Mao Mao came to this world after only 26 weeks in her mother's belly, 3 months earlier than ordinary children, weighing only more than 900 grams, and her arms are only a little thicker than an adult's finger.
Preterm birth or low birth weight is the leading cause of death among children under 5 years old in my country.
If a baby is born with a weight of less than 2500 grams, it is a low birth weight, and a baby with a weight of less than 1000 grams like Mao Mao is an ultra-low birth weight infant, which is a high risk in a high risk.
However, after careful treatment in the local hospital, Mao Mao turned the corner.
On July 26, when a reporter from China Youth Daily and China Youth Daily visited, Mao Mao’s weight increased to 1.45 kilograms after more than a month of birth. After staying in the hospital for another month, when his weight increased to about 2 kilograms, he could be discharged.
Women's and children's health is the cornerstone of national health and the premise of sustainable human development.
The World Health Organization also uses infant mortality, maternal mortality and life expectancy as the main indicators to measure the health level of a country's people. The health of women and children reflects the country's national health level, quality of life and civilization.
Since the 18th National Congress of the Communist Party of China, my country has attached great importance to women's and children's health, and the work of women's and children's health has made great progress and remarkable achievements.
At present, my country's maternal and child health core indicators such as maternal mortality and under-five mortality have ranked among the top middle- and high-income countries in the world.
Treatment of very low birth weight premature infants
Mao Mao was born in the Maternal and Child Health Hospital of Guyuan City, Ningxia.
Children born at this age have a high probability of suffering from respiratory distress syndrome. Usually, pulmonary surfactant is used to promote the expansion of alveoli, and the drug is administered into the lungs through tracheal intubation.
In addition, this medicine is relatively expensive. According to Mao Mao's weight, if it is used once, it may cost more than 3,000 yuan, and it may need to be used multiple times.
After looking at Mao Mao's lung ultrasound results, neonatologist Kai Fengfeng assessed that he had respiratory distress syndrome stage 1-2. The child's breathing was only a little labored and not serious.
Combined with Mao Mao's physical condition, Kai Fengfeng decided not to use pulmonary surfactant for the child, and only needs to use a non-invasive ventilator.
Kai Fengfeng's confidence in doing so stems from her one-year systematic study at Peking University First Hospital (hereinafter referred to as "Peking University Hospital") and Ningxia Children's Hospital.
On June 23, when the reporter interviewed Kai Fengfeng, Mao Mao was born a week ago and was lying in the incubator of the premature delivery ward of the neonatology department.
With the help of the non-invasive ventilator, Mao Mao's alveoli expand better, which means that his lung function is developing normally, and now the ventilator has also been removed.
Mao Mao in the incubator, although his body is thin, he moves very flexibly.
There are a total of 5 incubators in the premature birth ward of the Guyuan Maternal and Child Health Hospital, and complex equipment is connected around each incubator.
The incubator is not only constant temperature and humidity, but also can monitor the physical condition of Mao Mao at any time.
Kai Fengfeng started to study at Peking University Hospital in October 2020.
When he first started studying in the neonatology department, Kai Fengfeng was shocked by the detailed medical records of Peking University Hospital.
For every baby admitted to the neonatal unit, the doctor may write a 5-6 page medical record.
It records the whole process from the mother's early pregnancy to childbirth, as well as various problems of the child after birth.
Kai Fengfeng told a reporter from China Youth Daily and China Youth Daily that in the same situation, she might have only written 2-3 pages of medical records. "Some treatments were done, but they were not written in the medical records." Taking over the diagnosis and treatment, you will find that the child's condition is more serious than what is written on the medical record.
But at Peking University Hospital, any problems encountered must be recorded in the medical records.
"Because of a small problem, maybe at some point in the future, it may become a big problem."
At the beginning, Kai Fengfeng wrote his medical records according to his own habit. Because the writing was not detailed enough, he was often asked by senior doctors.
Later, when writing medical records, Kai Fengfeng tried to be as detailed as possible, and would communicate with family members and obstetricians many times to check information.
