Oct. 25, 2009 (The Yomiuri Shimbun) -- The average operating ratio of neonatal intensive care units (NICUs) at 64 of the nation's 77 perinatal medical centers was 93.7 percent between April and September, with 20 citing rates of "at least 100 percent," a Yomiuri Shimbun survey has found.
As each facility has an average of 13 beds in NICUs, the vacancy rate is only 0.8 bed, meaning the facilities have no room to accept emergency admissions.
As of April, there were 77 perinatal medical centers throughout the country designed to handle seriously ill pregnant women and offer emergency treatment for newborns. NICUs are used mainly to treat prematurely born babies. Of the 77 centers surveyed earlier this month, 64 facilities, or 83 percent of the total, gave valid answers.
About a year ago, a pregnant woman who suffered a stroke was refused admission by eight hospitals and died at Tokyo Metropolitan Bokuto Hospital in Sumida Ward, Tokyo. The survey reconfirms the nation's lack of NICUs, which is considered to be a key factor behind such incidents.
When Aomori Prefectural Chuo Hospital--a perinatal medical center--receives new patients, those with relatively mild symptoms are placed in a recovery room that is normally used by patients preparing to be discharged or moving to a general ward. Patients who no longer need artificial respirators are returned to the hospitals and clinics from which they were transferred.
If Kagoshima City Hospital receives a request to accept a patient when its NICUs are filled, it dispatches doctors and nurses to patients in a specially designed vehicle--fitted with equipment to treat newborns--and takes such patients to a cooperating hospital, while the medical staffers provide emergency treatment in transit.
The Tokyo metropolitan government in March designated three hospitals as "super perinatal medical centers" to accept without fail critically ill pregnant women, stipulating that one facility should undertake this responsibility on a rotational basis. So far, there have been no cases in which such patients have been passed around different establishments.
Another Yomiuri survey of all 47 prefectural governments found there were 2,429 beds in NICUs throughout the country--up 145 from a year ago.
However, only 16 prefectural governments, or 34 percent of the nation's 47 prefectures, met the required number of beds in NICUs--2.5 to 3 per 1,000 newborns--suggested in February by a panel of experts of the Health, Labor and Welfare Ministry. ===
Regional differences in NICUs
Regional differences exist in the number of beds in neonatal intensive care units, according to a Yomiuri survey of the nation's 47 prefectures.
Ten local governments including Tokyo have introduced a coordination system to find hospitals that will accept pregnant women, deploying doctors and nurses at general perinatal medical centers in respective areas.
Furthermore, six prefectures in the Kinki region and Tokushima, Fukui and Mie prefectures agreed in 2007 to work closely to transfer pregnant women to hospitals across prefectural borders.
By prefecture, Yamaguchi Prefecture met the Health, Labor and Welfare Ministry's suggested number of beds in each NICU--2.5 to 3 per 1,000 newborns--with 4.67 beds, while Kagoshima's figure stood at 3.5. Tokushima and Ibaraki prefectures failed to meet the required number, with 1.02 and 1.22 beds, respectively.
The Education, Science and Technology Ministry plans to newly establish six-bed NICUs at seven university hospitals whose NICUs are not covered by social insurance.
Hirosaki University, which plans to open a NICU in April, currently is recruiting three assistant professors and a number of lecturers as the university has only one full-time doctor. Toyama University, which is aiming to increase the nine beds of its NICU, also is seeking a professor, but has so far been unsuccessful.
Meanwhile, the number of obstetric gynecologists has increased this year, though the total has decreased about 10 percent from the figure of 11,000 registered 10 years ago.
According to the Japan Society of Obstetrics and Gynecology, 435 new members joined the society between April and September, up 57 from the same period last year.
In the Yomiuri survey conducted on perinatal medical centers across the nation, one center said obstetricians worked fewer nights as their number increased.
However, some hospitals said they were struggling to cope. Iwate Medical University said, "We're always carrying out a balancing act [as the facility] has insufficient personnel." Mie Chuou Medical Center said, "We've exceeded our limit," while Kyorin University in Tokyo said its working schedule had "deteriorated."
