Nyoro

In Japan, national government grants cover the medical care for any child born under 2500g, which ends up covering almost all the preemies. The only thing parents have to pay for is "nutritional needs" and "room"... Non-vitamin nutritional supplements aren`t covered - thickeners, milk, etc. I guess that the room charge is some micro percentage of the NICU space. On average, it`s around $200 to $300 a month. I`ve never heard of any big problems with parents paying for NICU stays, even long term ones. The grant only applies for a year, but usually any care after that is covered until 2 by the city. (Depending on the city though, that can range anywhere from 18 months to 12 years.) If the child is in hospital care for over 2 years then they usually have some sort of condition that would make them eligible for some other grant. When my son was in the NICU (25 weeker, 437g, in for 5 months), we would get monthly statements from our insurance telling us how much was actually spent on his care, along with a tiny bill for what wasn`t covered. The first couple months ran about $200,000 a month if you don`t count the first week... The first 3 days were $50,000 a day! I can see where this would really ruin your finances - even if you were only paying 20%. I always did wonder how that worked in the US though - especially with drug related preemies, etc. The parents definitely wouldn`t have any way to pay... We`re lucky in that I`ve never even heard of a drug related preemie in our NICU - Japan just doesn`t have that problem. (Thank God!) -Nyoro (Volunteer at an NICU in Japan)

Thanks - but all I really do now is try to offer some support, and to show the more shocked and depressed mothers that there is hope... And that the little red wrinkled thing in the box does eventually turn into a baby. :wink2: In our case, the placenta didn`t properly form and there was only one umbilical artery. Around 23 weeks it seems that the placenta started deteriorating and leaking contamination into my bloodstream. I started going into shock (Apparently, I felt fine though.) and my body started cutting off everything to my son. His blood thickened and he suffered a stroke. At the 25 week point, he totally stopped moving. When I went to the hospital they couldn`t even *find* the umbilical cord on the ultrasound, and I ended up being sent pretty much straight to surgery. He was pretty severely IUGR and dehydrated at "birth". From the moment I knew he`d have to come out, I begged the doctors just to let him be and to let him die in peace. I assumed that care for any baby that small was just prolonging the inevitable, and causing unnecessary pain. They overrode me as the law here says that after 24 weeks, the child is a separate patient and must be given care. I did to put a DNR on him after a week, but he never dropped low enough for it to come into consideration. Other than a few hiccups (MRSA is the big one), the NICU stay was a smooth ride. No NEC, no IVH, every problem other than ROP resolved without surgery, etc. I`m one of those people who instead of getting upset about something, *research* it. By the time he was discharged at 5 months I had read an entire syllabus of medical books. The more I know, the less I have to fear from ignorance. I figured that since I had read that much ANYWAY, I`d might as well put forth a little more effort and actually work toward being licensed. That`s taking quite a bit of time though, as my son is a bit demanding of my attention. Plus, most of the medical texts I read were imported from the US. The ones they test you on here are (obviously) Japanese, and Japanese medical terminology is a pain to memorize.

I really don`t know all that much detail about her case - I don`t have much to do with her other than disinfecting her plush toys and occasionally talking to her mother. But I do know that she DOES respond to attention, and turns her head and smiles in response to her name, and shows understanding in other situations - so she isn`t just a vegetable... But according to her mother, that makes it all the worse. I think that the opinion right now is that she *does* have the potential to improve, but that her physical condition is holding her back - hence the transplants. The thing is, in Japan, a child on a transplant list is just basically a formality. It is illegal here to remove organs from someone who isn`t old enough to give consent or put themselves on a list. The only thing it means is that she`ll get priority if she survives to the point where they can use an adult donor.

I`ve been away from this board for a while - actually doing some studying. Hard to manage with a demanding 2 year old around. That poor little baby... I really feel bad for her. And for the parents, in a different way. There is nothing that depresses or frustrates me more than parents who outright refuse to see reality. Sometimes there really only IS so much you can do. I may sound cold, but if those parents really understood what having their little girl hold on even longer REALLY meant for her, they would be happy she has the chance to pass on early in the game. Right now, I volunteer "support" in our NICU - trying to cheer mothers up, helping snuggle and feed, and then giving my "mother" advice. Parents tend to like to listen to someone who has been through a similar ride, but who isn`t a "real nurse". We only have one serious chronic in our unit right now. She has never been well enough to transfer out (We transfer out the chronics over 1 as soon as they can survive on lesser care.) She is 4 now, never been out of a hospital bed, never sat up on her own, on waiting lists for various transplants, etc. Even if she gets the transplants, she had a bilateral grade 4 IVH plus PVL, is blind, and seizes at least 20 times a day. Her mother fought and fought for her care... Until she DID get well enough to sort of survive. And THEN she thought about it. Now she regrets it, but it`s too late. She also volunteers to talk to mothers who are at the care crossroads... And most of them choose to let their baby go. I guess we`re lucky in that we never get the "God`s will" sort of talk in our unit, and I`ve only once seen a truly angry parent (36 week twins, bedded together, delayed their homecoming by one day because one of them had softer stool than usual. Better safe than sorry in my opinion, but not the dad`s!) We tend to get the weepy, must be the perfect mother! moms. The ones who sit 8 hours next to their baby`s isolette with teary eyes. By the way, our unit`s policy is 24 weeks or >500g. We get puffy 22 weekers sometimes, and bony 27 weekers too. The smallest we`ve had make it was 437g/25w. (My son, who I actually fought with the doctors to NOT give him care. I didn`t think anything so small could survive with any quality of life. Luckily, the didn`t listen to me, and now I have a virtually normal little boy.)

