Ryo

Hi, all. I heard about this topic from Kasha, my colleague in Finland. I can share some differences between Japan (or at least Nagano Children's Hospital, my home hospital) and some other European NICUs from my own experience. Resuscitation As Gustaf mentioned in the post, manual bag ventilation is commonly used to resuscitate a baby, which allows us to "feel" the baby's lung condition. Some (as far as I know) NICUs resuscitate very preterm infants "in" an incubator. All the procedures including intubation or umbilical lines insertion are done in the incubator. Cord milking is still a common practice instead of delayed cord clamping. We do it very gently after their respiratory circulation has established, which we think is comparable with delayed cord clamping. Acute phase We tend in many ways to evaluate and stabilize their circulation: using ultrasound (every 8-12 hours?) to find the appropriate water intake and any supportive medications (catecholamines or corticosteroid), in many NICUs, using sedative drugs (fentanyl and/or phenobarbital), and use prophylactic indomethacin. The initial target water intake (the first 24 hours), 60-80 ml/kg/day, may be smaller than other countries. Of course, we would adjust the amount by assessing the necessary water volume by physiological signs, physical examinations, and ultrasound. This is available because we maintain 95% humidity in the incubator at least for the first 72 hours and minimize the time to open their windows. We also seldom offer skin-to-skin opportunities during this period, which might be our challenge in the future. Minimum handling may be more "minimum" than other NICUs who have similar outcomes regarding 22-23 weekers: we won't move the baby's trunk (or only a little bit) and keep it in a supine position, no weight measurement for the first 72 hours, no ECG monitor, and insert a urinary catheter to minimize diaper change opportunity. After a very acute phase We use HFOV to cope with respiratory difficulties more often than other countries. Some NICUs (or more than that) consider HFOV as not only a rescue use but also a long-term support method. Nowadays, NAVA has also become more common. Always be prepared for late-onset circulatory collapse, which sometimes happens to very preterm infants in Japan, at least. You may be able to understand something about our common practice in Japan by the following articles. However, it is difficult to summarize our practice because we have about 400 NICUs in Japan. https://pubmed.ncbi.nlm.nih.gov/34862068/ https://pubmed.ncbi.nlm.nih.gov/35154903/ Please note that I am not telling you that these managements are better than others. On the contrary, I am thinking that we still have many things to learn from your NICUs, especially, to improve their long-term outcomes. I might forget something important, but hope that this might help you think more about these infants' management in NICUs. I am happy to have your questions or comments.