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Department of Perinatology, Osaka University Hospital Perinatal Center, Osaka, Japan The neonatal mortality rate has been consistently maintained at 1.1 deaths per 1,000 live births in Japan, which is the lowest level in the world. In addition, long-term survival and prognosis of extremely preterm infants, including neonates born at 22-23 weeks of gestation, has continued to improve. In order to provide high-quality medical care, we had constructed a perinatal transport network, 104 Level 3 perinatal centers, and 292 Level 2 perinatal centers as of 2016. To make additional progress in improving outcomes for high-risk infants, we developed a research database system, ‘Neonatal Research Network Japan (NRNJ)’ in 2003. Analysis through this database system enables comparison between various randomized controlled trials, domestically and internationally. To improve quality of care at neonatal intensive care units (NICU), we developed another unique project “INTACT” (Improvement of NICU Practice & Team Approach ClusterRandomized controlled Trial) in 2011. In this project, we aim to correct the disparity in clinical skills, techniques, and knowledge which exists between facilities, and provide a more equalized, highquality standard of neonatal care. The neonatal cardiopulmonary resuscitation (NCPR) training program is another strategy which helps maintain our clinical quality. With these challenges, (NRN database, INTACT RC traial, and NCPR program), we will strive towards reaching our goal of “intact survival” of all newborn babies.

Our challenges for the Intact Survival of Newborn Babies