INTENSIVE CARE
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of enormous importance to women and children and families.”<br />
The National Institute of Child Health and Human Development<br />
the placenta “the least understood human organ and arguably<br />
one of the more important, not only for the health of a woman<br />
and her fetus during pregnancy, but also for the lifelong health<br />
of both.” In May, the institute gathered about 70 scientists at its<br />
first conference devoted to the placenta, in hopes of starting a<br />
human placenta project, with the goal of finding ways to detect<br />
abnormalities in the organ earlier, and treat or prevent them.<br />
Baseline renal parameters may useful in predicting the risk for<br />
preeclampsia among pregnant women, according to a study.<br />
The findings suggest that a creatinine of 0.75 mg/dL or greater<br />
and a urine protein-to-creatinine ratio [UPCR] 0.12 or greater<br />
are associated with adverse pregnancy outcomes in women<br />
with chronic hypertension, much lower cutoffs than previously<br />
used. The researchers retrospectively evaluated data from<br />
pregnant women (singleton gestation) seen for prenatal care<br />
from January 1, 2000, to June 1, 2014. Included women had a<br />
history of chronic hypertension, received prenatal care before<br />
20 weeks of gestation, and had a baseline UPCR and serum<br />
creatinine measurement before 20 completed weeks of gestation.<br />
The primary outcome was the development of preeclampsia at<br />
less than 34 weeks’ gestation; secondary outcomes evaluated<br />
were the development of severe preeclampsia at any gestational<br />
age, any preeclampsia, small for gestational age, preterm birth at<br />
less than 35 weeks’ gestation, and composite perinatal outcome<br />
including perinatal death, neonatal seizures, assisted ventilation,<br />
arterial cord pH lower than 7, and 5-minute Apgar score of 3<br />
or lower. The researchers included data on 755 women and<br />
set the cutoffs for severe preeclampsia at 0.12 or higher for<br />
UPCR and 0.75 mg/dL or higher for serum creatinine, noting<br />
that these thresholds are much lower than typically considered<br />
abnormal. Using these cutoffs, the researchers found that the<br />
area under the receiver operating characteristic curve for severe<br />
preeclampsia at less than 34 weeks was 0.74 (95% confidence<br />
interval [CI], 0.7 - 0.8) for the UPCR and 0.67 (95% CI, 0.6 - 0.8)<br />
for serum creatinine. Overall, with respect to proteinuria, the<br />
study authors found that a UPCR of 0.12 or higher translated to<br />
a sevenfold increase in the risk for severe preeclampsia at less<br />
than 34 weeks’ gestation compared with in women with normal<br />
UPCR values (16.4% vs 2.6%; adjusted odds ratio [OR], 7.5; 95%<br />
CI, 3.9 - 14.6). In addition, the researchers note that women<br />
with a serum creatinine level of 0.75 mg/dL or higher were three<br />
times more likely to develop severe preeclampsia at less than 34<br />
weeks’ gestation compared with women with serum creatinine<br />
values within the normal reference range (15.7% vs 4.6%,<br />
respectively; adjusted OR, 3.5; 95% CI, 1.9 - 6.3). Of note, severe<br />
preeclampsia at less than 34 weeks’ gestation was only found<br />
in 1.6% of patients when both baseline renal function tests were<br />
below the cutoffs. Secondary outcomes such as the development<br />
of mild preeclampsia and severe preeclampsia at any gestational<br />
age were also increased among women with UPCR and serum<br />
creatinine levels above the threshold. A baseline UPCR above<br />
the cutoff was also associated with an increased risk for preterm<br />
birth at less than 35 weeks’ of gestation (31.8% vs 16.4%; adjusted<br />
OR, 2.4; 95% CI, 1.6 - 3.5). The results for neonatal composite<br />
and small for gestational age, in contrast, were not significantly<br />
different between groups. The study authors suggest that the<br />
utility of baseline renal values in pregnant women with chronic<br />
hypertension has been questioned because reference ranges<br />
used to assess renal impairment have been based on data from<br />
Therapeutic Temperature Management System<br />
Neonatal Whole Body Cooling is shown to improve outcomes for newborns meeting the requirements for<br />
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accurate and safe patient temperature management. This system offers the ability to reach and maintain goal<br />
temperature as well as provides controlled re-warming for the patient.<br />
All Therapeutic Hypothermia disposables<br />
located in one convenient package<br />
Self sealing/insulated blanket hoses<br />
Mittens/Socks allow more family contact<br />
without compromising patient temperature<br />
All products tested and validated by CSZ<br />
for CSZ equipment<br />
1. Shankaran, Seetha, et al. “Outcomes of Safety & Effectiveness in a Multicenter Randomized, Controlled Trial of Whole-Body Hypothermia for Neonatal<br />
Hypoxic- Ischemic Encephalopathy.” Pediatrics 122 (2008): 790-799.<br />
2. Zanelli, S.A., et al. “Implementation of a ‘Hypothermia for HIE’ program: 2-year experience in a single NICU.” Journal of Perinatology 28 (2008): 171-175.<br />
Phone: 513-772-8810<br />
Toll Free: 800-989-7373<br />
Fax: 513-772-9119<br />
www.cszmedical.com<br />
neonatal <strong>INTENSIVE</strong> <strong>CARE</strong> Vol. 29 No. 4 • Fall 2016 13