Hi all

There seems to be a wide variation in survival and morbidity  in babies < 26 weeks. The data from Sweden and Japan are much better than the ones from rest of the world.

I would like to know if any one from Sweden or Japan will be willing to share their protocol in the management of Babies < 26 weeks. 

Thanks

Mike

Mike Sukumar MD

Rockville USA

Hi Mike,

I've been in meetings with the Japanese, and what they do is very simple (but easier said than done):  Always use non-invasive ventilation, and feed early and exclusively with breast milk. Formula is not an option.

Other things they have is excellent prenatal care, almost 100% of antenatal corticosteroids, and adequate staffing of their NICUS...

Hello, I don't have a good answer but I think there are some things more important than others.

Like Japan we have almost full coverage of antenatal care (free service for all). About 95% of pregnancies are ultrasound-dated, i.e. we have a uniform estimate of gestational age. Obstetric and neonatal services are fairly well "coordinated" and available to all. Level-3 NICU care is centralized to (7?) regional/university hospitals and the vast majority small infants are transferred in utero to their level-3 hospital. And, we have a relatively low proportion of really socially disadvantaged parents.

Apart from that we also have a tradition of non-invasive ventilation (nCPAP) also in tiny infants - I am not sure but it is likely this was a strategy that was developed due to less staffing and budgets initially...

The National Board of Health issued national guidelines recently on some key topics: those are only available in Swe though.... but here they are:

http://www.socialstyrelsen.se/publikationer2014/2014-9-10

However, I think there is a greater room for improvements in Sweden:

• we don't use probiotics
• our transportation services are rather regional "initiatives" than a results of a national strategy
• there are no national consensus whether 22-weekers should be resuscitated
• we could still "do less" of things that lack evidence but has potential side-effects
• we need to combat nosocomial infections better

Most importantly, despite the structure of care/society that enables really large observational studies (we can track /link individual data from birth to death, data in several national registries), we do hardly no intervention research.

Greetings from Sweden  

Hallo,

We have the babies from 23 weeks, and very often there developed anuria with oedema. Bun were to 15-18, creatinin to 135, and hyponatremia. Could you help us about it?