The probability of neonatal respiratory distress syndrome as a function of gestational age and lecithin/sphingomyelin ratio.

We sought to define the risk of neonatal respiratory distress syndrome (RDS) as a function of both lecithin/sphingomyelin (L/S) ratio and gestational age. Amniotic fluid L/S ratio data were collected from consecutive women undergoing amniocentesis for fetal lung maturity at Yale-New Haven Hospital from January 1998 to December 2004. Women were included in the study if they delivered a live-born, singleton, nonanomalous infant within 72 hours of amniocentesis. The probability of RDS was modeled using multivariate logistic regression with L/S ratio and gestational age as predictors. A total of 210 mother-neonate pairs (8 RDS, 202 non-RDS) met criteria for analysis. Both gestational age and L/S ratio were independent predictors of RDS. A probability of RDS of 3% or less was noted at an L/S ratio cutoff of > or = 3.4 at 34 weeks, > or = 2.6 at 36 weeks, > or = 1.6 at 38 weeks, and > or = 1.2 at term. Under 34 weeks of gestation, the prevalence of RDS was so high that a probability of 3% or less was not observed by this model. These data describe a means of stratifying the probability of neonatal RDS using both gestational age and the L/S ratio and may aid in clinical decision making concerning the timing of delivery.

Domestic violence homicide in Oklahoma: 1998-1999.

BACKGROUND: Domestic violence homicide is a significant public health issue for healthcare providers. The objective of this study was to review all domestic violence homicides in Oklahoma from 1998-1999 in order to identify strategies to prevent domestic violence homicides. METHODS: All domestic violence homicides from the years 1998-1999 were identified and reviewed by the Oklahoma Domestic Violence Fatality Review Board (ODVFRB) through records provided by the Oklahoma State Bureau of Investigation (OSBI) list of homicides resulting from domestic violence. In addition eleven other sources were utilized to compliment the OSBI data. RESULTS: The ODVFRB reviewed 113 domestic violence fatalities in Oklahoma for the years 1998-1999. Of the 113 cases reviewed, 69 (61%) were committed by intimate partners (IP) and 44 (39%) were committed by other family members. Sixty-two percent of perpetrators had a documented history of committing domestic violence. Law enforcement had responded to domestic disturbances before the death event in at least 32% of the fatal cases. Firearms were used in 59% of the homicides. CONCLUSIONS: Through in depth multidisciplinary review of domestic violence homicide cases and subsequent system changes, domestic violence deaths can be prevented.