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In the past decade, there has been a dramatic growth in perinatal-neonatal care system at provincial and sub-provincial tertiary centers in China. China's statistics are staggering: with its 1.35 billion population, the annual number of births is 17 millions. Of this the premature rate is estimated at 8% in urban residents, and 4%–5% in rural residents. As urbanization reached nearly 50% for the whole country, the estimated average for the total premature born is 6%, or more than 1 million each year. In the face of such enormous numbers, it is encouraging that in the most recent years, the implementation of health insurance covering both urban and rural residents, has made the modern prevention and treatment of severe neonatal disorders possible. This was especially so for very immature infants. It is now possible to ensure that more than 90% births are in hospital. There has also been a steady reduction in neonatal and infant mortality, but regional variations remain in service quality and health insurance coverage, in many areas, such region-to-region differences may vary significantly.
In this regard, the neonatal intensive care unit (NICU) at regional tertiary center plays a pivotal role in supporting infrastructure and management and can guide modern technology and concept flows. NICU care grows faster than ever before, from provincial central hospitals to sub-provincial health care centers, with the south-eastern (coastal) provinces being the most advanced. These reach a level similar to the average of Europe in early 1990's. However, even in the newly industrialized (coastal) regions controversies remain. For example, there are discrepancies in equality and efficiency in the care of newborns from families with low-income or mobile families, and the still developing interaction and collaboration between well developed centers and newly developing ones. In north and mid-western regions of China, due to the relatively low economic and health care levels, care givers in neonatal medicine tend to have more difficulty in solving such problems. The health care standard there is low, in many counties there are only essential and intermediate care at level I and II clinics and service centers; and not many level III hospitals in sub-provincial cities are able to offer advanced neonatal care, which is consistent with local economic status and social health care policy and organization.
In 2001–2003, clinical investigators of neonatal services in different regions of China established a collaborative study group aiming at promotion of advanced management of neonatal respiratory diseases through collaborative network. This was the first attempt in Chinese neonatal community using contemporary concept and methodology of neonatal medicine. After its initial success in completing systematic studies,1,2 this collaboration extended to several provinces.3 Similar study groups across provinces were also formed and collaborative studies conducted since 2006.4 In parallel to this progress, there was support from a joint international collaborative study grant funded by the National Natural Science Foundation of China (NSFC) and Canadian Institute of Health Research (CIHR). This well organized program was to assist “advanced neonatal respiratory and critical care”. China-Canada collaboration aimed to assist the development of clinical epidemiology and neonatal respiratory therapy. In the past three years, several workshops and training courses were organized. Articles in this issue reflect in part these efforts as presented at an international symposium held in November 6–8, 2009 in Guangzhou, China.
In this issue, a number of review articles presented at that symposium by international experts and original articles from domestic clinical investigators have focused on recent advances in the pathogenesis, pathophysiology, management and outcome from international background or domestic neonatal respiratory and intensive care. The meeting served also as venue for the annual workshop for a network of more than 50 China-wide NICU promoting concepts and technologies in respiratory support and intensive care. Other review articles in this issue bring to the readers with new concept and management of critically ill infants with major complications due to instability in pulmonary, cardiovascular, gastrointestinal, and neurological development and function.
We hope that the topics and contents in this issue may be helpful to both clinical investigators and health care givers in NICU environment to develop their skills and upgrade capacity and quality in future, and expect that this may enhance international collaboration and exchange in near future.
Acknowledgements: We wish to thank the staffs from the Department of Pediatrics, Guangdong Provincial People's Hospital, Guangzhou Perinatal Society, as well as local firms for health care providing support to this symposium and publication.
REFERENCES
1. Qian LL, Huang QW, Sun MY, Song SM, Li KH, Song GW, et al. Treatment of severe meconium aspiration syndrome with porcine surfactant: A multicenter, randomized, controlled trial. Acta Paediatr 2005; 94: 896-902.
2. Qian LL, Liu CQ, Zhuang WZ, Guo YX, Yu JL, Chen HQ, et al. Neonatal respiratory failure: a 12-month clinical epidemiologic study from 2004 to 2005 in China. Pediatrics 2008; 121: e1115-e1124.
3. Sun B, Qian LL, Liu CQ, Wang SN, Yu JL, Cheng XY. Development of perinatal-neonatal medicine in China. Neoreviews 2008; 9: e95-e101.
4. Ma L, Liu CQ, Wang YQ, Li SF, Zhai FS, Gu XF, et al. Mortality of neonatal respiratory failure related to socioeconomic factors in Hebei Province of China. Neonatology 2010; in press.
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