A retrospective comparison of VLBW outcomes before and after implementing new delivery room guidelines at a regional tertiary care center.

OBJECTIVE: To evaluate the impact of implemented protocol changes on delivery room interventions and very low birth weight (VLBW) health outcomes. STUDY DESIGN: Retrospective study comparing birth characteristics, interventions and health outcomes of VLBW infants born in a tertiary care center before (calendar years 2008 to 2009) and after (calendar years 2012 to 2013) implementing new protocols using Chi-square analyses. RESULT: Four hundred and nine were born before and 303 after changes were implemented. Postimplementation infants had more use of antenatal steroids (P=0.02), gestational age ⩽24 weeks (P=0.03) and birth weights between 501 and 750 g (P=0.04) and less oxygen administration (P=0.002), face mask ventilation (P=0.0001), surfactant use (P=0.0001), chest compressions (P=0.0001), intubation (P=0.002), epinephrine use (P=0.011), hypothermia (P=0.0001) and discharges home on supplemental oxygen (P=0.05). CONCLUSION: Changes creating a new delivery team, adopting new delivery practice guidelines and updating delivery room equipment resulted in positive outcomes for delivery room practices and patient outcomes.

Thermal defense of extremely low gestational age newborns during resuscitation: exothermic mattresses vs polyethylene wrap.

OBJECTIVE: The purpose of this study was to assess the effectiveness of thermal warming mattresses compared with wrapping in a polyethylene sheet during resuscitation in extremely low gestational age newborns (ELGANs) in preventing admission hypothermia in the neonatal intensive care unit. STUDY DESIGN: Patients delivered between 24 and 28 weeks gestation and ≤1250 g were eligible for this prospective, randomized study. In the delivery room, the resuscitation team opened a sealed opaque envelope for treatment group assignment to either the wrap or the sodium acetate mattress group. Resuscitation followed protocols recommended by the Neonatal Resuscitation Program. The primary outcome for this study was comparison of axillary temperatures recorded at the time of neonatal intensive care unit admission between the two groups. RESULT: Thirty-nine patients were enrolled in the study. The mattress group's mean admission temperature was 36.5±0.67, whereas the plastic wrap group's was 36.1±0.66 (P=0.0445). CONCLUSION: Thermal mattresses improved admission temperature for ELGANs over plastic wrap. Although both plastic wrap and thermal mattresses improve the thermal status of ELGANs, all current interventions fall short of truly protecting all these vulnerable patients from thermal stress.

Double-blind comparison of intravenous butorphanol (Stadol) and fentanyl (Sublimaze) for analgesia during labor.

OBJECTIVE: Our purpose was to compare the analgesic properties, effect on labor, and maternal-fetal side effects of intravenous butorphanol and fentanyl. STUDY DESIGN: One hundred patients with uncomplicated term pregnancies were enrolled during early active labor. Each patient received standard doses of either fentanyl (50 to 100 micrograms) or butorphanol (1 to 2 mg) hourly on request in a double-blind manner. Pain was scored independently by the nurse and patient with a 10-point visual analog scale. Categoric and measurement data were collected for comparison of the effects on uterine activity, maternal and fetal well-being, and neonatal outcomes. RESULTS: The fentanyl (n = 50) and butorphanol (n = 50) groups were identical with respect to maternal age, race, parity, and weight. Greater improvement in pain relief was found after the first dose of butorphanol than after fentanyl (p < 0.05). When fentanyl was given, either more doses were necessary (3.2 +/- 1.3 vs 2.1 +/- 1.1, p < 0.01) or epidural analgesia was requested more often (16%, 32% vs 9%, 18%, p < 0.05). Uterine contraction patterns for the first hour after dosing were unchanged, and the duration of the first and second stages of labor were not different between the two groups. No differences in maternal or newborn adverse effects were observed. CONCLUSIONS: Both drugs were equally safe and without effect on active labor. Butorphanol provided better initial analgesia than fentanyl with fewer patient requests for more medication or epidural analgesia.

Crystal structure of human recombinant interleukin-4 at 2.25 A resolution.

The crystal structure of human recombinant interleukin-4 (IL-4) has been solved by multiple isomorphous replacement, and refined to an R factor of 0.218 at 2.25 A resolution. The molecule is a left-handed four-helix bundle with a short stretch of beta sheet. The structure bears close resemblance to other cytokines such as granulocyte-macrophage colony stimulating factor (GM-CSF). Although no sequence similarity of IL-4 to GM-CSF and other related cytokines has been previously postulated, structure-based alignment of IL-4 and GM-CSF revealed that the core of the molecules, including large parts of all four helices and extending over half of the molecule, has 30% sequence identity. This may have identified regions which are not only important to maintain structure, but could also play a role in receptor binding.