After repeated training, Kai Fengfeng's medical records finally passed the test.
She found that after writing the medical records clearly, and then treating the children, the thinking will be much clearer.
According to the training plan, after 9 months of study in Peking University Hospital, Kai Fengfeng continued to study in Ningxia Children's Hospital for 3 months.
Ji Yongjia, director of the Department of Neonatology at Ningxia Children's Hospital, told reporters that he clearly felt the changes of grass-roots neonatologists after studying in Peking University Hospital.
"I think they used to be more limited, thinking that neonatologists are just a job to support their families. After returning from Beijing, they can feel that they have found their own value in their work, and they also have plans for their personal careers, and their horizons are broadened. This is the biggest progress.”
Kai Fengfeng also said: "I went out to study and found that I have more things to learn."
Talent training is difficult
During the 9 months in Peking University Hospital, Kai Fengfeng went to the Neonatology Department, Neonatal Intensive Care Unit, Cranial Ultrasound Department, and Neonatal Clinic for systematic study. Sometimes, he was busy in the hospital until 11 or 2 pm before returning to the dormitory.
Kai Fengfeng said frankly that it was through these systematic studies that she had the confidence to treat ultra-low birth weight infants who were only 26 weeks gestational.
If it was in the past, she may have suggested that the child be transferred to another hospital for treatment.
The contiguous area of Liupan Mountain was once one of the 14 extremely poor areas in my country. The local people's health concept was backward, and even some young couples in the village did not have the awareness of obstetric examination, and did not go to the hospital until the child was born.
Lack of interventions during pregnancy can make it difficult for high-risk mothers to give birth and have more complications in their newborns.
Xiji County is the last county in Ningxia to get rid of poverty, and it is also a county that Ningxia Children's Hospital focuses on helping.
Ji Yongjia has led a team to Xiji County People's Hospital many times to carry out assistance work.
Five or six years ago, Xiji County People's Hospital did not have a special neonatology department, only a "pediatric ward" with the same structure as the adult ward, and there was a shortage of pediatricians, and the ability to treat critically ill newborns was even more lacking.
In 2018, the state issued relevant documents requiring the establishment of at least one treatment center for critically ill pregnant women and one treatment center for critically ill newborns at the city and county levels.
With the support of the policy, Xiji County has also begun to build a critically ill neonatal treatment center.
Hardware equipment such as ventilators and incubators that need to be purchased with money will soon be in place. The difficulty is the training of talents.
To this end, Ji Yongjia and other medical staff have comprehensively trained medical staff in the critically ill neonatal treatment center of Xiji County People's Hospital from academic training, clinical ward rounds to the operation process of the department.
Areas like Xihaigu, where Xiji County is located, are the focus of my country's maternal and child health protection work.
Since the 18th National Congress of the Communist Party of China, my country has been committed to continuously improving the level of equalization of women's and children's health, focusing on solving the problem of unbalanced and insufficient development of women's and children's health.
The continuous promotion of national basic public health services and children's nutrition improvement projects have given priority to covering all former national-level poverty-stricken counties.
In the past 10 years, the ratio of the maternal mortality ratio between the western and eastern regions has dropped from 2.1 to 1.5, and the ratio of the mortality rate of children under 5 in rural and urban areas has dropped from 2.7 to 2.1.
The improvement of maternal and child health in underdeveloped areas has played a role in promoting the overall situation.
According to the data released by the National Health and Medical Commission, in 2021, the maternal mortality rate in my country will drop to 16.1/100,000, the infant mortality rate will drop to 5.0‰, and the mortality rate of children under 5 will drop to 7.1‰. The core indicators of maternal and child health have reached The best level in history.
"Only when women and children are healthy can the whole society enter a state of healthy development." Jiang Yuwu, director of the Pediatrics Department of Peking University Hospital, said in an interview with a reporter from China Youth Daily and China Youth Daily. Worldwide, maternal and child health is an important public health indicator."
As a neonatologist who has worked for many years, Ji Yongjia can clearly feel the improvement in the level of newborn protection in my country.
