Perinatal Addiction/Developmental Consequences

Mission

Our mission includes evaluating risk factors for the development of adverse developmental and behavioral outcomes in children with intrauterine substance exposure and identifying optimal approaches to treating:

• Pregnant women with substance use disorder
• Newborns with intrauterine substance exposure

Leadership

The Perinatal Addiction and Developmental Consequence Core is led by Stephanie L. Merhar, MD, MS. As a neonatologist and clinical researcher, Dr. Merhar’s goal is to predict and improve outcomes of high risk infants. She provides care to infants in the NICU and in the NICU Follow Up Clinic until 3 years of age, including infants exposed to opioids in utero. Very little quality data exists on the effects of prenatal opioid exposure on the brain, and it is often difficult to counsel families of these infants on expected outcomes. While participating in the Ohio Perinatal Quality Collaborative project on neonatal abstinence syndrome (NAS) (PI: Michele Walsh) and leading a retrospective study on the 2-year outcomes of infants with NAS from our clinic, Dr. Merhar became interested in using the tools of advanced neuroimaging to evaluate the effects of prenatal opioid exposure on the brain. Her previous experience and KL2 award have focused on structural and diffusion tensor imaging and follow up in infants with perinatal brain injury. Her current research focuses on advanced neuroimaging in infants with prenatal opioid exposure, including diffusion tensor imaging and resting-state functional connectivity MRI. 

Maternal and Infant Data Hub

A team of researchers at Cincinnati Children's Hospital Medical Center developed a data repository that integrates maternal, neonatal and pediatric patient records from across the Cincinnati region. The Maternal and Infant Data Hub comprises information on 110,000-plus infants born at 14 regional hospitals between 2013 and 2017. The repository corrals data from electronic clinical and billing records, alongside geospatial information for each patient to support research into the roles neighborhoods and communities play on a patient's health.

Qualified researchers at Cincinnati Children's Hospital Medical Center and University of Cincinnati Medical Center can access the data repository to drive population health studies, such as investigations into inpatient, emergency department and urgent care visits during a child's first year of life or the impact opioids have on newborns in the region.

Perinatal Addiction/Developmental Consequences Faculty

Dr. McAllister has been involved in clinical care and research of children with prenatal opioid exposure throughout her entire career. In 2015, she established the Neonatal Opioid Withdrawal Syndrome (NOWS) Clinic at Cincinnati Children’s Hospital Medical Center, one of the first clinics dedicated to this high-risk population. As director of this multi-disciplinary clinic, she developed a model of care for these children, created a foundation for research, and has become a recognized leader in follow-up outcomes for children exposed to opioids in utero. She participates in NIH funded NOWS research, and her work and publications focus on medical and developmental outcomes of infants with NOWS.

Dr. Ashley Merianos has extensive training and experience in the epidemiology and prevention of substance use with an emphasis on tobacco, quantitative statistical methods, and clinical and translational research in the pediatric healthcare setting. She is a Certified Health Education Specialist and Tobacco Treatment Specialist. The National Institutes of Health (NIH) has successfully funded Dr. Merianos’ research as a Principal Investigator (K01DA044313 and R21ES032161). Her current K01 project measures the health and economic burden of child tobacco smoke exposure including secondhand and thirdhand smoke on the acute healthcare setting and creates an implementation plan to reduce exposure in a future trial. Dr. Merianos' current R21 project examines the prevalence, contributions, and health risks of exposure to tobacco smoke and electronic cigarette aerosol among children nationwide. She serves as a Co-Investigator on two active NIH research projects (R01ES027815 and R01ES030743) that focus on parental tobacco cessation and child tobacco smoke exposure reduction in the acute healthcare and inpatient settings, and assessment of complex tobacco smoke toxicant mixtures within microenvironments (e.g., homes). Dr. Merianos’ research program has contributed to the tobacco control field by identifying the multiple pathways through which nonsmoking children are exposed to tobacco smoke and evaluating policies aimed at protecting this highly vulnerable population from related harmful effects.

