Moderate and extended neonatal resuscitations occur in one in 10 births and require specialist cover 24 hours a day.

AIM: Neonatal resuscitation requires minimal equipment, but the immediate availability of expert staff accounts for the largest proportion of the costs. Despite this, staff requirements and timetables are currently planned without comprehensive epidemiologic data. The aim of this study was to evaluate the staffing required for neonatal resuscitations in the delivery room. METHODS: We measured attendance for each specific role in a tertiary university-affiliated hospital and for four possible intervention levels: preparation time, basic paediatric care, moderate resuscitation and extended resuscitation. RESULTS: Between 2005 and 2012, resuscitation staff attended 11 561 of the 32 799 births: 27.2% for preparation time, 17.7% for basic paediatric care, 6.4% for moderate resuscitation and 3.5% for extended resuscitation. Moderate and extended resuscitations occurred in roughly 10% of births and evenly during 24-h periods. Basic paediatric care levels were higher during weekday mornings, and extended resuscitations were uniformly distributed. However, there was a drop in all types of interventions around 7 a.m. to 8 a.m., when staff were changing shifts. CONCLUSION: Moderate and extended resuscitations occurred evenly over 24 h in roughly 10% of births, stressing the importance of having a highly competent neonatal team constantly available. All activities associated with resuscitation were lower during morning shift changes.

Radiopacity of current endovascular stents: evaluation in a multiple reader phantom study.

PURPOSE: To evaluate the radiopacity of endovascular stents based on the fluoroscopy mode in a phantom of the human pelvis. MATERIALS AND METHODS: The following stents were included in this study: Medtronic AVE Bridge, Medtronic AVE Bridge X, Cordis Covered Nitinol (Covent), Guidant Dynalink, Luminexx, Guidant Megalink, Memotherm Flexx, Palmaz Medium, Palmaz-Schatz Long-Medium, Palmaz Corinthian PQ394Q and PQ294Q, SelfX, SMART without markers, SMART with radiopaque markers, Easy Wallstent. To evaluate radiopacity, images of the stents placed in four different positions (lumbosacral junction left and right, iliosacral joint left and right) of a pelvic phantom were taken at the following modes: spotfilm, continuous fluoroscopy, 15 pulses per second, 7.5 pulses per second, and 3 pulses per second. Images were presented at random to four independent readers and radiopacity scores were assessed: 0 = not visible, 1 = poor visibility, 2 = average visibility, 3 = good visibility, and 4 = very good visibility. RESULTS: The Covent stent had the highest overall radiopacity score (3.25), followed by the Luminexx (3.04) and the Medtronic AVE Bridge X (2.74) stents. At the spotfilm mode, the best visible stents were the Medtronic AVE Bridge X, the Covent and the Easy Wallstent stents and at the continuous fluoroscopy mode, the Covent, the Luminexx, and the Medtronic AVE Bridge X stents. Decreasing the fluoroscopy mode went hand in hand with a reduction of the radiopacity scores of all stents. At the standard fluoroscopy mode of 7.5 pulses per second, the Covent stent was seen well or very well in 96.9%, followed by the Luminexx (76.9%), and the Medtronic AVE Bridge X (41.25%) stents. CONCLUSIONS: Stent radiopacity directly depends on the fluoroscopy mode; if the pulse frequency decreased, detecting the stents became more difficult. Stent mass correlates with stent radiopacity (e.g., Cordis Covered Nitinol, Bridge X). Radiopaque markers may improve stent radiopacity dramatically (e.g., Luminexx vs Memotherm Flexx).