retention. Secure infant attachment, which reflects the integrated effects of maternal and infant behavioral co-regulation during the first year of life, is a major predictor of long-term behavioral health, and has also been implicated in chronic disease outcomes such as child obesity.

As demonstrated by functional hypothalamic amenorrhea, a mismatch between environmental stressors and neuroendocrine modulation can profoundly affect reproductive function. Further research is needed to measure biological correlates of stress reactivity during pregnancy, such as maternal neuroendocrine profile during standardized stressors, in order to unravel individual vulnerabilities that may mediate associations between stressors and adverse outcomes. In the postpartum period, studies should consider biological mechanisms that drive maternal behavior, including fluctuations in oxytocin, prolactin, neurosteroids, and HPA axis reactivity. Such studies may identify novel targets for intervention to improve mother-infant co-regulation and reduce child neglect.

Many of the exposures implicated in DOHaD are ultimately functions of maternal behavior. If we plan to address obesity, gestational weight gain and substance use, we need to understand how to enable mothers to make lasting changes in health behavior. While work from non-pregnant populations is partially applicable, issues specific to pregnancy and early postpartum, including both motivation to change behavior "for the baby" and issues of autonomy, guilt and coercion, are unique to the perinatal period. I therefore urge the NICHD to include the maternal brain in its vision for the coming decade.


Submitted by Alison Stuebe on May 23, 2011 at 11:40 AM


In reviewing these whites papers, there is surprisingly little attention paid to infectious diseases among children and pregnant women which are groups that are disproportionately affected by infectious disease and accounts for the majority of morbidity and mortality in these groups in resource limited settings. A greater focus in this area is needed.


Submitted by Brooks Jackson on May 24, 2011 at 1:31 PM


There is no discussion in the white papers about bone development, or childhood and adolescence as key developmental periods for bone accretion. There is also no mention of the striking accomplishments of the Bone Mineral Density in Childhood Study (BMDCS), an NICHD-funded multi-site initiative, data from which represent important contributions to the pediatric bone health. Osteoporosis is considered by many to be a "pediatric disease" because of the opportunity for prevention during the childhood and teenage years. Therefore, it would seem that NICHD would want to embrace this topic as an extremely important one for new discoveries and therapeutic developments.


Submitted by Catherine Gordon on May 29, 2011 at 8:21 AM


There is an extreme lack of focus on major infectious diseases such as HIV and tuberculosis - diagnostic, therapeutic, prevention, pathogenesis. These conditions have important behavioral components as well. NICHD has an important role as an advocate for women and children globally. The major themes all have relevance to HIV and TB. For example - in plasticity theme; can one recover from HIV-related encephalopathy or after TB meningitis? Environment - how does poverty relate to infectious diseases and how can one intervene in a pragmatic way?


Submitted by Mark Cotton on June 1, 2011 at 2:53 PM


There is a notable lack of discussion of the skeleton - either its importance in achieveing optimal growth and development or the growing recognition of bone as an endocrine organ that contributes to metabolism and thus plays a role in development of adult diseases. Just one example is that osteoporosis is best prevented by achievement of peak genetic potential bone mass during childhood and young adulthood, yet I see no mention of optimizing this process for normal children nor of the effects that disease during childhood have on this process. Certainly a focus on the health of the skeleton and its role in the areas of interest to NICHD is warranted.