Dr. Mizuno has been involved in multiple studies focused on the pharmacokinetics, pharmacodynamics (PK/PD), and pharmacogenetics of opioids, including morphine, methadone, and buprenorphine in neonates, infants, and children treated for neonatal opioid withdrawal syndrome (NOWS) as well as part of their pain management. Dr. Mizuno’s research focusses on the application of quantitative pharmacology approaches such as PK/PD modeling and simulation, and quantitative systems and pediatric pharmacology approaches to personalized drug dosing and pediatric clinical trial design to support the improvement of patient care.

Dr. Redle’s work includes the “Preparing Early Intervention Providers for the Opioid Epidemic (PEPOpE)” project, which was funded by US Department of Education Personnel Preparation (H325K190069). This project will support a specialized training for 42 Allied Health students (Speech-Language Pathology, Occupational Therapy, and Social Worker) to provide high-quality, interdisciplinary early intervention services for children with intrauterine opioid exposure and their families. Students will complete a year-long educational program including shared coursework and field experiences while studying the biobehavioral impact of intrauterine exposure as well as best practices for treatment of early developmental and behavioral disorders in this population, including trauma-informed care.

Dr. Reyes is a neuroscientist using preclinical models to understand cellular and molecular pathways that link adverse early life environment to cognitive and emotional deficits. Dr. Reyes has been awarded federal (RO1 and R21) and foundation (Rally Foundation, NARSAD) grants for her work, and is currently the co-director of an NIH-sponsored training grant for summer undergraduate research in Neuroscience. She is currently investigating how perinatal exposure to opioids can influence brain development and cognition.

Dr. Vannest brings her expertise in neuroimaging and cognitive development to evaluate the potential neurodevelopmental consequences of intrauterine exposure to opioids and other substances.

Dr. Vinks is a pediatric clinical pharmacology and clinical trials expert. He is the director of the Division of Clinical Pharmacology at Cincinnati Children’s Hospital Medical Center. As the principal investigator of the former National Institute of Child Health and Human Development (NICHD) Pediatric Pharmacology Research Unit he has conducted multiple pediatric and adult clinical trials focused on population pharmacokinetics-pharmacodynamics (PK/PD) and pharmacogenetics/genomics. His recent efforts have focused on the development of PK/PD model-informed precision dosing strategies and clinical decision support in a variety of indications including for the management of neonates with opioid withdrawal syndrome (NOWS).

Dr. Wilder is an Associate Professor at the University of Cincinnati Department of Psychiatry and Behavioral Neuroscience and Medical Director of the Addiction Sciences Division at UC Health. She is board certified in General and Addiction Psychiatry. Her current research interests are the treatment of pregnant and postpartum women with opioid use disorder and the prevention of opioid overdose. She is a site PI for the Clinical Trials Network study: Medication Treatment for Opioid-dependent Expecting Mothers: A Pragmatic Randomized Trial Comparing Two Buprenorphine Formulations. She is also active in the Cincinnati community as a member of the Hamilton County Mental Health and Recovery Services Board.

Dr. Winhusen has conducted NIDA-funded clinical trials for the past 20 years devoted to improving the treatment of substance use disorders including opioid, cocaine, and tobacco use disorders. He is one of the foremost experts in conducting multi-site addiction trials in clinical settings, having served as the national PI for six National Drug Abuse Clinical Trials Network trials. Dr. Winhusen’s research has contributed to our understanding of co-occurring disorders (e.g., tobacco use disorder with ADHD and with stimulant use disorders), the treatment of pregnant substance abusers, and the neurocognitive functioning of individuals with stimulant use disorders.

Dr. Yolton is an NIH-funded developmental psychologist with nearly 30 years of experience studying the impact of prenatal and early life exposures on neurobehavior from infancy throughout childhood. She has extensive experience with infants and children who were prenatally exposed to substances of abuse, who were born prematurely or at low birth weight, or who come from disadvantaged home environments. She has expertise in a specialized neurobehavioral assessment used in a variety of studies examining children at-risk. She currently directs the longitudinal Health Outcomes and Measures of the Environment (HOME) Study located in Cincinnati and collaborates on several studies on the impact of prenatal opiate exposure on infant and child health.