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Children’s Medical Foundation
Report of the Conference on CMF NICU Network
April 26 & 27, 2009 in Shanghai, China
CONTENTS
1. Executive Summary P. 1
2. Conference Program P. 3
3. Presentation Summaries P. 5
4. Expectations of CMF to NICU Network P. 8
5. Group Discussion Summaries P. 9
6. Inauguration Ceremony P.13
7. List of Participants P.15
Sponsor: Zeshan Foundation
Conference Report – CMF NICU Network
1. Executive Summary
Background of CMF NICU program
The Children’s Medical Foundation was established in 1995 as a non-governmental
organization in Hong Kong with tax-reduction status. Its mission was to develop and
implement sustainable solutions in health care for children in Asia, in particular for
children in underprivileged situations. Through the establishment of collaborative
partnerships and institutional linkages, CMF provides resources towards capacity
building initiatives, bringing accessible healthcare to rural communities and
strengthening community health and primary care in Asia.
Since 2001, CMF has been working with our hospital partners to establish Neonatal
Intensive Care Units at hospitals in underprivileged cities in attempt to reduce
neonatal mortality rates and to improve the service level of neonatal care. As one of
the core programs of CMF, the Neonatal Intensive Care Unit (NICU) program
sponsors the establishment of an NICU in local hospitals where none exist. We also
provide training for the doctors and nurses of these hospitals in order to enhance the
level of pediatric treatment and lower the neonatal mortality rate.
In 2009, the target of 20 NICUs was reached. CMF has taken this opportunity to
assess the effectiveness of our NICU program and to provide more useful data for
future program development. CMF, hence, invited Prof. Emily CHAN and Dr. Kevin
HUNG from the School of Public Health, Chinese University of Hong Kong to
conduct this evaluation.
Conference on CMF NICU Network
The Conference on CMF NICU Network of Fudan University), Advisor from CMF’s
was held to bring together the China Medical Advisory Board (CMAB)
representatives of CMF established and representative of our sponsoring
NICUs with the following two key organization and 2 CMF staff.
purposes:
(1) To form the CMF NICU Network; and
(2) To discuss and conclude the results
of NICU evaluation.
Forty-one participants took part in this
conference. They included
representatives of 13 established NICUs
and 7 new NICUs, Directors and Heads
of neonatology of our partner hospitals in
Shanghai (SCMC and Children’s Hospital
Shanghai, CHINA * April 26 – 27, 2009 1
Conference Report – CMF NICU Network
Summary of Contents
Three papers were presented to all the participants at the first part of the conference
to set an equal platform for discussion. Three speakers, prominent in Neonatology,
covered the following topics:
o Current challenges in the Neonatal Care Service in China – Prof. CHEN
Chao, Director of Neonatology, Children’s Hospital of Fudan University
o Training needs for improving neonatal care in underprivileged areas – Dr.
SUN Jianhua, Director of Neonatology, Shanghai Children’s Medical Centre
o Development of Neonatal Resuscitation Program (NRP) in China - Prof.
WANG Huishan, National Centre for Women & Children’s Health
The conference was also addressed by Prof. GUI Yonghao, Vice-president of Fudan
University, President of Division of Pediatrics, Chinese Medical Association and also
CMF CMAB Advisor, who shared his views on the roles and functions of NICU in
underprivileged areas in China and also the proposed function of NICU network.
After the presentations, participants (1) Functions of NICU Network
were divided into 4 groups to discuss o Training
two topics with specific questions: o Standardization
o Transferal system
o Other expectations
(2) Impacts and further development
of NICU
o Pros and cons brought by the
NICU
o Problems encountered and
possible solutions
o Key neonatal problems in the
district
o Suggestions to improve these
problems
The CMF NICU Network was formed during the conference. Each participant
showed a picture with a story, which encouraged his or her commitment in improving
neonatal care in China, to all other participants and guests.
In addition, participants had the opportunity to get to know each other better through
the networking dinner. At the dinner, apart from the speeches delivered by
Professor LIU Jinfen, Director of Shanghai Children’s Medical Centre and Professor
HUANG Guoying, President of Children’s Hospital of Fudan University, every NICU
representative presented the background and characteristics of his or her own NICU
to others. The top three presentations were awarded a souvenir from CMF.