Submitted by Kimberley Dilley on June 3, 2011 at 3:02 PM


The topic of prevention of children infectious diseases is underrepresented in the Vision. Millions of children lives can continue to be saved by ensuring access to vaccines, and by developing new vaccines. But vaccines are mentioned only briefly in two separate places in the NICHD Vision: Diagnostics and Therapeutics and Environment. There is no follow up discussion on vaccines in either of these documents, or in any other place. The challenges in this area include: Enteric diseases. Each year, diarrhea causes more than 1.7 million deaths in children under 5, those who survive often have other health problems and reduced cognitive development, potentially causing lifelong impairment. Respiratory diseases. There are now vaccines available to for the major causes of bacterial pneumonia, however, some of them have significant shortcomings, i.e. only reduce the occurrence of some forms of pneumonia. Others need to be improved to eradicate the disease. There is an urgent need for new vaccines against viral respiratory infections, like RSV. Malaria. Most cases occur in young children. Efforts should be made to discover and test malaria vaccines that prevent infection and reduce the risk of serious complications and death. Other. Tuberculosis continues to pose one of the world's most urgent health challenges. There are no vaccines against infections caused by streptococcus groups A and B, otitis caused by non-typable H. influenza,gonococci, schistosomiasis, Lyme disease, other viral and neglected diseases. Finally, the connection between infection and cancer is a very important to investigate during the coming years, as exemplified by HPV. Within NICHD, PDMI possesses an advanced research platform to move vaccine program forward. The contributions of the PDMI include the introduction of the conjugate vaccines concept and development of vaccines for H. influenzae type b, pneumococci, typhoid and others, which have yet to achieve their potential. For the 21st century, the visionary program of the PDMI includes the introduction of vaccines for diarrheal diseases and malaria. Promising results have been achieved for Lyme Disease, tuberculosis, new vaccine for pertussis and for H. influenzae type a to be added to type b. In the era of growing antibiotic resistance, prevention of infections by vaccination is a more valid approach, and should be better addressed and supported in the Vision as a separate or a major topic within the existing Vision Themes.


Submitted by Joanna Kubler-Kielb on June 7, 2011 at 3:15 PM


Cross-Cutting Issue: Bioethics

Five of the nine Visioning White Papers mentioned frustrations with regulations governing human subject research and with IRB reviews. These White Papers called for regulatory reform, elimination of "redundant or conflicting regulations," [Plasticity White Paper], "better training of IRB members," and development by the NICHD of "standard HIC [Human Investigation Committee] protocols so IRB approval can be identical across institutions" [Development White Paper].

In other White Papers, IRBs were portrayed as "adversaries" [Developmental Origins White Paper] that "impede" [Behavior White Paper] and "hamper progress and collaboration" [Developmental Origins White Paper]. The Developmental Origins White Paper also noted," investigators may be stymied by IRBs that invoke interpretations of the regulations by the OHRP as obstacles above and beyond regulatory intent." This White Paper also noted, "some IRBs...foster a paternalistic atmosphere" by incorrectly requiring "paternal consent in studies that do not require it."

IRB decisions were mentioned as being inconsistent and possibly unethical, e.g., when disapproving research on pregnant women deemed necessary by the investigators: "What are the ethics of a 'no' to at-risk women and children from an IRB?" [Diagnostics and Therapeutics White Paper]. This White Paper called for the development of treatments specifically for pregnant mothers and fetuses, which would "require new methods of training for IRB members."

In view of the fact that participants in five of the Visioning Workshops raised questions about federal regulations governing human subjects research and about idiosyncratic or uninformed IRB decisions, it would seem reasonable as a first step to convene a workshop devoted to developing a data base with robust numerators and denominators that would rise above the level of anecdote and would permit an unbiased assessment of the magnitude of the problem. It is important to ascertain if these comments reflect the view of most clinical investigators or just a small number of aggrieved individuals.


Submitted by Gilman Grave on June 8, 2011 at 10:03 AM


(Cross-Cutting Issue: Bioethics, continued)

A subsequent workshop could be structured around a dialogue that the Plasticity White Paper calls for: "Representatives of federal research, regulatory, and healthcare funding agencies should enter into a dialogue to review and evaluate the impact of their respective regulations and policies on the process of scientific discovery and translation to clinical practice."

