Health and longevity are the common aspirations of humanity, as well as eternal topics in human existence. With economic and social development, as well as changes in population structure, people's demands for health have become more diverse. It is not only about pursuing the length of life but also striving for its quality.
On March 7th-9th, 2024, the Fourth Shanghai Cardiovascular Development and Regenerative Medicine Summit Forum and the 2024 Xinhua Lifecyle Cardiovascular Health Forum are about to be held. On the eve of the conference, Professor Sun Kun, Chairman of the conference and Dean of Xinhua Hospital affiliated with Shanghai Jiao Tong University School of Medicine, vividly recounted one heartwarming real-life story after another, tracing the past, present, and future of "fetal medicine" while earnestly elucidating Xinhua Hospital's grand vision for "lifecycle health management from 0 to 100+ years old.
Shanghai Jiao Tong University School of Medicine Affiliated Xinhua Hospital
Professor Sun Kun
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0-100+ years full life health cycle management
Pediatric and adult discipline dual "brand gene"
“Xinhua Hospital is a very distinctive comprehensive teaching hospital in the country's large third-class A hospitals. We not only have a complete pediatric system and adult discipline system, but also are well-known in the field of obstetrics and gynecology, especially perinatal medicine.”
Professor Sun Kun said that as early as the 1980s, Xinhua Hospital took the lead in the diagnosis and treatment of children with congenital heart disease in China. On this basis, Xinhua Hospital has initially established a subject system of intrauterine pediatrics, so far successfully completed 2,000 cases from intrauterine to perinatal sequential treatment, congenital esophageal atresia cure rate reached 96.8%, congenital septal hernia overall survival rate also reached 73%.
As the only general hospital in Shanghai that has both perinatal and complete pediatrics subspecialties, and is also the first national demonstration base for early childhood development, Xinhua Hospital has the dual "brand gene" of pediatrics and adult disciplines, which enables the medical services of Xinhua Hospital to cover from fertilized eggs to pregnancy, to delivery, to newborns and children. Even in adulthood and old age, to provide 0-100+ full life cycle health services for patients.
Reverse the fate of "birth as death"
In 2023, a medical drama "Asking Heart" has aroused the attention of all sectors of society, there is such a plot in the play: the nurse is pregnant at an old age, but the fetus was found to be born with right ventricular dysplasia during childbirth. For the future of the fetus, the protagonists launched a debate, and finally, after fully weighing the pros and cons of the risks, the head nurse accepted intrauterine heart interventional surgery.
Intrauterine fetal cardiac interventional surgery technology is extremely difficult, only a few medical institutions in the world have the ability to carry out, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine is one of them.
On July 17, 2018, under the leadership of Professor Kun Sun, the intrauterine Pediatrics team of Xinhua Hospital completed the first fetal aortic valve balloon dilation in Asia. The success of the operation made the baby's heart develop better in utero, and the condition was stable after birth without emergency surgical intervention, creating good conditions for subsequent surgical treatment. Changed the child's birth and death.
When recalling the case, Professor Sun Kun said with feeling, "We operated on him at 30 weeks of pregnancy, and after the full-term delivery at 40 weeks of pregnancy, we did not find the needle eye left during intrauterine treatment on his body, and the uterus gave him a magical healing ability." That's what uterine pediatrics is all about, offering hope, surprise and wonder to pregnant families."
The past and present lives of intrauterine pediatrics
The history of intrauterine pediatrics can be traced back to the "fetal origin theory" in 1995, which holds that malnutrition in the fetus during the second and third trimesters of pregnancy can cause growth disorders, leading to a predisposition for atherosclerotic heart disease in adulthood.
At the beginning of the 21st century, Doha theory was further expanded on the basis of the "fetal origin theory", emphasizing that in addition to genetics and later lifestyle, human beings experience adverse factors in early life (fetal, infant, childhood), which will affect the occurrence and development of chronic noncommunicable diseases (chronic diseases) in adulthood.
In the 1980s, the new concept of "Fetus as a patient" was put forward internationally, and the fetus was treated as a patient for the first time, ushering in the era of fetal medicine.