Shanghai, CHINA * April 26 – 27, 2009 2
Conference Report – CMF NICU Network
2. Conference Program
(1) Purpose: To build a support network among established NICUs in an
effort to raise the level of neonatology in China.
(2) Date & place: April 26 & 27, 2009 in Shanghai
(3) Program:
26/4 (Sun) First Session
2:00-2:10p.m. Welcome & Introduction CMF Staff
2:10-2:20p.m. Briefing on CMF & NICU Program CMF Staff
2:20-2:50p.m. Current Challenges in the Neonatal Prof. CHEN Chao, Director
Care Service in China of Neonatology, Children’s
Hospital of Fudan
University
2:50-3:20p.m. Training Needs for Improving Dr. SUN Jianhua, Director
Neonatal Care in Underprivileged of Neonatology, Shanghai
Areas Children’s Medical Centre
3:20-3:40p.m. Development of Neonatal Prof. WANG Huishan,
Resuscitation Program (NRP) in National Centre for Women
China & Children’s Health
3:40-4:00p.m. Tea Break
4:00-4:05p.m. Introduction of NICU Network CMF Staff
4:05-4:45p.m. Group Discussion 4 Group Leaders
(1) Training
(2) Policies and Standardization
(3) Transferal System
(4) Other Expectations
4:45-5:30p.m. Report Back (by representative of Chaired by Prof. CHEN
each group) Chao, Deputy Chairperson,
Committee on Neonatology,
China Medical Association
5:30-5:40p.m. Expectations of CMF to NICU Prof. GUI Yonghao, CMAB
Network Advisor, CMF
5:40-6:00p.m. Inauguration Ceremony
Shanghai, CHINA * April 26 – 27, 2009 3
Conference Report – CMF NICU Network
Networking Dinner
6:30-6:35p.m. Welcome Prof. GUI Yonghao, CMAB
Advisor, CMF
6:35-6:40p.m. Speech by Guest Prof. LIU Jinfen, Director of
Shanghai Children’s Medical
Centre
6:40-6:45p.m. Speech by Guest Prof. HUANG Guoying,
President, Children’s
Hospital of Fudan
University
6:45-7:10p.m. Introduction of each NICU (1) 7 NICU representatives
7:10-7:30p.m. Dinner
7:30-7:50p.m. Introduction of each NICU (2) 6 NICU representatives
7:50-8:15p.m. Dinner
8:15-8:40p.m. Introduction of each NICU (3) 6 NICU representatives
9:00p.m. End of Dinner
27/4 (Mon) Second Session
9:00-9:10a.m. Conclusion of first session CMF Staff
9:10-9:30a.m. Highlight of Key Findings from the CMF Staff
Evaluation of NICU Program
9:30-10:20a.m. Group Discussion 4 Group Leaders
(1) Pros & Cons brought by NICU
Program
(2) Problems Encountered and
Possible Solutions
(3) Key Neonatal Problems in the
District
(4) Suggestions to Improve these
Problems
10:20-10:40a.m. Tea Break
10:40-11:35a.m. Report Back (by representative of Chaired by Prof. CHEN
each group) Chao, Deputy Chairperson,
Committee on Neonatology,
China Medical Association
11:35-12:00noon Q&A and Conclusion of Conference Prof. CHEN Chao, Deputy
Chairperson, Committee on
Neonatology, China Medical
Association
12:00noon End of Meeting
Shanghai, CHINA * April 26 – 27, 2009 4
Conference Report – CMF NICU Network
3. Presentation Summaries
A. Current Challenges in the Neonatal Care Service in China
- Prof. CHEN Chao, Director of Neonatology, Children’s Hospital, Fudan
University
Prof. CHEN presented this topic
from 5 aspects:
1. Developmental stages of
neonatology in China
2. Challenges ahead
o The national neonatal
mortality rate of 1.25% is
still high
o Only 0.3-0.4% of
neonatal mortality rate in
developed countries
3. Professional issues
o Asphyxia
o Breathing problems
o Brain damage
o Infections
o Prematurity
o Congenital anomalies
4. Current challenges
o Increase in birth rate
o Imbalance of resources and development of neonatal care: too poor in
west region and villages
o Mobile population
o Obviously insufficient NICU facilities
o Insufficient no. of professional staff and training for staff
5. Facing the new challenges, we could:
o Develop clinical settings with different levels
o Establish NICUs at hospitals where none exists
o Provide more specific and effective training to relevant professional
B. Training Needs for Improving Neonatal Care in Underprivileged
Areas
- Dr. SUN Jianhua, Director of Neonatology Department, Shanghai
Children’s Medical Centre
This paper was presented by Prof. SUN and she covered the following areas
regarding training needs:
1. Training needs of NICU program
o Lack of trained neonatal professionals in the fields
Shanghai, CHINA * April 26 – 27, 2009 5
Conference Report – CMF NICU Network
o Most of the neonatologists do not know how to apply what they have
learnt or do not have chance to apply what they have learnt
o Training aims: identify high-risk fetus and neonates; train up who are
suitable to work in NICU; equip them up with knowledge and skills in
transferring high-risk neonates to tertiary hospitals.