It is difficult, but not totally impossible, to alter the rules and regulations governing human subject research; for example Zeke Emmanuel, Head of the Department of Bioethics at the NIH Clinical Center, is leading an initiative to off-load responsibility for maintaining confidentiality from IRBs to IT Departments, and to dispense with full IRB annual reviews of protocols involving no more than minimal risk. However, this initiative is still a work in progress and may take months or years to activate. It is doubtful that Subparts B and D of the 45CFR46 will be changed during our lifetimes, or ever, since the special protections they offer pregnant women, neonates, infants, children, and adolescents are seen as helpful by most and inspired by some.

Dave Wendler from the NIH Clinical Center and Jerry Menikoff, head of the OHRP, would probably agree to help organize these workshops.

Submitted by Gilman Grave, Chair, NICHD IRB)


Submitted by Gilman Grave on June 8, 2011 at 10:05 AM


Upon review of the NICHD Vision White Papers, we were disappointed to find they do not specifically address priorities for research in pelvic floor disorders (PFDs).
PFDs are highly prevalent and a major source of morbidity for adult women. As noted by NICHD, "as many as 10 percent of women ... will undergo a major surgical procedure to correct urinary incontinence or pelvic prolapse... As the population in the United States ages... these disorders will also increase" (NICHD CRH website, 2006).
Scientific discovery in this area is critical to the NICHD mission of insuring that women suffer no harmful effects from reproductive processes. Over the past decade, research supported by HD-99-003, HD-00-012, and HD-08-008 has led to new discoveries, described in 180 scientific publications. Also, NICHD support for the Pelvic Floor Disorders Network has advanced patient care. Despite these successes, there are many unanswered questions in this field.
In 2010, our Society convened 150 scientists to address pressing PFD research challenges. Priorities identified include:
-Expand research in pathophysiology / phenotyping
-Develop a centralized tissue bank
-Prioritize safety before efficacy in the introduction of new therapies
-Comparative effectiveness studies
-Standardize outcome measures
-Study health implementations and health behavior changes
-Evaluate cost effectiveness of treatment methods
-Support for partnerships between clinician scientists and basic/ translational scientists to maximize the bi-directional flow of research
The full text of the recommendations is available at www.augs.org/researchsummit.
The importance of continued support for PFD research cannot be overestimated. As noted by the NICHD (2008): "The number of investigator-initiated applications on PFD research has increased since 1999. However, the number is not yet high enough to maintain a self-sustaining community of researchers ... stimulation of new applications is still necessary to support and encourage research in this early phase of maturation of the research community." Ongoing support will be critical to maintain the progress gained over the past decade.
PFDs represent a substantial public health burden to women. NICHD support of PFD research has been pivotal in gains made in understanding the epidemiology, pathophysiology and treatment of these disorders. We urge the NICHD to consider inclusion of PFD research in NICHD's vision for future research.


Submitted by Board of Directors American Urogynecologic Society on June 10, 2011 at 10:29 AM


Because of the NICHD's focus on development over time and on assessing the influence of environmental factors on development, it is important to maintain longitudinal cohort studies, especially multigenerational cohort studies, into the future. The Fels Longitudinal Study, the Child Health and Development Studies, and the Guatemala Study all include information on three generations, and a fourth generation is being enrolled in the Fels Study. All of these studies continue to generate interesting and important information about environmental influences on development and environmental origins of disease as well as gene-environmental interactions. New statistical genetic techniques and multilevel hierarchical modeling can be applied to these longitudinal databases to reveal associations and causal pathways that may surprise and inform, for instance, the development of schizophrenia in offspring of mothers exposed to influenza types A and B in the first trimester, and the development of schizophrenia in offspring of mothers with high titers of inflammatory cytokines. These major longitudinal studies can also inform the observational protocols of the NCS as it moves forward.


