David Reuter, MD, PhD, a pediatrician at Allegro Pediatrics and a consultant with Seattle Children’s and PATH, is dedicating his career to helping children grow up as healthy, valued individuals. At Purdue University, which supported his medical school and PhD in engineering studies, Dr. Reuter developed a foundation for thinking big and making a difference. Since then he has carved out a career focused on creating solutions to unsolved problems. Purdue’s trust and generosity also led to his own commitment to others—both in preparing the next generation of care providers to create positive change, and in supporting parents. “The parents and children I meet handle their challenges with extraordinary strength, dignity, and courage,” says Dr. Reuter. “They inspire me to not simply manage the status quo; I feel compelled to make a larger difference.” His approach reflects perfectly Allegro Pediatrics’ commitment to giving children a healthy future, by partnering with families to heal, nurture, and empower each child in their journey to adulthood.
Earlier in his career, Dr. Reuter, an innovator in both engineering and medicine, invented a cardiac implant for patients with heart failure and trained doctors around the world how to use it. Building on his experience of innovation, development, health improvement, and patient appreciation, Dr. Reuter’s research work now focuses on saving the lives of pregnant women and babies locally, nationally, and globally.
He understands that pregnancy and childbirth are universal. And that at the personal level, all expectant parents wonder, will we have a healthy baby? He cares deeply about a big problem some women face: high blood pressure, preeclampsia, and premature birth. So he has rolled up his sleeves and set out to tackle the problem. This November, Dr. Reuter and his research colleagues had a manuscript, “Can preeclampsia be considered a renal compartment syndrome? A hypothesis and analysis of the literature,” published in the Journal of the American Society of Hypertension. Those are some pretty clinical words, but the goal is clear: What do we know about these problems and how do we build on important findings?
Preeclampsia most often leads to premature birth. Of the 15 million premature births each year throughout the world, 20 percent are caused by preeclampsia. We have all known or seen pictures of premature babies—tiny bodies, machines, tubes, and worried parents, trying to help their families adjust to the “new normal” of stress and worry. Premature birth is associated with a variety of problems—neurological, heart, digestive, lungs, immune system, vision, and more. Some preemies are not developed enough to survive, some heroically struggle to stay alive, and some live with chronic problems, such as cerebral palsy, learning disabilities, and vision challenges.
Supported by Seattle Children’s Guild Association, Dr. Reuter and his co-researchers reviewed many studies that examined the nature of preeclampsia—how it develops, how to identify it, what successful interventions have been used—and came upon a goldmine of information. “We simply followed the science and identified important clues,” says Dr. Reuter.
These studies confirmed what the researchers thought. A pregnant woman’s uterus, with its growing fetus, can block blood flow out of the left kidney by pressing on the left renal vein. The pressure can build up in the kidney, and produce a hormone that signals the body to retain fluid and raise blood pressure. As time goes on this can injure the pregnant woman’s kidney cells and cause permanent damage. Each woman’s unique anatomy, and other factors, such as obesity and carrying more than one fetus, helps determine her risk of preeclampsia and how severe it will be. The great hope of this manuscript and a new, follow-up study, is that seeing problems early and keeping them from worsening can be lifesaving.
One excellent finding that Dr. Reuter and his team came across in their review was a simple “roll-over” test that showed that if a woman’s blood pressure rises when she goes from lying on her left side to her back, she will develop high blood pressure and possibly preeclampsia. If she spends more time on her left side each day, her health can improve. With a sense of urgency to explore novel ways to diagnose and prevent these problems, Dr. Reuter believes that simple solutions could save women and babies from distress and possibly death. Just like cars have changed and gotten more fuel efficient over time, and computers today are faster than 10 years ago, he believes that building on these earlier studies about preeclampsia and prematurity will get us closer to his vision of healthy children around the world.
In future clinical trials, Dr. Reuter sees value in searching for answers to questions like: What if we do these roll-over tests all during a woman’s pregnancy, rather than performing it when she is 28–32 weeks along? What will help women who develop high blood pressure early in their pregnancy? What will keep high blood pressure from developing into preeclampsia? What positions and activities, for example, swimming with tummy down, are effective for prevention? Continued partnership between the pediatric and obstetric community with organizations like Seattle Children’s and PATH should catalyze the ongoing efforts to further refine care for women and children locally and globally.