ARCHIVED - Research About – Child and Youth Health

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The Canadian Institutes of Health Research (CIHR) is the Government of Canada's agency for health research. CIHR's mission is to create new scientific knowledge and to catalyze its translation into improved health, more effective health services and products, and a strengthened Canadian health-care system. Composed of 13 Institutes, CIHR provides leadership and support to more than 13,000 health researchers and trainees across Canada. Through CIHR, the Government of Canada invested approximately $92.3 million in 2008-09 in child and youth health research.

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The Facts

• First-born children of mothers age 35 and older generally do not differ significantly from children born to younger mothers in health, behaviour and cognitive outcomes measured up to age five.*
• In 1994/1995, about 11% of Canadian children aged 11 and under had been diagnosed with asthma. By 2000/2001, the rate had risen to more than 13%. Asthma attacks, however, declined in prevalence with just 39% reporting an attack in the previous year, compared to more than 50% in 1994/1995.**
• The proportion of teens who become sexually active at an early age has shown a decline. In 2005, 8% reported having had sexual intercourse before age 15, down from 12% in 1996/1997. The proportion fell among girls, but did not change significantly among boys.***
• In 2005, 51% of children aged 5 to 14 regularly took part in organized sports – down from 57% in 1992.****

Sources:

* Statistics Canada, The Daily, Sept. 24, 2008, Study: Health and development of children of older first-time mothers

** Statistics Canada, The Daily, April 16, 2008, Study: Changes in the prevalence of asthma among Canadian children.

*** Statistics Canada, The Daily, Aug. 20, 2008, Study: Teen sexual behaviour and condom use.

**** Statistics Canada, The Daily, June 3, 2008, Study: Organized sports participation among children.

Finding Solutions

Searching for the roots of childhood asthma
Asthma has become increasingly common among children in the developed world over the past few decades, and researchers are trying to determine why. Now, Dr. Anita Kozyrskyj, a CIHR-funded researcher at the University of Alberta, has uncovered a new piece of the asthma puzzle. Dr. Kozyrskyj and her team have found that children who receive four or more antibiotic prescriptions in their first year of life have an elevated risk of developing asthma. More research is needed to explain this observation, but overuse of antibiotics may be wiping out protective microbes that live in infants' intestines.

Multivitamin better for birth weight
Women who take a multivitamin during their pregnancy may be doing more to improve their baby's birth weight than if they took just an iron-folic acid supplement, a new study suggests. The CIHR-funded study – an analysis of 13 trials that evaluated the effect of multivitamin supplementation during pregnancy – found that birth weights were significantly higher in the multivitamin group than in the iron-folic acid only group. The World Health Organization recommends pregnant women take an iron-folic acid supplement. Dr. Prakesh Shah of Mount Sinai Hospital in Toronto led the study, which was reported in June in the Canadian Medical Association Journal.

Drug combo can ease lung infection, reduce hospital stays
A CIHR-funded study of 800 babies at eight children's hospitals across Canada has found a way to reduce bronchiolitis admissions by more than a third. The study, published in the New England Journal of Medicine in May, found that babies treated for the common lung infection with a combination of epinephrine and a steroid called dexamethasone recovered much more quickly, with 35% fewer requiring admission to hospital. The two therapies have been tried separately without success. "These findings are truly significant to the health-care system and to families of young children around the world," said Dr. Amy Plint, lead author of the study and an emergency physician at the Children's Hospital of Eastern Ontario, in an interview with the Ottawa Citizen.

Project Ice Storm: The effects of prenatal maternal stress on young children
The stress of a natural disaster is difficult for everyone affected. The January 1998 ice storm in Quebec resulted in power outages ranging from a few hours to more than 6 weeks for more than 1.4 million households during the coldest month of the year. The Insurance Bureau of Canada has listed the ice storm as the most costly natural disaster in Canadian history. CIHR-funded researchers Drs. David P. Laplante, Alain Brunet, Norbert Schmitz, Antonio Ciampi and Suzanne King recruited Quebec women who were pregnant at the time of the ice storm and studied their children's developmental progress at 5 ½ years of age to determine the impact of prenatal maternal stress (PNMS). The researchers found that children who were in the womb as their mothers were living through the ice storm had lower cognitive and language abilities than children whose mothers were not affected by the storm. The research was published in the Journal of the American Academy of Child and Adolescent Psychiatry.

The Researchers

Dr. Kellie Murphy – Babies and Steroids

With medications, when is there too much of a good thing? For Dr. Kellie Murphy, an obstetrician and mother-infant researcher at Toronto's Mount Sinai Hospital, it's a question she knows could have major consequences for pre-term babies.

Her 10-year, CIHR-supported quest to find an answer is transforming prenatal care and improving the health of babies around the world.

Obstetricians have known since the 1970s that giving a pregnant woman at risk of pre-term birth a dose of corticosteroids improves neonatal outcome. Corticosteroids are widely used drugs commonly given to reduce inflammation in conditions such as asthma.

Used with expectant mothers, corticosteroids reduced the incidence of both neonatal death and respiratory distress syndrome—the complications related to underdeveloped lungs in pre-term babies.

However, as obstetricians sought to further improve the outcome of pre-term births, by the late 1990s what had started as a single course of steroids had become many. This caused concern for clinician-researchers such as Dr. Murphy, and her mentor, Dr. Mary Hannah, former director of Mount Sinai's Mother Infant Research Unit.

Were these multiple courses of steroids helpful, or could they actually have a negative impact on developing babies?

In 1999, two days before the birth of her first daughter, Dr. Murphy submitted the grant proposal for a research program to find the answer.

The CIHR-supported randomized controlled international trial, the largest ever of its kind, involved 1858 women and their infants at 80 hospitals in 20 countries from Europe to South America. In 2007, the 150 collaborating physicians arrived in Toronto to hear the bitter-sweet preliminary results.

"There's absolutely no benefit to multiple courses of corticosteroids. They don't further decrease the rate of infant mortality, or of respiratory problems in newborns," says Dr. Murphy, also an assistant professor at the University of Toronto.

"Many of my collaborators were initially quite disappointed with these results. They'd hoped that giving more steroids would help. The drugs are cheap and easy to give, while neonatal care is expensive and difficult, especially in economically less developed countries. But it's extremely important to know that the practice is not beneficial and that it stop."

Dr. Murphy's study initially found that the mothers in the study who'd received multiple doses of corticosteroids delivered babies that weighed less, were shorter, and had smaller heads.

The big question now is whether the use of multiple courses of corticosteroids with pregnant mothers has longer-term effects on their children's health.

"We're now studying these longer-term effects," says Dr. Murphy. "For example, are the differences in body weight and head circumference at birth associated with differences later in life?" says Dr. Murphy.

She hopes to determine this in two years when the children in the ongoing study are five years old.

For More Information

CIHR's Institute of Human Development, Child and Youth Health (CIHR-IHDCYH) has identified 11 strategic research priorities that will help ensure a healthy start in life and optimal growth and development for all Canadians. To learn more about these priorities and other CIHR- IHDCYH activities, please visit the Institute's website.

For more information, go to ARCHIVED - Your Health Research Dollars at Work