ReviewPediatric research2026
Japan at the limits of viability: national experience and evolving outcomes of infants born at 22-23 weeks' gestation.
Review in Pediatric research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
0 citing papers in PubMed.
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Corrections and comments
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Infants born at 22-23 weeks' gestation represent the limits of viability with substantial international variation in outcomes. Japan has consistently reported some of the highest survival rates; however, the underlying healthcare systems and clinical practices have not been comprehensively synthesized. This review summarizes Japan's national experience using data from a nationwide network database, epidemiologic studies, clinical practice surveys, and international comparisons. Survival at discharge is approximately 60% and 80% for infants born at 22 and 23 weeks' gestation, respectively, with relatively low rates of severe intraventricular hemorrhage and necrotizing enterocolitis. Key healthcare system features include regionalized perinatal care promoting antenatal maternal transfer, a nationwide clinical network for benchmarking, and universal health insurance. Clinical practice is characterized by active resuscitation and meticulous, individualized, pathophysiology-based management, including invasive respiratory support, echocardiography-guided hemodynamic management, intensive neuroprotection, and specialized nursing care. The effectiveness of these practices remains uncertain, and further research is needed. Continuous outcome monitoring and quality improvement are essential to refine context-specific strategies. IMPACT: This review provides the comprehensive synthesis of Japan's national experience in the care of infants born at 22-23 weeks' gestation, integrating outcomes with healthcare system structures and clinical practices. It identifies key system-level and clinical factors-such as regionalized perinatal care, nationwide data-driven quality improvement, and pathophysiology-based management-that may contribute to Japan's high survival rates and relatively low morbidity. It highlights the importance of integrated "package-of-care" approaches and continuous outcome monitoring, offering insights that may inform strategies to improve outcomes at the limits of viability globally.
Identifiers
42881264What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.