Postpartum triage, services provided, and length of stay for infants born at 35 weeks gestation.

OBJECTIVES: The aim of this article is to (1) compare the care setting to which 35-week infants are initially triaged postpartum to the level of services subsequently provided; and (2) identify factors known at delivery or immediately postpartum associated with services received and length of stay during the birth hospitalization. STUDY DESIGN: In this multicenter retrospective study of 35-week infants born between 2007 and 2008, service capabilities of the initial postpartum care setting were categorized as level 1 or neonatal intensive care unit (NICU) using American Academy of Pediatrics definitions. Subsequent services actually provided were categorized as routine care, level 1, or >level 1. RESULTS: Over half of 431 studied infants were sent to a level 1 nursery postpartum. Of these, over 90% ultimately received routine care or level 1 services. Of 200 infants triaged to a NICU, the majority received only routine care or level 1 services. The great majority of infants requiring > level 1 services were identified promptly postpartum. Initial triage to the NICU was associated with significantly (p < 0.05) increased length of stay despite provision of similar services. CONCLUSIONS: This study suggests a need for improved triage of 35-week infants and provides tools for this purpose. Validation of the models presented here is warranted.

Phase II trial of weekly docetaxel/irinotecan combination in advanced pancreatic cancer.

BACKGROUND: Docetaxel and irinotecan have activity in pancreatic cancer. The combination of docetaxel and irinotecan is attractive because of preclinical evidence of synergy between the two drugs. We have previously demonstrated the safety of docetaxel 35 mg/m(2) and irinotecan 50 mg/m(2) given on days 1, 8, 15, and 21 of a 35-day schedule. PATIENTS AND METHODS: Patients who had unresectable or metastatic adenocarcinoma of the pancreas, bidimensionally measurable disease, Eastern Cooperative Oncology Group (ECOG) performance status 0-2, and normal bilirubin levels were eligible. Tumor assessment was performed with computed tomography, computed tomographic angiography, or magnetic resonance imaging every 2 cycles. Response was graded according to World Health Organization criteria. RESULTS: We enrolled 37 eligible patients. Principal grade 3/4 toxicities were diarrhea (21%), neutropenia (30%), and hyperglycemia (30%). There were 3 patients with febrile neutropenia and no toxic deaths. There were 4 early deaths. Among 36 evaluable patients, 9 (24%) attained a partial response and 1 (3%) attained a complete response for an objective response rate of 27%. One patient enrolled because she had been deemed to have unresectable disease but then underwent resection with negative margins after attaining a confirmed partial response. Median survival for all eligible patients is 9.4 months (range 0-68+ months) with minimum follow-up for surviving patients of 23.4 months. One-year survival is 43%. The patient who attained a complete response is alive with recurrent disease at 68 months. CONCLUSIONS: The docetaxel/irinotecan combination given on a weekly schedule is an active treatment for advanced pancreatic cancer.

Five-year update of an expanded phase II study of dose-dense and -intense doxorubicin, paclitaxel and cyclophosphamide (ATC) in high-risk breast cancer.

OBJECTIVES: This study evaluated the safety and efficacy of dose-dense and -intense sequential doxorubicin (A), paclitaxel (T) and cyclophosphamide (C) as adjuvant therapy for breast cancer (BC) with >or=4 ipsilateral axillary lymph nodes. METHODS: Patients were recruited after BC surgery if >or=4 axillary nodes were involved by metastatic cancer. Planned treatment was A 90 mg/m(2) three times every 14 days (q14d x 3), T 250 mg/m(2) q14d x 3 and C 3 g/m(2) q14d x 3 combined with filgrastim support. RESULTS: The study enrolled 85 eligible patients. The median number of lymph nodes involved was 9. Mean dose intensity was >94% of planned for each drug. Common grade 3 toxicities included nausea and/or vomiting (24%), mucositis (18%), neuropathy (16%), palmar-plantar erythrodysesthesia (12%), myalgia (6%) and arthralgia (6%). Grade 3/4 neutropenia occurred in 77 (91%) patients, and 32 (38%) patients had neutropenic fever. One patient developed acute leukemia. Sixty-nine (81%) patients are alive, and 59 (69%) patients are alive and free of distant disease at a median follow-up of 5 years. CONCLUSIONS: ATC is a feasible regimen for adjuvant therapy of high-risk BC, with a relatively low rate of relapse at the 5-year follow up.