Before the establishment of critically ill neonatal treatment centers in various cities and counties in Ningxia, Ji Yongjia often saw doctors who were unable to recover when they were referred to their hospitals.
Ji Yongjia said that in fact, many children just need some breathing support, but there is no such level in the local area.
Even if some of the children who are referred can be rescued, they may suffer from serious sequelae after being rescued due to long-term hypoxia.
With the establishment of the critically ill neonatal treatment center, Ji Yongjia found that in the past year or two, the children who have been referred have rarely seen those who are difficult to treat because of hypoxia.
The number of children being referred has also decreased due to improved local treatment capacity.
Establishing rules and regulations is the core of helping
In May of this year, "The Third Batch of National Regional Medical Center Construction Project List" was released, and the Ningxia Women's and Children's Hospital of Peking University Hospital, which was converted from Ningxia Children's Hospital, was on the list.
On June 17, a special work class from Peking University Hospital came to Ningxia.
"I am glad that the continuous efforts of the past five years have finally come to fruition, and continue to work hard to benefit one patient on a higher platform." On the same day, Jiang Yuwu specially posted a circle of friends.
Under the promotion of Jiang Yuwu, in January 2018, Peking University Hospital began to help Ningxia Children's Hospital.
Establishing rules and regulations is the core work of assistance.
As of 2020, Peking University Hospital’s Department of Pediatrics has dispatched an expert to Ningxia Children’s Hospital as a temporary vice president every year, in charge of pediatric business work, and a total of 4 have been stationed; in addition, 12 senior physicians have also been stationed in charge of wards.
Before carrying out the assistance work, there was basically no three-level ward round system in Ningxia Children's Hospital.
The first level of the three-level ward rounds is the junior resident physician (the doctor in charge of the bed). These doctors make rounds at least twice a day. They are the doctors who have the most direct communication with the patients, and are responsible for feeding back the patient's information to the superior doctor in charge. , to issue and execute medical orders; the second-level is a middle-aged attending physician who rounds the ward once a day and is mainly responsible for the daily medical behavior of the patient; the third-level is a senior physician (chief physician or deputy chief physician with at least 5 years of experience) ), ward rounds 1-2 times a week, mainly responsible for the medical quality management of patients during hospitalization.
Jiang Yuwu said that three-level ward rounds are one of the most important systems in medical work to ensure the medical safety of patients and provide high-quality diagnosis and treatment for all inpatients, and it is also an important part of training young and middle-aged doctors.
Doctors from Peking University Hospital helped Ningxia Children's Hospital establish a three-level ward round system, improving the quality of medical care.
The deputy dean insists on weekly director rounds and pediatric ward rounds, and instructs the ward to carry out director rounds twice a week and a discussion of difficult cases once a week. Three-level doctor ward round system.
During ward rounds and case discussions, experts from Peking University Hospital will also point out some irregular diagnosis and treatment behaviors without evidence-based medical evidence, and discuss them, which will subtly affect the diagnosis and treatment behaviors of doctors at all levels and improve the quality of doctors at all levels. Occupational competence and the standardization of their physical examination, case analysis, diagnosis and treatment.
In addition, under the standard of the three-level ward round system, the neonatal specialty, pediatric intensive care (PICU) specialty, pediatric respiratory specialty, and pediatric nephrology specialty have also been systematically constructed.
Jiang Yuwu said: "They often call for consultation. Our director of the department of neonatology is 'online' almost 24 hours a day. If there are problems in Ningxia, they can basically help solve them, so their overall pediatric medical level has improved very quickly."
In addition to the above-mentioned three-level ward rounds, Peking University Hospital also has four-level ward rounds, also known as general practice rounds, where doctors from general practice see a patient together.
This patient often suffers from intractable diseases and requires joint diagnosis and treatment by multiple professional doctors.
The fourth-level ward round is also a teaching activity while solving clinical problems.
