# Nationwide survey on neonatal resuscitation across delivery facilities in Japan

## TL;DR

A nationwide survey in Japan found that neonatal resuscitation practices vary across delivery facilities, highlighting the need for better training and resource distribution.

## Contribution

This study provides a comprehensive assessment of neonatal resuscitation practices and guideline implementation across Japanese delivery facilities.

## Key findings

- Pulse oximeters are widely available, but ECG monitors and oxygen–air blenders are less common.
- Only 11% of facilities have experience using supraglottic airway devices.
- Implementation of revised guidelines varies by facility type, indicating a need for targeted training.

## Abstract

Neonatal resuscitation is crucial for transitioning to extrauterine life. The Neonatal Cardiopulmonary Resuscitation (NCPR) guidelines in Japan were first developed based on the 2005 International Liaison Committee on Resuscitation (ILCOR) recommendations and have since been revised approximately every 5 years. However, the extent of their implementation in clinical practice remains unclear. This study aimed to assess the current status of neonatal resuscitation practices.

We conducted a survey targeting 2297 delivery facilities in Japan. The questionnaire assessed equipment availability, provider training, and adoption of updated practices.

In total, 1553 facilities responded, of which 1505 were actively conducting deliveries. Therefore, the analysis was performed based on the responses from 1505 delivery‐performing facilities. Pulse oximeters were widely available, whereas electrocardiogram monitors and oxygen–air blenders were less common. T‐piece resuscitators were used in 32% of the facilities. Only 11% of the facilities had experience using supraglottic airway devices. Although 81% reported that all or almost all staff had completed NCPR training, 23 clinics lacked trained personnel. Regarding umbilical cord management in infants born before 28 weeks of gestation, cut cord milking was the most common method, followed by intact cord milking, early cord clamping, and delayed cord clamping.

Neonatal resuscitation systems are generally established across delivery facilities in Japan. However, the implementation of revised guidelines varies based on facility type. These findings offer important insights for the upcoming 2025 NCPR guideline revision and emphasize the need for targeted training and equitable resource distribution to improve neonatal outcomes.