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August 6, 2012 — According to 2 recent studies, two thirds of children admitted to pediatric intensive care units (PICUs) may be deficient in vitamin D, which may make them vulnerable to more severe illness. The studies were published online August 6 in Pediatrics.
The first study was conducted by Kate Madden, MD, an assistant in critical care medicine in the Division of Critical Care Medicine, Department of Anesthesia, Perioperative and Pain Medicine at Children’s Hospital Boston and the Department of Anesthesia at Harvard Medical School in Boston, Massachusetts, and colleagues.
Dr. Madden and coauthors analyzed the vitamin D levels of 511 severely or critically ill children who were admitted to the PICU from November 2009 to November 2010 to determine the prevalence of vitamin D deficiency in severely ill children and determine factors that influence admission 25-hydroxy vitamin D (25(OH)D) levels.
Vitamin D deficiency is common in critically ill adults and is associated with sepsis and more severe critical illness, but the associations between vitamin D deficiency and pediatric critical illness have not yet been determined.
The children had 25(OH)D levels analyzed on blood that was taken as soon after PICU admission as possible, either by drawing fresh blood or by testing leftover plasma that was refrigerated in the hospital laboratory. Severity of illness was determined within the first 24 hours by using the Pediatric Risk of Mortality III score.
The median 25(OH)D level of the children studied was 22.5 ng/mL (interquartile range [IQR], 16.4 – 31.3 ng/mL), 71.2% of the patients had insufficient 25 (OH)D (
A total of 13 (2.5%) children died during hospitalization, and the median 25(OH)D level was 19.4 ng/mL (IQR, 16.6 – 31.4 ng/mL).
Serum 25(OH)D levels were considerably lower in the 51 children who had severe septic shock but were not associated with the primary reason for PICU admission. Patients with lower respiratory tract infection had the same median 25(OH)D levels (22.5 ng/mL) as patients without.
Almost half (46.6%; n = 238) of the patients were admitted with life-threatening infections, and 25(OH)D levels were not lower in this group unless they had septic shock (n = 51, 10.0%; median 25(OH)D level, 19.2 ng/mL [IQR, 12.6 – 24.8 ng/mL]; P = .0008).
In multinomial logistic regression analysis, lower admission 25(OH)D levels were associated with higher illness severity on the Sequential Organ Failure Assessment cardiovascular (CV-SOFA) tool, with a 5 ng/mL decrease in 25(OH)D corresponding to a 1.13-fold increase in odds of placing in the next higher category of CV-SOFA score (95% confidence interval [CI], 1.01 – 1.27; P = .03). This relationship continued after adjusting for severe septic shock (OR, 1.16; 95% CI, 1.02 – 1.31; P = .02).
Multivariate analysis found a correlation between age and race and vitamin D deficiency, with school-age children and those with dark skin being more likely to have low 25(OH)D levels.
“We hypothesize that higher 25(OH)D levels may decrease the severity of critical illness brought on by an overwhelming insult such as infection or injury,” the authors write.
“Given the high rate of vitamin D deficiency in critically ill children and the essential role of vitamin D in healthy bone development, we recommend screening critically ill children with risk factors for vitamin D deficiency and identifying effective repletion strategies,” the authors write.
The second study was conducted by J. Dayre McNally, MD, PhD, a pediatric intensivist in the Department of Pediatrics at Children’s Hospital of Eastern Ontario and an associate investigator at Children’s Hospital of Eastern Ontario Research Institute in Ottawa, Ontario, Canada, and colleagues.
The researchers conducted a secondary analysis of data collected during a prospective cohort study from 2005 to 2008 in 7 tertiary-care PICUs in Canada (Adrenal Insufficiency in Pediatric Critical Illness Study [AIP]). For this study, data from only 6 centers were studied, as 1 center declined permission.
The prevalence of vitamin D deficiency (25(OH)D2 plus 25(OH)D3 < 50 nmol/L) among the children was 69% (95% CI, 64% – 74%). Another 23% (95% CI, 19% – 28%) had a concentration between 50 and 75 nmol/L.
Lower mean 25(OH)D levels were found in patients requiring catecholamine infusion (45 ± 19 nmol/L vs 38.5 ± 16 nmol/L; P = .006) and more than 40 mL/kg fluid bolus on the day of PICU admission (44.7 ± 19.6 nmol/L vs 34.5 ± 18.5 nmol/L; P = .001).
Patients who were mechanically ventilated had lower 25(OH)D levels compared with patients who did not require mechanical ventilation (47.2 ± 19.9 nmol/L vs 41.7 ± 19.1 nmol/L; P = .02).
25(OH)D levels were significantly lower in patients with at least 1 hypocalcemic episode compared with patients with normal or minimally reduced calcium levels (51.0 ± 20.6 nmol/L vs 36.6 ± 15.9 nmol/L; P = .001).
The researchers found no significant relationship between 25(OH)D levels and serum albumin (Spearman correlation coefficient, −0.08; P = .48). There was a moderate association between albumin and preexisting illness (Spearman correlation coefficient, 0.57; P < .001).
Multivariate regression analysis showed that a 25(OH)D level less than 50 nmol/L was independently associated with a PICU stay of an additional 1.92 days (95% CI, 0.2 – 3.7; P = .03) and an increasing illness severity, as measured by the Pediatric Risk of Mortality tool.
Steven A. Abrams, MD, a professor of pediatrics at Baylor College of Medicine and an attending physician in the Section of Neonatology at Texas Children’s Hospital in Houston, and Jorge A. Coss-Bu, MD, an associate professor in the Section of Critical Care Medicine at Baylor College of Medicine and an attending physician at Texas Children’s Hospital, commented on the studies in an accompanying editorial.