Jiang Yuwu said that firstly, the attending physician reported the diagnosis and treatment of the entire case, existing problems and related academic progress to the physicians sent by all departments of the hospital to participate in the fourth-level ward round. What is the guideline, why is it currently treated like this, what is the effect of the treatment, and what kind of difficult problems need to be discussed and resolved.” After the attending physician reports, the ward director will make additional explanations, and then the resident physicians and other young doctors in each ward will give further explanations. First express your own opinions or ask questions, the attending physician and the director of the ward are responsible for explaining the response, and finally the experts from the general practice conduct targeted discussions.
The fourth-level ward rounds are about two hours a week, and they have been going on in Peking University Hospital for more than 40 years.
In addition to effectively solving the problems of diagnosis and treatment of some particularly difficult patients, this system is a good exercise for doctors of all seniority. It is a comprehensive training of academic knowledge, clinical thinking, academic quality of democratic science and academic discussion ability .
Although he is already a senior professor, Jiang Yuwu still likes to listen to big rounds.
"Because new and other specialties are always learned, and the process of diagnosing and treating such difficult cases is challenging," he said.
More importantly, the entire four-level ward round process is open to Ningxia Children's Hospital through the Internet.
The summary materials for Ningxia Children's Hospital completed by Peking University Hospital in May 2021 read: "Most of the diagnoses and treatments in the past few years are diseases that have never been diagnosed or treated in Ningxia Children's Hospital. With the efforts of all the medical staff in the Children's Hospital, the children received timely and effective diagnosis and treatment, which greatly improved the service ability and confidence of local medical staff, and patient satisfaction increased from 85% to 92%."
It is understood that in 2017 before the assistance, the number of outpatient visits in Ningxia Children's Hospital was 46,000, and the average length of stay was 6.01 days. sky.
Meanwhile, the infant mortality rate in Ningxia Hui Autonomous Region dropped from 6.87‰ in 2017 to 3.83‰ in 2020, lower than the national average.
child healthcare with temperature
The National Health Commission will set up the National Children's Regional Medical Center in 2020, namely Shengjing Hospital Affiliated to China Medical University, Children's Hospital Affiliated to Zhejiang University School of Medicine, Guangzhou Women's and Children's Medical Center, Children's Hospital Affiliated to Chongqing Medical University, Xi'an Jiaotong University The 5 national children's regional medical centers with the Affiliated Children's Hospital as the main body play a leading role in the Northeast, East China, Central South, Southwest and Northwest regions, driving the improvement of children's medical, teaching, scientific research and preventive health care services in the region, and promoting interregional pediatrics Homogenization of medical services, giving full play to the leading role of the National Children's Medical Center and the National Children's Regional Medical Center, promoting the construction of a hierarchical pediatric diagnosis and treatment system, and striving to promote fair, accessible, systematic, and balanced development of children's medical care services.
On May 30, 2022, at the press conference of the National Health and Health Commission introducing the progress and achievements of the maternal and child health work since the 18th National Congress of the Communist Party of China, Song Li, director of the Department of Women and Children of the National Health and Health Commission, said that the organization was established under the unified arrangement of the National Health and Health Commission. The cross-regional pediatric alliance has 47 children's hospitals in 31 provinces (autonomous regions and municipalities), involving more than 3,000 network hospitals.
Under the premise of well-established institutions in the national pediatric department, the interaction of personnel truly reflects that the national pediatric department is one family.
Through six sharing, one goal is achieved, that is, experts, medicine, teaching, research, prevention, and management sharing, and one goal is achieved, that is, let the doctor move and the patient does not move.
Song Li said that in the future, she will continue to increase the construction of the pediatric service system in some underdeveloped areas. Through the construction of the network system, the personnel in these areas will be effectively trained to truly reflect the full-cycle, all-round and warm children's medical care and health care. Serve.
"Entering a new stage of development, we will always adhere to the focus on women's and children's health, further promote the high-quality development of women's and children's health, and strive to make women and children feel better, more sustainable, and more secure."
China Youth Daily, China Youth Daily reporter Liu Changrong Source: China Youth Daily