China Cal: Newborn Screening Training and Evaluation Program

Early CHD Detection is Crucial

​Nineteen-year-old Rui Rui broke down crying when she heard the doctor’s news—it’s too late for her to have surgery. Her congenital heart disease wasn’t diagnosed early enough. Over the years she’s developed high pressure in her pulmonary artery, which prevents her from getting the surgery she hoped would cure her. Now she can only resort to medication to stabilize her condition. Imagine how Rui Rui’s life could have been different if only she had been diagnosed earlier. China Cal is striving to change the situation before it’s too late for other children.

New Training Program in Yunnan

​In 2014, China Cal and the Kunming Medical University formed a committee to implement a new training program in Yunnan Province. Their purpose is to train all county hospital personnel in the province who are responsible for the care of newborns, teaching the doctors how to properly screen for congenital heart disease.

​The committee is developing a staff of trainers who will travel to rural county hospitals. They will train obstetricians, pediatricians, and nurses how to evaluate newborns using pulse oximetry and stethoscope exams.

Trainees in Hong He prefecture screen a newborn baby using pulse oximetry.

Fangqi Guo trains rural doctors and nurses how to properly screen newborns.

Training Objectives

​The training will help the doctors know what to look for, such as heart murmurs. It will also equip them to proficiently use the necessary screening tools, such as stethoscopes and high quality pulse-oximeters, which should be available for their delivery rooms and neonatal wards. If an infant fails the screening exams, the doctors will also be trained on follow up steps for the baby and its parents. The goal is for each hospital to establish the long-term practice of regular screening for all their newborns so congenital heart disease can be diagnosed early.

Dr. Ya Ni Li trains the proper method to auscultate a newborn baby’s heart.

Fangqi checks examination skills.

Results and Plans

​By the end of 2015, training will have occurred in 5 of the 16 Yunnan prefectures. After the training, the average screening rate for these areas is about 84%, which is comparable to the rates in developed nations.  The training team follows up with the hospitals to collect data and to ensure proper implementation of the training. In 2016, China Cal plans to train in 8 more prefectures.

This map shows the county hospitals that have already received training this year.

This map shows the county hospitals that will be visited by the end of 2015.

Dr. Detrano gives a pulse oximeter to a hospital in Hong He prefecture.

Evaluation of Training Program

With the help of a grant from the Chao Foundation, China Cal has added an evaluation component to their training program to assess its results. Ms. Fangqi Guo will be the principal investigator in these evaluations. She is a University of California, Irvine Program in Public Health, PhD graduate student. Fangqi will work with the China Cal team in Yunnan for several months to evaluate the increased knowledge and change in behavior of the trainees. 

Pilot Project for Surgical Care

Since more Yunnan babies are being screened, we anticipate more cases of critical congenital heart disease being diagnosed. If the diagnosed children require surgery, then we want to help them and their parents through that process. The Chao Foundation is collaborating with China Cal in a pilot project to provide that support. All children benefiting from this project will undergo corrective surgery at KMU First Affiliate Hospital in Kunming, Yunnan Province. This pilot project will enhance the support that China Cal and one of its partner organizations (the Children's Heart Link of Minneapolis, MN) are providing to KMU to improve the quality of its care for children in Yunnan Province. 

First Heart Surgery in Yunnan: Rong Rong

Rong Rong was the first child to benefit from our surgical support in Yunnan. This little girl was born with an extra toe, and when she was around 3 or 4, her family took her to the hospital for surgery. During a preoperative examination, she was diagnosed with congenital heart disease. At that moment, the doctor canceled the surgery and recommended she receive treatment for congenital heart disease first. Because heart surgery was so expensive, Rong Rong's family wouldn't have been able to afford it. Her parents worked hard but still couldn't save enough money. Rong Rong would have only lived for another 5 to 6 years. With our help, 9-year-old Rong Rong was able to have a successful surgery in September 2014.  She recovered well and has a bright, healthy future ahead of her. We look forward to helping many more children in Yunnan like Rong Rong!