2. Insight from completed
programs
o Training should be
specially designed for 4
groups of medical
professionals:
One for NICU-in-
charge
One for nursing
supervisor
One for doctor
One for nurse
3. Follow up work after training
o Submission of training plan: The trained fellows are requested to
provide training plan (including training targets, training contents,
format and assessment methods) to the training institute
o Regular reporting: The trained fellows are requested to provide regular
working and training reports (3 months to 6 months)
o Follow up and evaluation: The training institute (SCMC or Children’s
Hospital of Fudan University) will follow up with the newly established
NICU to assess its development and write up a follow up report
C. Development of Neonatal Resuscitation Problem (NRP) in China
- Prof. WANG Huishan, Director, Child Health Care, National Centre for
Women & Children’s Health
Prof. WANG told the participants about the Neonatal Resuscitation
Program (NRP) implemented by her organization in cooperation with the
Johnson and Johnson. This was a five-year project started in 2004 with
the objectives to:
(1) Ensure the presence of an NRP trained professional at every hospital
delivery;
(2) Conduct of NRP training in 600 cities within 5 years; and
(3) Lower the percentage of neonatal asphyxia & the percentage of
disabilities.
In 2004-2007, they have provided 383 classes to 26,028 persons. They
have also provided equipments to the hospitals. According to the data
Shanghai, CHINA * April 26 – 27, 2009 6
Conference Report – CMF NICU Network
collected from 80 hospitals, there was a decrease in the percentage of
neonatal asphyxia and the percentage of neonatal death of asphyxia on
the spots of delivery.
The course has also encouraged the
provincial government: to formulate the
annual NRP training plan; to set up the
expert technical support team on NRP in
each province; to solicit resources to
develop and implement NRP training;
and to develop the system of
certification of NRP.
Apart from the positive feedback of the
course, some problems of the program
were also noticed. It was found that the
substandard quality of some trainers
would adversely affect the quality of training. Some trainees could not
fully grasp what they learned and therefore there was room for
improvement regarding the quality of training. For some of the trainees,
the knowledge and skills could not be well applied to the daily rescue
work. In order to have a better impact for the future development of NRP,
it was suggested that:
o Use the county-or-above hospitals as the base for NRP
o Enhance the training and management of NRP within hospitals
o Facilitate the co-operation of different departments within the hospital
The team to be developed in the hospital should comprise: management
level of hospital; neonatologist or pediatrician; obstetrician; birth attendant;
midwife; and anesthetist. The responsibilities of this expert team include:
o Provide training, re-training and assessment of relevant knowledge
and skills;
o Assess relevant equipment and drugs;
o Organize and coordinate a conference to study different cases (AKA a
case conference)
o Assess clinical history of neonatal asphyxia death; and
o Collect any related data.