Submitted by Gilman Grave on June 10, 2011 at 12:47 PM


Opportunities for Translational Science in Pediatric Critical Care Research:
The recent Critical Illness Immune Suppression Prevention (CRISIS) trial conducted in the CPCCRN sought to test a nutritional and pharmacologic strategy to prevent hospital-acquired (nosocomial) infection and sepsis in critically ill and injured children. Agents were chosen that are known to stabilize prolactin levels (metaclopramide) and provide support for lymphocyte populations (Zinc, Selenium, Glutamine). CDC definitions of nosocomial sepsis and infection were used as outcome measures. The trial was stopped for futility after 300 children were enrolled and randomized. Nevertheless, there was a trend toward positive effect in immunosuppressed children. Investigation of the strategy in a trial adequately powered to study childhood cancer patients with immunosuppression might be low-hanging and dramatically productive fruit.
High Throughput Technologies in Informatics, Clinical Decision Support, Epigenetics and iRNA:
Examples of problems presently being tackled that might bear dramatic scientific fruit include, but are not limited to, 1. Understanding of epigenetic change in sepsis, and its persistence beyond the acute period, along with further mortality and morbidity risk in specific populations of children with complex illnesses; 2. Understanding of how mechanical ventilator support ( modalities and strategies) might be standardized and understood in childhood critical illness and injury; 3. Understanding (using advanced hemodynamics and instrumentation) how variation in practice in cardiopulmonary resuscitation in CPCCRN units occurs, and if and how minimizing such variation might improve outcomes (return of spontaneous circulation (ROSC) and neurodevelopmental outcomes). Generalization of such results to non-monitored and outpatient and developing world settings.
Health Disparities Research:
In the CPCCRN Critical Asthma Research Development and Design Project, African American children had triple the risk of fatal and near fatal asthma, representing 47% of the study population, whereas they represent 21% of the population of children admitted to CPCCRN units overall. Detailed investigation of this dramatic disparity is urgent, and might be expected to inform health disparity research in a way that would be productive, even paradigm-shifting, for those seeking to understand and correct health disparities.


Submitted by Carol Nicholson on June 10, 2011 at 1:07 PM


Focusing on Global Health:
How might support of research in technologically advanced units in the USA benefit the health of all children? Since the vast majority of the world's children live in circumstances where pediatric critical care services are unavailable, how can support of such research be of real value in view of the increased focus at NIH/NICHD on global health? An example of the importance of NICHD-supported pediatric critical care research of substantial importance to the developing world is the critical pertussis project. The project seeks to characterize the intensive care unit course of pertussis critical illness in children in the United States, with special reference to level of support and advanced therapeutic modalities: high frequency oscillatory ventilation, inhaled nitric oxide, Extra-corporeal membrane oxygenation, leukopheresis, exchange transfusion and others.
Benefiting Health Care Reform:
At present, a comprehensive, rigorously designed study (Trichomatous Outcome Prediction in Critical Care, TOPICC) linking pediatric critical care course and physiologic variable to morbidity (rather than just mortality) is ready to execute across the CPCCRN. The anticipated benefit of TOPICC is the potential development and validation of a new predictive instrument to measure quality of care provided t o children in PICUs across the country. This instrument will facilitate comparisons in quality of care and help inform the development of new interventions aimed at improving the quality of pediatric critical, and guiding life support and technology deployment in pediatric critical illness and injury, adding significantly to our understanding of how to predict the likelihood of death disability or suboptimal outcomes.


Submitted by Carol Nicholson on June 10, 2011 at 1:09 PM


Maternal infant attachment and assisting the breastfeeding process have the potential to achieve life long health benefits. Research on how changing health providers behavior to assist with this is vital


Submitted by Rosemary Bolza on June 10, 2011 at 1:16 PM


There is no discussion in this white paper to loan support and necessity of breastfeeding education to all healthcare providers and to consumers. Breastfeeding is the most cost-effective way to decrease infant mortality and morbidity and save healthcare dollars. Although there is a body of research on breastfeeding, significant knowledge gaps are evident. These gaps must be filled to ensure that accurate, evidence-based information is available to parents, health care providers, public health programs, and policy makers.