In 2021, Professor Kun Sun's team first proposed the concept of "intrauterine pediatrics" in the Lancet sub-journal of Global Health: a discipline that studies early prevention, screening, diagnosis and treatment of diseases from fertilized eggs to children and adolescents and even the whole life cycle for the purpose of prevention and treatment of developmental diseases.
"We believe that focusing on the early embryo is directly related to healthy outcomes in childhood and even later in life."
Professor Sun Kun said that intrauterine pediatrics further organically combines intrauterine diagnosis and treatment of fetuses with the sequential management of the whole life cycle of children's health, forming a new and rapidly developing interdisciplinary discipline, emphasizing the whole process and consistency of early life health management, and will become an important engine for the realization of whole life cycle management.
To protect the desire to have children
At present, Xinhua Hospital has set up an intrauterine pediatric disease diagnosis and treatment center, which regularly carries out multidisciplinary outpatient diagnosis and treatment, gathering experts in obstetrics, pediatrics, imaging, genetics and other disciplines to provide more authoritative judgment and diagnosis and treatment plans.
The miracle of successful treatment one by one also made Professor Sun Kun have a more profound thinking about "the choice of life".
At present, China has initially established a comprehensive prevention and treatment system for birth defects, and promoted the establishment of tertiary prevention measures to reduce the incidence of birth defects. However, it is noteworthy that due to the lack of participation of pediatric medicine in network construction, one-sided pursuit of the reduction of birth defects rate has led to misjudgment and over-interpretation of pregnancy diagnosis in some areas. To some extent, it will increase the occurrence of unnecessary medical abortions, which greatly undermines the confidence of families of childbearing age and affects the number of births.
In an interview, Professor Sun said that many expectant mothers in the clinic came to consult for fetal adductus, and they were very anxious because the local obstetrician told them that the child would grow up to be a congenital heart disease patient. But in fact, fetal patent ductus arteriosus is a normal phenomenon, which is in line with the law of fetal growth and development. Moreover, the cure rate of congenital heart disease is very high.
"It can be said that more than 80% of children with congenital heart disease can be cured. By healing, I mean growing up like a healthy child, exercising, studying, getting married, and having children.”
But unfortunately, in the grass-roots birth defect prevention network, not all obstetricians and obstetrical sonographers understand the development of pediatric medicine. Also based on this, the proposal of intrauterine pediatrics promoted the cross-integration and common development of obstetric medicine, and truly guaranteed people's fertility willingness.
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Multi-hospital model, to build "six centers, two platforms"
Since the outline of the "14th Five-Year Plan" was proposed, Xinhua Hospital has emphasized the service concept of centering on people's health and taking the multidisciplinary integration of MDT as the starting point.
"This is expected to allow us to break down the disciplinary structure of medicine and surgery, break down the age barrier between adults and children, break down the isolation of clinical and research, break down the separation of basic research and clinical research, so as to achieve the full life cycle of health management."
Centering on the "six centers and two platforms", Xinhua Hospital has formulated a three-year climbing plan to comprehensively promote the construction of research-oriented specialty and special disease centers, relying on multidisciplinary cooperation, encouraging leaders to take the lead, driving clinical research, promoting the cross-integration of medical and industrial services, and restructuring the medical service system and model.
In the future, the disciplines of Xinhua Hospital will put more emphasis on the capacity building of clinical specialties, advocate integrity, innovation and win-win cooperation, explore to break the barriers set by the original medical disciplines and clinical departments, optimize the organizational form and operating mechanism of clinical specialties with patients as the center and disease diagnosis and treatment as the chain, and provide one-stop and full-process diagnosis and treatment services for patients. Drive personnel training, technological innovation and development, medical quality and safety work.
The brilliant achievements of Xinhua Hospital for more than 60 years cannot be separated from the hard work and accumulation of the older generation of experts, nor can it be separated from the new generation of experts. On the road of medicine, countless doctors have dared to challenge and studied diligently to protect the line of defense and hope of life.
At the end of the interview, Professor Kun Sun explained his original intention as a doctor: "Since he has chosen to devote himself to the medical career, he must not forget his mission to protect human health." The medical career is very long and there will be numerous setbacks and challenges. I hope our young doctors can stick to their original intention and feel the meaning and value of life in this career."