Guidelines to help doctors treat children

Top Chinese experts in pediatric medicine converged on Shanghai this week to start work on compiling national guidelines aimed at standardizing the diagnosis and treatment of children's illnesses and other health issues.

The panel, which includes hospital presidents, surgeons and academics, met for the first time at Fudan University Children's Hospital on Tuesday and chose the first four topics for advisories to be shared with doctors nationwide.

Guidelines on inflammatory bowel disease, pediatric gastroscopy procedures, nutritional support for critically ill children and general physical activity are expected to be released by the end of 2018, according to Zhang Chongfan, editorial director of the Chinese Journal of Evidence-Based Pediatrics and a member of the 41-strong panel.

Huang Guoying, president of the hospital, said a lack of national guidelines has led to inconsistent quality of treatment in China.

"It's often the case that 10 doctors will give 10 different ideas about the diagnosis and treatment of a sick child, which confuses the patient, parents and even the doctors," he said. "The guidelines are intended to ensure that children receive the same treatment at all hospitals, and that medical mistakes can be avoided as much as possible."

The medical journal, which is influential with the country's pediatricians, is based at the hospital and has previously seen some success in standardizing doctors' behavior.

Over the past seven years, it has published guidelines on treating fevers in children under age 5 and helping newborns with hypoxic ischemic encephalopathy, or HIE, a condition that occurs when the brain doesn't get sufficient oxygen.

"Before, one hospital might have a guideline about a certain disease, but another hospital might disagree. Now we're trying to look for universal conclusions based on the nationwide data that has not been obtained before," Huang said.

For example, he said, if a child with pneumonia goes to see the doctor, the guidelines will make clear which tests should be used for diagnosis, and, if the child shows certain complications, which additional tests should be done to find out why the child is sick.

"In the guideline for HIE among newborns, we stipulated that doctors must reduce the use of some medicines, which are unnecessary and could result in the patient's parents having to pay higher medical bills," said Yuan Lin, director of the Fudan hospital's administrative office. "Doctors always want to see the best results from their treatment and the best outcomes for the patients, but this can sometimes mean they prescribe unnecessary medicines."

Zhang said the national guidelines will be compiled from analyses of articles in the journal that received the best feedback, research from hospitals nationwide and international advisories.

The expert panel was convened by the National Children's Medical Center following a request from the National Health and Family Planning Commission in April.

Huang, the hospital president, said the goal is to eventually have guidelines covering more than 300 childhood diseases and conditions, with the initial target being to release five per year.