Osaka day 8 @wcmtuk Another day, another 500g delivery! It seems all the ELBW (Extremely low birth weight) babies are arriving whilst I’m here to learn. Incredible team, so giving of their time to support my project. Typically this unit might have 30-40 babies of this age and size per year; this makes 3 just this week. An unanticipated opportunity to witness 1st hand the care and methods I’ve heard and read so much about.
Attempts to improve our ability to predict and prevent IVH in #ELBW at 23 weeks – are doppler waveforms on cranial ultrasound an important addition? Meticulous calculations and attention poured over fluid balance and haemodynamics too. 8 hourly echocardiography and CrUSS for the early days.. Innovative approaches combined with great attention to the basics.
Also meeting some of the long term residents on the NICU today; 3 months… 10 months…(!) discharge planning complexities for challenging growth and tracheostomies are common across the globe #ELBW
This morning an in depth discussion around nutrition in the ELBW infant. Some familiar challenges, but a real breadth of approaches and possible solutions. Local practices, specific challenges here in Tokyo with some very interesting clinically focused research – well done National Centre for Child Health and Development, excellent initiative to answer some taxing PN (parenteral nutrition) questions. Enteral feeding practices subtly different from those typical in the UK with some interesting food for thought (excuse the excellent pun) around breast milk fortification, oral supplements and metabolic bone disease.
In between observations and meetings, some important down time with the admin team… an origami swan Masterclass! Now mine looks a little er, less than perfect, but it’s a good start. Also a heart for the origami Christmas tree. Feeling very welcomed.
Some hugely thought provoking discussions on working practices too. Am mindful of the working and workforce issues which may seem so challenging back home, but the many privileges we have too. How about 1 week of annual leave per year UK trainees?
45 floors up seemed a good a place as any for an update! After a morning of travelling and introductions, an afternoon for exploring. The Tokyo Government Building (2 extensive architectural behemoths in the Shinjuku skyline) has a free to access observatory. It’s pretty amazing. I tried a shrine and “peaceful park” after leaving the hospital. Closed today. It’s on Saturday’s list now.
So the hospital itself – The National Centre for Child Health and Development, sits around 40 minutes outside Tokyo. Well an hour and a half with a bulky case vs subway system (Ouch – seems folk were right about luggage forwarding). The hospital site and clinical building is less sprawling than I imagined. My room in the residences is the opposite! I could yoga a plenty in there. The hospital building has an airy atrium, the neonatal unit on the 4th floor. Exceptionally clean (wholly unsurprisingly). I’ve only met the dimly lit serene central corridor today and a brief intro to the staff. Though their English is actually very good, they don’t seem to much like to show it off!
International leg 1 – Japan: Morning all! So – in a very tired fashion as I never sleep well before flights – we’re just about to take off. I’m bound for Helsinki then on to Tokyo – very exciting but a little nerve-wracking. Thanks to the very kind FinnAir check-in attendant at Manchester airport this morning; you were very helpful indeed. So, powered by Pret porridge and the Winston Churchill Memorial Trust’s backing (with a flat white or two thrown in this morning) this is the start of my “Exploration of Improving Outcomes for Premature Babies”.
In research acronym form it’s the EQuIIP project: Exploring Quality Improvement Internationally for Preterms #EQuIIP. In truth it’s not really the beginning as I’ve been ensconced in planning and preparation for a number of months.
(Take Off!) All smooth. Small plane. Only a short flight. So many people have already engaged with this project to support me in getting as much as possible from the experience – both for my development and perhaps more importantly, to reduce the variation we see in important outcomes for very early babies. Centres in Japan seem to be leading the way in some key areas so I’m hoping to learn as much as I can from these travels to bring back and share in the UK. What will translate to our practice? What doesn’t quite fit with our populations? How can we make crucial changes to our own practice? Watch this space! I’ll be continuing to work with BAPM (British Association for Perinatal Medicine) as part of their Quality Collaborative to spread as much helpful learning as is possible, sensible and appropriate – #NSQI to find out more…
Thanks Caryl Skene at Sheffield’s Jessop Wing NICU (Newborn Intensive Care Unit) for her spectacular support in organising and hosting focus groups with me. It’s been such an eye-opener to consider what questions, themes and aspects to look out for and investigate from the perspective of many different team members. Thanks Jessop Wing Team. So a little in-flight relaxation I think. Where’s that book…
I’ve been saying a lot in the run up to this project how lucky I feel to be doing something so exciting, and to have the backing and engagement of so many people who believe in me. A friend reminded me of this…
“Luck is a matter of preparation meeting opportunity”
Lucius Annaeus Seneca
However effort, motivation, opportunity and/or the stars and moon have brought about this opportunity – thank you for joining me on the journey. Follow my travels here on the webpage, share my posts far and wide, keep up with me on Twitter… however you choose to stay in touch, I look forward to sharing the adventure with you.