Blood pressure goals: Is cerebral saturation the new mean arterial pressure?

Objective: To correlate hypotension and cerebral saturation from near-infrared spectroscopy (cNIRS) in neonates on dopamine. Study Design: Retrospective review of neonates receiving dopamine between August 2018-2019 was performed. Hypotension thresholds included mean arterial pressure (MAP) of postmenstrual age (PMA) ± 5mmHg, 30mmHg, and gestational age (GA) ± 5mmHg. Time below threshold MAP was compared to time with cerebral hypoxia (cNIRS <55%). Results: Hypotension occurred 6-33% of time on dopamine in 59 cases. Hypotension did not correlate with abnormal cNIRS overall, within PMA subgroups, or by outcomes. Hypotensive periods with MAP<GA had fewer corresponding percent time with abnormal cNIRS events (3.7±1.3%) compared to MAP <PMA (11.9±4.9%, p<0.003) or 30 mm Hg thresholds (12.2±4.7%, p<0.0001). In the most premature infants, mean cNIRS values during hypotension were still within normal range (57±6%). Conclusion: cNIRS may be a more clinically relevant measure than MAP for assessment of neonatal hypotension.

Diabetic nephropathy in type 1 diabetes and pregnancy. Modern view of the problem

Diabetic nephropathy (DN) is specific kidney damage in patients with diabetes mellitus. DN develops relatively often in pregestational diabetes patients (5,9-26%) and stills one of the main limitations for successful pregnancy in this patients’ group. Advanced DN increases risks of poor pregnancy outcomes for women and fetuses including chronic kidney disease (CKD) progression, high rate of preeclampsia, preterm deliveries, Cesarean sections, perinatal mortality and neonatal morbidity. At the same time there are more and more successful pregnancies with advanced DN in the wold.In our paper we systematize global experience of planning and management pregnancies with type 1 diabetes and DN in different stages of renal impairment. We discuss role of nephroprotective therapy in preconception care, achievement and maintaining blood pressure goals, multidisciplinary team care for improvement pregnancy outcomes in type 1 diabetic women with DN.