Survey Shows Limited Adoption of the Avoidance of Mechanical Ventilation in Japan: A Cross-Sectional Study

To investigate Japanese perspectives on the avoidance of mechanical ventilation strategy for extremely preterm infants.

A web-based questionnaire was sent to the perinatal centres enrolled in the Japanese Neonatologist Association and the Japanese Society of Perinatal and Neonatal Circulatory Management. The enrollment window was between the 21st of July and the 31st of December 2021.

This survey covered 59% of the general perinatal centres in Japan. The study revealed that 64% of respondents would not attempt early continuous positive airway pressure strategy for extremely preterm infants. Intubation-surfactant-extubation and less-invasive surfactant administration were used in 58% and 11% of the institutes, respectively. Technical unfamiliarity, insufficient evidence, lack of videolaryngoscopy and concerns about potential complications hindered the implementation of less-invasive surfactant administration.

Early continuous positive airway pressure strategy was uncommon for extremely preterm infants. Intubation-surfactant-extubation was five times more popular than less-invasive surfactant administration. Lack of training, evidence, videolaryngoscopy and assurance were the key limiting factors for the uptake of less-invasive surfactant administration across Japan.