The Surgeon General's Call to Action to Support Breastfeeding calls for increased funding of research on breastfeeding (Action 17) and strengthened capacity for conducting research on breastfeeding (Action 18).
Specifically the Surgeon General calls for the development of a national consortium on breastfeeding research. The Call to Action states : "Such a consortium would help overcome the limitations that researchers now face in designing studies, increase the generalizability of research on breastfeeding, help prioritize key research areas, enable expanded and advanced research to be performed, and foster the timely translation of research into practice."
I encourage NICHD to take the lead on this action by developing a platform for a national consortium of researchers interested in breastfeeding research.


Submitted by Pat Lindsey on June 10, 2011 at 1:33 PM


A cross cutting issue that has been neglected in all of the visioning papers is the nutrition of the neonate. While evolutionary and other considerations lead to the conclusion that breastfeeding must be the gold standard for the newborn infant, many questions remain: When breastfeeding is not possible, what is the best method of alternative nutrition? How does breastfeeding fit into the concept that proper nutrition in the first 1000 days (from the onset of pregnancy to the end of the second year of life) is essential to the prevention of long term consequences of malnutrition? What is the role of ruminant and soy milk in nutrition during this period? What are the components of breast milk that promote survival and health of the preterm infant? How important are these components for the term infant? What components of milk promote its anti-infectious qualities? Are there human or ruminant milk components that can provide therapeutic interventions in adult disease? Does the early interaction between mother and her breastfed infant have long term behavioral effects and if so, what are the elements of the interaction that provoke these responses? What is the impact of environmental agents and drugs on the growth and development of the breast-fed infant? What is the impact of antiretroviral, psychotropic and other drugs on milk secretion? How does maternal nutrition impact lactation? Why do obese women have problems lactating? Does the hormone regulated development of the mammary gland provide a model for other developmentally regulated organs? How do the hormones of pregnancy impinge on mammary gland development? These questions are just the tip of the iceberg but if we are to optimize the early growth and development of the infant they require answers.


Submitted by Margaret Neville on June 10, 2011 at 1:52 PM


On behalf of the American Psychological Association, a scientific and professional society with more than 150,000 scientists, academics, practitioners and students worldwide, I am writing to express our support of the Eunice Kennedy Shriver National Institute of Child Health and Human Development's Vision Process. We commend the institute for including the external scientific community in this process and to recognize the contributions of scientists across multiple disciplines who participated in the nine workshops and the development of the white papers. As behavioral research cuts across many of the research themes, we were glad to see the inclusion of psychological scientists in most of the workshops. Overall, we are impressed by the breadth of research within NICHD's mission and the unique opportunity it provides to truly advance the public health through interventions at the global, community and individual level.
The following issues were raised across several of the working groups and are of particular importance to psychological scientists:

Normative Development
According to the World Health Organization, health is more than the absence of disease, but a state of physical, mental and social well-being. Given NICHD's broad portfolio of health and development, we support the institute's continued focus on normative development, not only to advance our understanding of disordered development, but, to promote health and well-being across the lifespan. Optimizing developmental outcomes begins with a more complete understanding of typical development across multiple domains of inquiry, including behavior, genes, environment and the brain. Without fully understanding and explaining normal development, we will miss opportunities to identify early risk factors that contribute to atypical development or protective factors that may prevent disorders in childhood or allow children to reach their full potential.
(continued in second post)


Submitted by Karen Studwell on June 10, 2011 at 2:11 PM


(APA comments continued)
Basic Behavioral Science
While integrating scientific questions across multiple levels of inquiry is a laudable goal identified in multiple workshops, there remains a need for supporting basic science at single levels of analysis, whether at the genetic, social, or behavioral level. Basic behavioral research on theory of mind, perception, attention, and spatial development has led to advances in understanding developmental disorders and creating behavioral interventions for treating autism spectrum disorders. While APA supports integrating research across multiple levels of analysis and examining the interactions among genes, environment, the brain and behavior, progress in individual disciplines from psychology, cell biology, and genetics are still needed to provide a solid basic science foundation in these individual disciplines.

