This article presents an overview of a neonatal intensive care unit along with resuscitative care and management of the 22 to 23 weeks gestational age infant is as it was noted during a visit to the NICU of a large academic center in Japan. Non-English speaking neonatology communities may be at a disadvantage of having their research and practices well known in the English speaking ones. Thus, visits such as this are beneficial in exchanging ideas and practices that may ultimately be mutually beneficial in reducing mortality and morbidity in a specific category of neonates.