These data support programs and interventions aimed at preventing vitamin D deficiency, they write, adding that, “at a minimum, comprehensive efforts to ensure that children receive at least the recommended intake of vitamin D (400 IU/day for infants, 600 IU/day for children aged > 1 year) should be developed and emphasized.”
They continue, “[T]hese studies move forward and to the front concerns regarding vitamin D status in critically ill children. They do not yet tell us the best way of assessing or treating low serum 25(OH)D levels in a PICU setting but point us to a program of public health and research on this topic, with clear identification of final outcomes and their clinical significance, focusing on both efficacy and safety of any proposed interventions.”
One study author serves as a consultant for Diasorin Inc. The other authors and editorialists have disclosed no relevant financial relationships.
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After months of preparation we are proud to announce we have launched our first issue of our own bi-annual publication THE TRENCH on the 1st. November 2001.
Each issue will contain approx. 24-44 pages of information and photographs, printed in size A5 on high quality paper.
Contents of THE TRENCH will consist of a description of some of new acquisitions, relics we have discovered and retrieved from the various battlefields in Europe, and from time to articles written by some of our fellow collectors and enthusiasts. Basic rule is that the article should concern an item or event that is dated pré 1919, or is related in one way or another to the First World War. And last but not least articles on the so-called 'wannahaves'. Items that are not part of our collection yet, but certainly on our wish-slip.
Our 72" universal quick attach Low Profile Bucket features tough durable construction. Our buckets are built from 3/16" A-36 steel and features a 3/4" x 6" high carbon C1060 cutting edge and 1/2" thick bottom wear strips. Height is 21" and depth is 27.5".
Although most cropland was operated by farms with less than 600 crop acres in the early 1980s, today most cropland is on farms with at least 1,100 acres, says Farm Size and the Organization of U.S. Crop Farming, a new report from USDA Economic Research Service (ERS). Long-term shifts in farm size have been accompanied by greater specialization. Technology also plays an important role in driving increases in farm size.
A program being offered by Cornell Cooperative Extension, American Farmland Trust, and AgFlex is helping 35 family farmers on Long Island reduce their use of nitrogen fertilizers on sweet corn and potato crops. Last year's participants in the program were able to cut fertilizer use by an average of 20% while sustaining farm productivity. The farmers are enrolled in the BMP Challenge, an innovative program that eliminates financial risk as a barrier to farmers' adoption of conservation practices.
A team of Michigan State University Extension educators from the Upper Peninsula conducted a project to explore what makes beginning farmers successful. The project sought a better understanding of how farming has impacted newer operators in the areas of economics, family relationships, community involvement, and general lifestyle. One of the most common observations was the enthusiasm farmers have about their businesses and how much they love the lifestyle of farming. A full report on the study is available online.
The latest version of the Web Soil Survey was recently launched by USDA's Natural Resources Conservation Service (NRCS). The application provides free soils information along with soil maps, properties, and interpretations aimed at helping with land use decisions. The new version includes improved map appearance, increased Area of Interest acreage, and upgraded options for changing map properties. Web Soil Survey is now online 24 hours a day.
Americans are increasingly installing wind turbines near their homes, farms, and businesses, according to The 2012 Market Report on Wind Technologies in Distributed Applications, a new report by the Department of Energy's Pacific Northwest National Laboratory. About a third of all U.S. wind turbines installed in 2012 were distributed, representing about 3,800 turbines that can generate a combined 175 megawatts.
A project at Appalachian State University will use bio volatilization (BV) to convert biomass to biofuel and biochar economically. BV converts biomass into biochar, pyrolosis oil, fuel gas, and heat. The biochar can be used as a soil additive and waste energy will be used to heat the university's bioshelter/greenhouse. The researchers' goals are to provide a sustainable energy source and a potential revenue stream for farmers.
Northeast SARE offers Partnership Grants for agricultural service providers—extension staff, nonprofits, consultants, state departments of agriculture, and others working in the agricultural community—who want to conduct on-farm demonstrations, research, marketing, and other projects with farmers as active cooperators.
Wisconsin Department of Agriculture, Trade and Consumer Protection is offering Buy Local, Buy Wisconsin matching grants of up to $50,000. Proposals will be accepted from individuals, groups, businesses, and organizations involved in Wisconsin agriculture, food processing, food distribution, food warehousing, retail food establishments, or agricultural tourism sites. Eligible expenses for grant-funded projects include operating expenses, real estate, and equipment.
The NRCS State Office in Missouri is offering cooperative agreements and grants up to $120,000 to promote public awareness and implementation of Farm Bill activities. Projects may include workshops, conferences, and training that will help educate Missouri's farm community, private landowners, conservation organizations, cooperating agencies, and general citizenry.
The National Farm Viability Conference is geared towards professionals in farm and food business planning, financial planning, agricultural financing, farmland conservation, agricultural market development, and food hub management. The conference is an opportunity to network, develop new knowledge and skills, and visit farms and value-added processing facilities.
The gates and barns of 31 farms certified Appalachian Grown will be open to the public in this tour. Appalachian Sustainable Agriculture Project's self-guided driving tour is a chance to learn how food grows, taste farm-fresh treats, hang out with farm animals, and meet the community's food producers.
In this afternoon field day, explore how Radiance Dairy "harvests" alternative energy with a 40-kW wind turbine, solar-thermal water heater, solar-powered pumping system for livestock watering, and a geothermal heating and cooling system.
What is the nutritional value of King Ranch bluestem for cattle? My grass-fed stocker steers don't seem to like it. Is shredding it a good idea?