Barriers to Behavioral Research
As mentioned in the Behavior white paper, interdisciplinary research is impeded by a lack of fluency across disciplines. To capitalize on the scientific opportunities made available by integrating levels of inquiry across genes, environment, brain and behavior, scientists need more training in not only other disciplines, but in how to manage and develop true team science and adopt trans-disciplinary approaches to scientific questions. APA has collaborated with the institute in the past on Advanced Training Institutes to provide an opportunity for psychological scientists to build capacity in the field for using advanced technologies, understanding genetics, and learning how to leverage large databases such as the Add Health Study for further research.

APA also appreciates the recognition of the impact of Institutional Review Boards (IRBs) on behavioral research and the inconsistent or misinterpretations of federal regulations. We support any institute efforts for improving how IRBs interpret the current patient safety and privacy regulations.

Thank you for your consideration of our comments and we look forward to working with you as the institute moves forward to implement the recommendations.


Submitted by Karen Studwell on June 10, 2011 at 2:11 PM


Cross-Cutting Issue: cognitive, developmental origins of health and disease, plasticity, behavior

While the identification numerous genetic variants have theoretically opened an unprecedented opportunity to understand genetic contributions to the etiology of diseases and cognitive processes, with the present research infrastructure, it is improbable that this coffer of knowledge will be used productively to develop diagnosis tools and treatments in the next decade.

The Vision: Creation of an NICHD or NIH supported national center for the generation of novel lines of animals, over- or under-expressing different combination of genes associated with risk for disease and cognitive deficits, that can be made available to investigators world-wide. The central goal is to identify combinations of multiple "at risk" genetic variants, based on our present knowledge from GWAS and CNV studies, which contribute to the development of diseases and cognitive deficits. This effort can be incorporated to presently funded projects that are generating different strains of GFP-reporter mice, and strains of inducible cre- or flp-recombinase mice targeting different cell types during development.

The potential outcomes during the coming decade:
* Identify signaling, cellular and functional networks that constitute the biological mechanisms underlying deficits

* Identify the role of development and GXE interactions in cognitive deficits and disease using inducible recombinant systems

* Identify combination of genes that are highly penetrant and associated with behavioral deficits/disease, and subsequently test a combination of these variants for predictive value for different diseases associated with cognitive deficits (i.e. schizophrenia, bipolar disorder, autism spectrum and ADHD)

* Develop diagnostic kits based on gene variants (SNPs) associated with disease or cognitive deficits

* Based on the identified combination of variants that are highly penetrant, develop iPS cells (from patients and/or animal models) that can be propagated and differentiated to screen for novel drug targets

The Good News: We already have all the technologies, but simply have not combined them, to study the effects of multiple gene variants on disease and cognition. Presently available: mice/fish harboring targeted mutations, cre- and flp- recomb mice, shRNAs for knockdown, rodent test for behavior and cognition studies, and electrophys/imaging techniques to identify net


Submitted by Andres Buonanno on June 10, 2011 at 4:50 PM


On behalf of the California Breastfeeding Coalition, I respectfully submit the following comments.
* Although there is a body of research on breastfeeding, significant knowledge gaps are evident. These gaps must be filled to ensure that accurate, evidence-based information is available to parents, health care providers, public health programs, and policy makers.
* The Surgeon General's Call to Action to Support Breastfeeding calls for increased funding of research on breastfeeding (Action 17) and strengthened capacity for conducting research on breastfeeding (Action 18).
* Specifically the Surgeon General calls for the development of a national consortium on breastfeeding research. The Call to Action states : "Such a consortium would help overcome the limitations that researchers now face in designing studies, increase the generalizability of research on breastfeeding, help prioritize key research areas, enable expanded and advanced research to be performed, and foster the timely translation of research into practice."
* We encourage NICHD to take the lead on this action by developing a platform for a national consortium of researchers interested in breastfeeding research.