Shanghai, CHINA * April 26 – 27, 2009 7
Conference Report – CMF NICU Network 4. CMF’s Expectations for the CMF NICU Network Professor GUI Yonghao, the advisor of China Medical Advisory Board, representing the CMF to present the expectations towards NICU Network to all participants. He mentioned that through the network, we could: o Disseminate the use of international definitions of perinatal and neonatal conditions; o Introduce the concepts of efficacy, cost-effectiveness, risk factors, case management, holistic single patient approach; o Promote evidence-based policies of care and cost-effective interventions, multidisciplinary collaboration, communication and counseling; o Improve clinical data recording and epidemiological data collection and evaluation; and o Discuss public health issues relevant to neonatal care and how to strengthen the health system, and family and community practices. Based on the strengths of CMF and the current linkages, it was hoped that this network could: o Effectively liaise the established NICUs, the training institutes, CMF and other relevant organizations; o Share information and useful resources; and o Gradually develop a scientific and systematic NICU model. Possible work plan for CMF NICU Network: o Conduct annual or bi-annual meeting to share working experiences or to discuss specific topics o Invite international experts to share experiences o Form a team of experts to provide consultation to members within the network o Set up a data collection model and develop a standardized service criteria o Organize study tours to Hong Kong or other countries for exchange and learning Shanghai, CHINA * April 26 – 27, 2009 8
Conference Report – CMF NICU Network
5. Discussion Summaries
Participants were divided into 4 groups for two facilitated discussion sessions
during the conference. Four NICU doctors from the Children’s Hospital of Fudan
University had kindly taken up the role of group leaders for each group. After
each round of discussion, one participant represented the group to present the
discussion summaries to all conference participants.
In the first discussion session,
participants had focused their
discussion on “The Functions of the
NICU Network” with focus on the
following specific areas:
o Training
o Standardization
o Transferral system
o Other expectations
Training:
Standardize the retraining
Secondary training
Specialized training
Develop training course for different posts in NICUs (e.g. for doctors, for
nurses, for obstetricians and so on)
Assessment
Teaching and research
Conduct on-line training
On-line training and on-spot training
Develop training plans
Exchange of clinical cases within network
Professional exchange through regular annual meetings
Exchange of national or international information
Distance learning
Standardization:
Develop a 3-level standard for NICUs in China based on demand, hospital
conditions, resources and expertise
Standardization of clinical work
Differences in different locations should be taken into consideration while
building up the standard for NICU
Clear obligations and responsibilities
Support from the leaders/ management of hospitals
Standardization of NICU needs some “sub-standard”
Shanghai, CHINA * April 26 – 27, 2009 9Conference Report – CMF NICU Network
Transferal System:
Cooperation between the hospitals of upper and lower level
Transferal of high-risk pregnant women
Difficulties in transferal up to tertiary hospitals
Setting up of transferal center to facilitate the communication
Lack of transferal equipment
Setting up of the regional transferal network
Provision of transferal equipment, record of transferal files and cases,
sharing of data and information regarding transferal of cases
Other expectations towards the Network:
Running cost of NICU
Research opportunities among network members
Develop a comprehensive network and extend the influence of the
network
Develop and promote best practices
Consistent standard for each NICU
Publicize the network and let more people know of the Network
Provision of support to transferal system in different regions
Organize “distance-expert-consultation” to discuss the complicated cases
Organize study tours to Hong Kong or other countries for exchange and
learning
During the second discussion session,
participants discussed the impact of
CMF’s NICU program and the further
development of their NICUs under the
following discussion topics:
o Pros and cons brought by NICU
o Problems encountered and possible
solutions
o Key neonatal problems in the district
o Suggestions to improve these
problems
Pros and cons brought by the NICU:
Pros:
♦ Upgrade of technical skills and equipment
♦ Improve management capability
♦ Standardization of work
♦ Arouse the interest of and support from hospital leaders
♦ Strengthen clinical capability and rescue ability of medical
professionals
Shanghai, CHINA * April 26 – 27, 2009 10Conference Report – CMF NICU Network
♦ Strengthen communication and exchange (scientific development,
clinical research and teaching) between tertiary hospitals and other
city hospitals
♦ Provision of equipment could directly improve the capability of
saving lives
♦ Build up a team of high quality staff through training
♦ Confidence of staff increased
♦ Upgrade in service standard and quality
♦ Lowering of the neonatal mortality rate
♦ Good economic effect for the hospital
♦ Upgrade of the brand image of the hospital in the region
♦ Newly established NICU stimulates top management to further
invest in neonatal care
Cons:
♦ Working life becomes very busy after setting up the NICU
♦ Very stressful working environment in NICU
♦ High risk clinical work
♦ Not much communication and exchange within hospital
♦ Not enough resources to upgrade and operate equipment
♦ Insufficient equipment
♦ Disability caused by the treatment in NICU
♦ Increase in debt in NICU
Problems encountered and possible solutions after setting up of NICU:
Affordability of patients and their families
Standardization and data base are very important in developing the NICU
Insufficient input, insufficient manpower
Management standard needs to be enhanced
Not enough support from top management of the hospitals
Strengthen the publicity of NICU and encourage more participation from
the leaders of hospitals
The mortality rate and the rescue success rate would be affected by the
cases given-up
Economic level in the district, debt to the NICU due to given-up cases and
being unable to pay the hospital bill – is it possible to set up a “foundation”
to help solve these cases?
