A lthough neonatal intensive care curriculums require teaching newborn resuscitation, the efficacy of current programs may be suboptimal (1,2). The neonatal resuscitation program (NRP) is widely used in Canada and the United States to provide learners with the basic steps in neonatal resuscitation; it has recently been updated (3).The skill set taught by the NRP often forms the basis of acute care training for paediatric residents and staff paediatricians working in hospitals with neonates. Additionally, the NRP is mandated for staff working on maternity floors. Assessment of the NRP has been infrequent, although there are reports that approximately 30% of the NRP steps are not performed or are performed incorrectly (4). Furthermore, it has been reported that residents are successful less than 50% of the time when attempting intubation, despite recent certification in the NRP (1,2,5). Several studies (6,7) have demonstrated that residents have relatively few opportunities to lead resuscitations, even by the end of their training. This precludes the consolidation of learned skill sets and the development of competence through experience.These reports are disconcerting and may be due to a number of factors, including methods used in teaching the neonatal resuscitation skill set. Different approaches to ©2009 Pulsus Group Inc. All rights reserved InTroDuCTIon: There are currently few studies describing the use of high-fidelity (hi-fi) simulation in teaching neonatal resuscitation. Traditionally, residents are certified in the neonatal resuscitation program (NRP) after successful completion of a multiple-choice written examination and demonstration of skills during a hands-on 'megacode'. In the present study, the use of a hi-fi simulation mannequin was compared with a standard plastic mannequin when teaching the megacode portion of the NRP. MeTHoDS: In the present pilot study, 15 first-year residents were randomly assigned to demonstrate neonatal resuscitation knowledge, with either the hi-fi mannequin (SimBaby, Laerdal Medical Corporation, USA) or a traditional plastic mannequin (ALS Baby, Laerdal Medical Corporation, USA). A written evaluation was conducted before and after the intervention. Each pair of residents experienced the two scenarios. Video performance was then assessed and compared. reSulTS: Residents randomly assigned to the hi-fi mannequin rated the experience higher (31±3.3 versus 27±3.5; P=0.026), and required less redirection from instructors during the megacode (scenario 1: 4.5±1.7 versus 15±6.9; P=0.015 and scenario 2: 1.8±1.3 versus 9.3±2.5; P=0.0009) than those who were randomly assigned to the plastic mannequin. Residents randomly assigned to the hi-fi mannequin did not have improved written scores or improved intubation times. ConCluSIonS:The present pilot study demonstrated that a hi-fi mannequin can be used as part of an educational program, such as the NRP. The use of this technology in neonatal resuscitation training is well-received by learners and may provide a more realistic model for ...

Background:The success in performing organ transplantations and prevention of rejection has resulted not only in a substantial increase in life expectancy, but also improvement in the patients' quality of life. Thus, women who underwent organ transplantation are now reaching puberty and the age of reproduction. This has presented new challenges regarding the teratogenicity and the long-term effect of immunosuppressive medications used by these patients. Previous studies have shown that pregnancies after renal transplantation are associated with an increased risk for both the mother and the fetus. There is, however, very little information available on neonatal and long-term pediatric follow-up of babies born to mothers who have undergone renal transplantation and have been exposed to immunosuppressive medications, compared to controls. We report the experience of our center, the largest in Canada, regarding the prenatal and long-term postnatal outcome of pregnancies after renal transplantation.