Submitted by Robbie Gonzalez-Dow on June 10, 2011 at 6:36 PM


"This white paper summarizes the findings of a workshop explicitly organized to address this challenge. The mandate and structure for the conference as well as the expertise of the invited participants were all developed to generate highly interactive discussion and innovative recommendations. The workshop participants were organized into seven groups, each focused on a specific arena of pregnancy or birth outcomes, e.g., 1) New Methodologies; 2) Balancing Maternal and Fetal Risks and Timing of Delivery; 3) Preventing Cesarean Deliveries; 4) Pregnancy and Future Health; 5) Prenatal Diagnosis; 6) Placental Medicine and Syndromes; and 7) Preterm Birth."

I am inquiring about where does the postpartum piece come into play? Pregnancy and future health? This would include lactation? I am not seeing this area being addresses in the "white paper" When one speaking of Pregnancy and future health that would be the promotion of human milk in this arena.
After all, breast-feeding is the single most powerful and well documented prevention in future health.There are significant lower rates of ear infection, diarrhea,lower respiratory tract infections, TYPE 1 and TYPE 2 Diabetes, NEC, childhood leukemia and lower rates of SIDS. Women who have breast-fed have lower risks of ovarian and breast cancer, lower risk of type 2 diabetes also the evidence suggests a reduction in the risk of cardiovascular disease.
Numerous agencies actively encourage and support maintenance of breast-feeding which includes that American Academy of Pediatrics, American Academy of OB/Gyn, the American Academy of American Physicians, Association of Women's Health, OB and Neonatal Nurses, the American Dietetic Assoc., and the American Public Health Assoc. and the US Department of Health and Human Services.
The benefits of Breastfeeding TRANSLATES into hundreds of dollars of savings at the family level and BILLIONS of dollars at the NATIONAL level, through decreased hospitalizations and pediatric visits.

Researchers Wiemer and Bartick have estimate that between $3.6 and 13 billion would be saved on pediatric health care costs in their review and analysis.
I feel that breast-feeding needs to be addressed as an individual topic and I would urge that issues concerning breast-feeding be considered as a crucial factor for this process.
Thank You ,
Jean De Lapp


Jean De Lapp, BSN, RN, CLC
Perinatal Services Coordinator


Submitted by Jean De Lapp on June 10, 2011 at 8:10 PM


On behalf of the Breastfeeding Task Force of Greater Los Angeles, I submit the following comments and recommendation:
* Although there is a body of research on breastfeeding, significant knowledge gaps are evident. These gaps must be filled to ensure that accurate, evidence-based information is available to parents, health care providers, public health programs, and policy makers.
* The Surgeon General's Call to Action to Support Breastfeeding (2011) calls for increased funding of research on breastfeeding (Action 17) and strengthened capacity for conducting research on breastfeeding (Action 18).
* Specifically the Surgeon General calls for the development of a national consortium on breastfeeding research. The Call to Action states : "Such a consortium would help overcome the limitations that researchers now face in designing studies, increase the generalizability of research on breastfeeding, help prioritize key research areas, enable expanded and advanced research to be performed, and foster the timely translation of research into practice."
* We encourage NICHD to take the lead on this action by developing a platform for a national consortium of researchers interested in breastfeeding research.


Submitted by Karen Peters on June 10, 2011 at 8:25 PM


Breastfeeding is an important aspect of Infant nutrition research that must be further evaluated, especially given the Surgeon General's recent Call to Action which calls for calls for increased funding of research on breastfeeding (Action 17) and strengthened capacity for conducting research on breastfeeding (Action 18). Although there is a body of research on breastfeeding, significant knowledge gaps are evident. These gaps must be filled to ensure that accurate, evidence-based information is available to parents, health care providers, public health programs, and policy makers.

Submitted by Ronda Yoder on June 11, 2011 at 1:47 AM


The period for commenting on NICHD scientific Vision white papers is now closed. 

Last Updated Date: 07/06/2012
Last Reviewed Date: 07/06/2012