Our NICU actually encourages cosleeping with preemies! (As in providing a lot of booklets about it when the baby is discharged.) Apparently they did a study here (Japan) that showed babies who coslept hardly ever had SIDS. If I remember the figures correctly, the "cosleeping effect" more than tripled in preemie cases and was shown to drastically reduce abuse by stimulating bonding. As cosleeping is the norm here, almost NOONE has heard of SIDS - even a lot of doctors. Most of the papers we give out about it say things like "Just because your baby slept alone in the NICU doesn`t mean that they should at home! Motherly instinct may keep your baby from having apnea!" According to the study info we have, over 80% of the test mothers woke within 20 seconds of their baby ceasing to breathe, usually only halfway, but enough to stimulate the baby... which is one of the possible things helping the low SIDS rate. I know there is a lot of pressure for babies to sleep alone, but unless you have something preventing you from having "normal" sleep awareness (ie. medications, alcohol, medical condition) it is really not unsafe at all. Cosleeping really is the norm here, in almost all situations, and the SIDS rate is less than 1/10th that of the US. Food for thought.

I myself want to know more, but here is what I know now: While CPAP provides constant air pressure, DPAP is multi-level. It has a very low base pressure, but gradually ups the pressure when it detects a decrease in air intake. It supposedly stimulates more "normal" breathing patterns, but still prevents apnea. Sort of like CPAP that only comes on when you need it, and self adjusts the pressure to the what you need.

I am curious as to which is used at other hospitals - CPAP, DPAP, or both - and when. I have heard that DPAP is more cost prohibitive, etc. Is this true? What are the factors in deciding whether you use CPAP or DPAP? In our hospital, we use CPAP only when intubated and when apnea is a really signifigant problem. Otherwise, it`s always DPAP, advancing to N-DPAP after extubation. We NEVER use CPAP once the baby has been extubated. Our NICU has a very low rate of chronic lung problems, and we almost never have babies go home on O2 or monitors. I am wondering if the CPAP/DPAP difference has anything to do with this. The head neonatologist just says "We use it because it works better, and is easier to wean off of", but I`d like to know a bit more! Thanks!

I hate to write so much here, but *I* too am a parent. I too have been through the entire NICU experience from the parent perspective. And I STILL would never want them to let anyone other than the mother and father in. My son was born at 25 weeks, weighing 437 grams, and was in the NICU for 5 months. I know that it is stressful, and I know that it can be draining. However, you don`t live in the NICU. You can go home. You can have them wait in the waiting room, take pictures, talk about it, etc. The more people that are allowed to come in, the more chances that someone will bring in something.... And I don`t care how much support I needed, I most certainly didn`t need it enough to risk someone else`s baby dying for it. Washing up is great, but there are countless illnesses you can carry without showing symptoms. For every additional person coming in, the risk of someone`s baby becoming ill goes up. Sure, it may only be a tiny percentage of change, but for a tiny baby it could mean death. I`m sorry, but this is something that I feel very strongly about, despite being a former NICU parent. People other than the parents do not need to be in there.

Wow, some of these messages make me thankful for the difference in culture! I posted a bit back in the thread about our policies - 3 minute wash, gowns, 24/hr visitation, parents ONLY, etc... I never ever would have imagined parents being noisy would be a problem! We can have every parent in there at once and still hear a pin drop if the feeders are all fed and quiet (We`re a series of connected rooms). No one ever talks above a whisper, and they end up apologizing if their baby is crying! In fact, most of our nurses are noisier than the parents ever are. I can only remember one situation where noise was a slight problem - we had 700g set of triplets going home after 8 months. Mom and dad were scared to carry them out alone, so we let grandparents in. They were just too thrilled, and declared it quite vocally. We asked them to be quieter, and they were. I just can`t imagine anyone refusing.

Generally, once the IVs are out and the baby is considered stable, we will allow parents to provide front-opening clothing for the baby. As soon as we drop the temp in the isolette, they get dressed fully. Of course, there are exceptions in both which babies can wear clothes and what clothes they can wear. Once they are out in a cot, all the babies are dressed. In our case, most babies never wear anything until they are out. Even then, it`s hospital issue guaze gowns. Small stuff isn`t available here, and most parents assume that no clothes on the baby = no clothes allowed. Parents wash the clothes they bring, and the guaze gowns get sent to laundry. We also do not allow any toys, etc. Parent-brought clothes go into two clearly marked sealed plastic bags - "Clean" and "Dirty". - that are put on the bottom shelf of the isolette or cot. Nothing else is allowed, EVER.

This is my first post here, so hello! I'm not exactly a nurse, but I volunteer at our local level IV NICU, and end up doing just about everything you don`t need a license for - especially when it`s busy! I guess they trust me because of how long my son was there (born at 14 oz.) I hope that I can provide a little insight into NICU practices in Japan. In our NICU, only the mother and father are allowed in - 3 minute wash, and gowns. Masks are provided if you feel you may have been around someone sick, but it is suggested that "If you feel you need a mask, you probably don`t want to come in.". There is no one specifically watching the hand washes, but the washroom is visible to the NICU through a window, so you never know when someone will look. It works pretty well as someone is always near the window (It`s in front of the feeders). Visiting is 24 hours a day, but parents have to ring in via an intercom outside the entrance. If their baby is in the middle of something, they`re asked to come back a bit later. I seriously can`t imagine letting grandparents in, let alone other people! Almost all the MRSA cases we have come from a carrier parent - we figure it is better the babies get it now than after they go home where we won`t be able to catch it quickly. In all my time there, I have never seen a single case of RSV. (Both volunteer time, and the time my son was hospitalized.) It is probably just because RSV isn`t as prevalent here. -Nyoro