Despite successful rescue by the NICU, some newborns live with disease
and disability; suggestion to develop rehabilitation services to address this
need
Not enough clinical skills – more training?
Problems in both soft and hard ware – solicit more support from the top
management of the hospitals and provide more training to the staff
Shanghai, CHINA * April 26 – 27, 2009 11Conference Report – CMF NICU Network
Key neonatal problems in the district:
Asphyxia
Prematurity
Congenital anomalies
No pediatrician in the delivery room
Some patients are unable to afford the NICU fee
Transferal system – no transferal equipment; no connection with the
tertiary hospitals and no where to transfer
No good understanding about NICU for those non-NICU-professional
Low level of trust between patients and medical professionals
Prognosis of congenital anomalies and asphyxia and the affordability of
parents
No resuscitation training for county or village level medical units
The standard for neonatal care is not high and may cause some
misdiagnosis or mistreatment
Suggestions to improve the problems:
Need to develop a 3-level standard for NICUs in China based on demand,
hospital conditions, resources and expertise
Need to also develop a 3-level transferal system – for county, prefecture
city and provincial city
Offer regular retraining for trainers in the hospital, especially for those
using ventilators
Standardization of diagnosis and management of NICU should be further
actualized
Health education to the public
Establishment of rehabilitation centre
Regularly report to the hospital’s leaders to make them better understand
the importance of NICU
Shanghai, CHINA * April 26 – 27, 2009 12Conference Report – CMF NICU Network
6. Inauguration Ceremony
Representatives from each NICU were requested to bring a photo which could
tell other participants a story regarding his or her experience in neonatal care
service or NICU services. During the inauguration ceremony, representatives
shared their photo and story. Here are some of the stories and photos:
“These twins were born prematurely
with very low birth weight. They
needed respiration equipment to
support their fragile lives. Thanks to
the donated ventilator from CMF, we
could save their lives by using the
ventilator. They were saved and now
growing up healthily.” – Dr. CHEN
Yanxiang from Yichuan No. 1
People’s Hospital in Ningxia (NICU
est. in 2003)
critical conditions was sent in from the
city maternal and children’s hospital in
the afternoon. This transfer-in
neonate was unable to breathe by
herself. They were fortunate to be
saved because we have two
ventilators in our NICU (one donated
by CMF and another one was added
by our hospital later on). We were
thankful to CMF not only for their
“On the 25th of February in 2009, donation but also the facilitation effect
there was one preterm neonate of its donation.” – Dr. CAO Yuntao
