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  • Survival and unique clinical practices of extremely preterm infants born at 22–23 weeks’ gestation in Japan: a national survey

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Original research
Survival and unique clinical practices of extremely preterm infants born at 22–23 weeks’ gestation in Japan: a national survey
  1. Tetsuya Isayama1,
  2. Kei Miyakoshi2,
  3. Fumihiko Namba3,
  4. Mariko Hida4,
  5. Ichiro Morioka5,
  6. Keisuke Ishii6,
  7. Susumu Miyashita7,
  8. Shuichiro Uehara8,
  9. Yoshiaki Kinoshita9,
  10. Sachie Suga10,
  11. Katsutoshi Nakahata11,
  12. Atsushi Uchiyama12,
  13. Katsufumi Otsuki13
  1. 1 Division of Neonatology, National Center for Child Health and Development (NCCHD), Tokyo, Japan
  2. 2 Obstetrics and Gynecology, International Catholic Hospital, Tokyo, Japan
  3. 3 Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
  4. 4 Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
  5. 5 Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
  6. 6 Department of Maternal Fetal Medicine, Osaka Women's and Children’s Hospital, Izumi, Japan
  7. 7 Department of Maternal Fetal Medicine, Miyagi Children’s Hospital, Sendai, Miyagi, Japan
  8. 8 Department of Pediatric Surgery, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
  9. 9 Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
  10. 10 Department of Obstetrics and Gynecology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
  11. 11 Department of Anesthesiology, Kansai Medical University, Hirakata, Osaka, Japan
  12. 12 Department of Pediatrics, Tokai University School of Medicine, Isehara, Kanagawa, Japan
  13. 13 Department of Obstetrics and Gynecology, Showa University Koto Toyosu Hospital, Koto-ku, Tokyo, Japan
  1. Correspondence to Dr Tetsuya Isayama; isayama-t{at}ncchd.go.jp

Abstract

Objectives To investigate prognosis and clinical practices of infants born at 22–23 weeks’ gestational age (wkGA) in Japan.

Design A national institutional-level electronic questionnaire surveys performed in September 2021.

Setting All perinatal centres across Japan.

Patients Infants born at 22–23 wkGA in 2018–2020.

Main outcome measures Proportion of active resuscitation and survival at neonatal intensive care unit (NICU) discharge, and various clinical practices.

Results In total, 255 of 295 NICUs (86%) responded. Among them, 145 took care of infants born at 22–23 wkGA and answered the questions regarding their outcomes and care. In most NICUs (129 of 145 (89%)), infants born at 22+0 wkGA can be actively resuscitated. In almost half of the NICUs (79 of 145 (54%)), infants born at ≥22+0 wkGA were always actively resuscitated. Among 341 and 757 infants born alive at 22 and 23 wkGA, respectively, 85% (291 of 341) and 98% (745 of 757) received active resuscitation after birth. Among infants actively resuscitated at birth, 63% (183 of 291) and 80% (594 of 745) of infants born at 22 and 23 wkGA survived, respectively. The survey revealed unique clinical management for these infants in Japan, including delivery with caul in caesarean section, cut-cord milking after clamping cord, immediate intubation at birth, hydrocortisone use for chronic lung disease, analgesia/sedation use for infants on mechanical ventilation, routine echocardiography and brain ultrasound, probiotics administration, routine glycerin enema and skin dressing to prevent pressure ulcers.

Conclusions Many 22–23 wkGA infants were actively resuscitated in Japan and had a high survival rate. Various unique clinical practices were highlighted.

  • Mortality
  • Resuscitation
  • Intensive Care Units, Neonatal
  • Neonatology

Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information.

https://doi.org/10.1136/archdischild-2023-326355

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplemental information.

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    Footnotes

    • Contributors TI conceptualised and designed the study, designed the data collection instruments, collected data, performed the analyses, drafted the initial manuscript, and critically reviewed and revised the manuscript. KM conceptualised and designed the study, designed the data collection instruments, collected the data, and critically reviewed and revised the manuscript. FN, MH, IM, KI, SM, SU, YK, SS, KN, AU and KO conceptualised and designed the study, reviewed the data collection instruments, and critically reviewed and revised the manuscript. TI is guarantor.

    • Funding This study was supported by the Japan Society for Perinatal and Neonatal Medicine (JSPNM). The English editing service was supported by JSPS KAKENHI (grant no: JP22K07929).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.