-Original-

Neonatal Intensive Care for Preterm Very Low-Birth-Weight Infants at a Medical School-Affiliated Neonatal Intensive Care Unit

Yoshio Shima¹, Keishi Yoshida¹, Tamaho Suzuki¹, Makiko Mine¹, Masanori Abe¹, Takashi Matsushima² and Makoto Migita³

¹Department of Neonatal Medicine, Nippon Medical School Musashi Kosugi Hospital, Kanagawa, Japan
²Department of Obstetrics and Gynecology, Nippon Medical School Musashi Kosugi Hospital, Kanagawa, Japan
³Department of Pediatrics, Nippon Medical School Musashi Kosugi Hospital, Kanagawa, Japan

Background: The standard of care in Japan for preterm very low-birth-weight (VLBW) infants has long been at the highest level internationally, owing to advances in technology and the perinatal medical system throughout the country.
Methods: To identify issues for further improvement of outcomes for preterm VLBW infants in our neonatal intensive care unit (NICU), perinatal care practice was reviewed by analyzing data from medical records on pregnancy complications and management and infant mortality and morbidity.
Results: Data from 250 preterm VLBW infants, excluding those with severe congenital anomalies, were analyzed. There were 49 cases (19.6%) of cumulative morbidity, including infants who died before discharge and those who had major complications such as bronchopulmonary dysplasia, intraventricular hemorrhage/periventricular leukomalacia, and retinopathy of prematurity. The prevalence remained constant throughout the study period. Infants born via medically indicated preterm birth had a higher cumulative morbidity rate than those born via spontaneous preterm birth. Small-for-gestational-age status was the only factor significantly associated with cumulative morbidity in multivariate analysis. Of all the infants, 69 (47.3%) completed a course of antenatal corticosteroids (ACS).
Conclusions: The quality of neonatal intensive care for preterm VLBW infants in our NICU was consistent with outcomes for top-ranked NICUs in Japan. Critical issues in improving outcomes for these infants include determining the optimal timing of delivery by comprehensively assessing fetal well-being and promoting ACS.

J Nippon Med Sch 2025; 92: 262-267

Keywords
neonatal intensive care, very low-birth-weight infant, preterm birth, perinatal medical system

Correspondence to
Yoshio Shima, Department of Neonatal Medicine, Nippon Medical School Musashi Kosugi Hospital, 1-383 Kosugi-cho, Nakahara-ku, Kawasaki, Kanagawa 211-8533, Japan
shima-p@nms.ac.jp

Received, October 28, 2024
Accepted, February 21, 2025