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Children's National News - Spring 2010

Low Levels of Vitamin D Linked to Higher Rates of Asthma in African American Kids

Researchers at Children’s National Medical Center have discovered that African American children with asthma in metropolitan Washington, DC, are significantly more likely to have low levels of vitamin D than healthy African American children.

This study supports recent research that suggests vitamin D plays a greater role in the body than just keeping bones healthy. Vitamin D deficiency has been recently linked to a variety of non-bone related diseases including depression, autoimmune disorders, and now asthma.

“African Americans are more likely than other racial groups to have low levels of vitamin D,” said Robert Freishtat, MD, MPH, an emergency medicine physician and lead author on the study. “After adjusting for differences in age, weight, and the time of year of the testing, the odds of these kids with asthma being vitamin D deficient were nearly 20 times those of healthy kids.”

The research team found that 86 percent of the children in the study with asthma had insufficient levels of vitamin D, while only 19 percent of non-asthmatics had these low levels. These findings may mean that low vitamin D levels have more serious effects on a child’s lung health than previously believed. Though more research is needed to establish definitively how vitamin D deficiency can contribute to asthma, parents can ensure that their children receive healthier amounts of vitamin D by following the current USDA guidelines for milk consumption and seeking a doctor’s advice about multivitamins.

“The District of Columbia has among the highest rates of pediatric asthma in the United States, and we’re working to find out why,” says Stephen Teach, MD, MPH, senior author of the study. “For African American kids with asthma, vitamin D testing and ensuring adequate vitamin D intake may need to become necessary steps in their primary care.”

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General Anesthesia Results in Carbon Monoxide Exposure in Young Children

Doctors at Children’s National Medical Center have found carbon monoxide levels in the blood of young children increase during routine general anesthesia. Because carbon monoxide can be generated as a byproduct of anesthesia, anesthesiologists world-wide use specific precautions to prevent and limit its production. However, Richard J. Levy, MD, Chief of Cardiac Anesthesiology, has found for the first time that, under certain circumstances, infants and children may be exposed to carbon monoxide during routine anesthesia resulting in a rise in the carbon monoxide levels in the child’s blood.

Dr. Levy’s team identified the conditions in which carbon monoxide may be inhaled during anesthesia:

  1. The first study demonstrated that carbon monoxide detected in the breathing circuit correlated with the increase in blood levels in children 2 years of age and higher. The study included 15 patients between 4 months and 8 years.
  2. They also have identified that the patient’s own exhaled carbon monoxide may be “re-breathed” during “low-flow” anesthesia, the current standard of care, where the fresh gas flows more slowly into the circuit, rather than rapidly.

Much remains unknown regarding the effects of low-dose carbon monoxide exposure on the developing brain. Several recent studies have suggested there may be a link to hearing impairments. Though there is more research to be done to determine these impacts, Dr. Levy recommends two immediate changes that will eliminate the risk of carbon monoxide exposure in children:

  • In the anesthesia machine, use carbon dioxide absorbents that lack strong metal alkali and do not degrade inhaled anesthetics (avoids CO production risk)
  • Avoidance of low-flow anesthesia (avoids CO re-breathing risk)

Following Dr. Levy’s study findings, Children’s National switched to the recommended absorbent to minimize the risk to patients. Although the sample size is small, the results are compelling and Dr. Levy believes changes should be implemented. Dr. Levy’s research has been named the top study out of 600 at the International Anesthesia Research Society 2010 meeting, and won the John J. Downes Research Award for best abstract at the upcoming Society of Pediatric Anesthesia/American Academy of Pediatrics 2010 Annual meeting.

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Introducing the Center for Molecular Physiology Research

“Lifestyle can trump genetics,” says Pedro A. Jose, MD, PhD, director of the new Center for Molecular Physiology Research.

Though it might be surprising to hear a basic scientist make the argument that external choices could overrule centuries of genetic evolution and established biochemical processes, his pronouncement focuses on one specific area where this is true: overcoming essential hypertension, or high blood pressure that occurs for no known reason.

Dr. Jose and his team believe that unlocking the root causes of essential hypertension will help doctors identify this disorder before serious complications occur, and when diet and exercise could have a greater impact on managing high blood pressure. They believe they can do this through intensive study of one of the body’s primary regulators, the kidney. Last year, Dr. Jose brought a team of nephrology, genetic, veterinary, and basic science experts together at Children’s National to continue studies of the kidney’s most basic processes, and the cellular signaling and functions that make this complex organ effectively function.

The kidney isn’t just a sodium regulator, however. The team also studies the many other ways this delicate organ packs a powerful punch in the day-to-day operation of the body. Led by veteran Children’s National researcher and Robert Parrott Professor of Pediatrics Patricio Ray, MD, the center investigates basic and translational science of other key renal functions and processes, including the causes and effects of the devastating nephropathy often seen in patients with compromised immune systems, specifically those with HIV-AIDS.

There is still no definitive explanation as to why some children are prone to high blood pressure and others are not, but researchers in the center are beginning to make headway in understanding how the kidney factors in. As a result, they also are close to identifying potential biomarkers that would indicate hypertension and other renal diseases faster, before the long term effects of these disorders begin to take hold, and while diet and exercise interventions might have a chance to improve the lives of those who face a lifetime struggle with high blood pressure.

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Defining A New Era in Pediatric Surgery


The Sheikh Zayed Institute for Pediatric Surgical Innovation
On September 16, 2009, Children’s National Medical Center announced the creation of the Sheikh Zayed Institute for Pediatric Surgical Innovation, made possible by an historic philanthropic gift from the Government of Abu Dhabi. The $150 million gift will allow the hospital to bring together surgeons and researchers to make surgery more precise, less invasive, and pain-free for children around the world.

The Institute will focus on four initiatives that together will open a new era for pediatric surgery:

  • Pain Medicine: The team’s goal is to eliminate pain before, during, and after surgery, by accurately measuring pain and identifying more effective medications and treatments.
  • Bioengineering: Surgeons and researchers will harness the full power of biomedical imaging and the computational sciences to achieve unprecedented levels of precision.
  • Immunology: The Institute team will seek innovative immunotherapies to suppress or stimulate a child’s own immune system to cure disease – in many cases, eliminating the need for surgery.
  • Systems Biology: The decoding of the human genome will allow surgeons and researchers to personalize surgery for every child based on his or her specific genetic makeup.

Learn more about the Institute, request Children’s Annual Report or watch a video detailing the transformational gift to Children’s National and the creation of the Sheikh Zayed Institute for Pediatric Surgical Innovation.

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Reducing the Risk of Sudden Infant Death Syndrome

Although the number of deaths from SIDS has decreased in recent years, about 2,500 babies die from SIDS each year. Children’s National has a team of researchers, doctors, and staff committed to learning more about SIDS and educating parents about ways to reduce the risk of SIDS.

Find out more facts about SIDS and request a free copy of the Reducing the Risk of SIDS poster for physician offices or waiting rooms (while supplies last). The poster is in English language on one side and Spanish language on the other.

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Children’s National Alumni nnual Reception at the Pediatric Academic Society Meeting

Children’s National Alumni

Annual Reception at the Pediatric Academic Society Meeting

Sunday, May 2, 2010
7:30-9 pm PST
Port Alberni Room, Sheraton Vancouver Wall Centre

Register by April 29, 2010

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