using the ventilator in our NICU. from Affiliated Hospital of Zunyi
However, another neonate with Medical College (NICU est. in 2007)
Shanghai, CHINA * April 26 – 27, 2009 13Conference Report – CMF NICU Network “I would like to share this case of the his follow up at 1 year old. We were smallest kids saved by our hospital so glad that he is now a very healthy to you. His mother carried two 3-year old boy.” (Dr. LIU Ling from babies during her pregnancy. Yet, Guiyang Maternal and Children’s both of them were born in their 27 Hospital (NICU est. in 2009) weeks and the first one was found dead right after birth. The live one weight 900 grams and he had gone through a very tough period in our neonatal unit. We suspected he had cerebral palsy when he was 3 months old. Fortunately, after systematic therapy and rehabilitation training, his development was found totally normal when he was 1 year old. This picture was taken during Shanghai, CHINA * April 26 – 27, 2009 14
Conference Report – CMF NICU Network
7. List of participants
1 儿童医健基金会中国医健顾问委员会委员桂永浩教授 Professor GUI Yonghao
2 上海复旦大学儿科医院院长黄国英教授 Professor HUANG Guoying
3 上海儿科医学中心院长刘锦纷教授 Professor LIU Jinfen
4 上海儿科医学中心新生儿科科主任孙建华教授 Professor SUN Jianhua
5 上海儿科医学中心副院长王伟医生 Dr. WANG Wei
6 上海儿科医学中心科教部主任金燕樑医生 Dr. JIN Yinliang
7 中华医学会儿科分会新生儿组副组长陈超教授 Professor CHEN Chao
8 上海复旦大学儿科医院新生儿科副主任曹云医生 Professor CAO Yun
9 上海复旦大学儿科医院社会发展部主任罗伟奋主任 Ms. LUO Weifen
10 上海复旦大学儿科医院社会发展部刘玉楣女士 Ms. LIU Yumei
11 择善基金会项目主任唐悦文女士 Ms. Nora TONG
12 中国疾病预防控制中心妇幼保健中心副主任王临虹教授 Professor WANG Linhong
13 中国疾病预防控制中心妇幼保健中心儿童卫生保健部主任王惠珊主任 Professor WANG Huishan
13 上海复旦大学儿科医院小组组长王谨医生 Dr. WANG Jin
14 上海复旦大学儿科医院小组组长刘江勤医生 Dr. LIU Jiangqin
15 上海复旦大学儿科医院小组组长张澜医生 Dr. ZHANG Lan
16 上海复旦大学儿科医院小组组长朱丽医生 Dr. ZHU Li
17 儿童医健基金会项目总监陈淑茵女士 Ms. Yan CHAN
18 儿童医健基金会项目经理黄咏仪女士 Ms. Winnie WONG
19 浙江龙游县妇幼保健院金智敏儿科主任 Dr. JIN Zhimin
20 浙江富阳市妇幼保健院王陈裕儿科副主任 Dr. WANG Chenyu
21 浙江江山市妇幼保健院姜双英主任 Dr. JIANG Shuangying
22 浙江海宁市妇幼保健院沈鹏院长 Dr. SHEN Peng
23 浙江永康市妇幼保健院朱东波院长 Dr. ZHU Dongbo
24 浙江永康市妇幼保健院程可萍 NICU 主任 Dr. CHENG Keping
25 四川雅安市人民医院邹永蓉儿科副主任 Dr. ZOU Yongrong
26 宁夏银川市第一人民医院陈彦香儿科主任 Dr. CHEN Yanxiang
27 内蒙古妇幼保健院富景春院长 Dr. FU Jingchun
28 内蒙古妇幼保健院王红云主任 Dr. WANG Hongyun
29 贵州遵义医学院附属医院曹云涛新生儿科主任 Dr. CAO Yuntao
30 广西柳州市人民医院杨彤副主任 Dr. YANG Tong
31 新疆石河子大学医学院第一附属医院谷强副主任 Dr. GU Qiang
32 四川达州市第二人民医院李竹徽主任 Dr. LI Zhuhui
33 湖南衡阳市中心医院祝平照新生儿科医生 Dr. ZHU Pingzhao
34 陕西延安大学附属医院刘世平新生儿科主任 Dr. LIU Shiping
35 贵州贵阳市妇幼保健院刘玲新生儿科副主任 Dr. LIU Ling
36 江西上饶市人民医院吴启勇新生儿科负责人 Dr. WU Qiyong
37 广西右江民族医学院附属医院潘红飞教授 Dr. PANG Hongfei
38 西藏拉萨市人民医院邱全芳主任 Dr. QIU Quanfang
39 四川绵阳市中心医院余静儿科主任 Dr. YU Jing
40 四川绵阳市中心医院管利荣副主任 Dr. LI Rong
41 四川绵阳市中心医院魏丽蓉主管护师 Dr. WEI Lirong
Shanghai, CHINA * April 26 – 27, 2009 15Conference Report – CMF NICU Network
Children’s Medical Foundation
78/F., The Centre, Queen’s Road Central,
Central, Hong Kong
Tel: (852) 2877-4118
Fax: (852) 2525-0511
E-mail: develop@cmf.org.hk
Website: http://www.cmf.org.hk
Shanghai, CHINA * April 26 – 27, 2009 16You can also read
