Paired support sends neonatal care to Nagqu

Despite gradually getting accustomed to the thin air at 4,700 meters in Nagqu since arriving in the Xizang autonomous region early last year, neonatologist Tian Congliang still wears a backpack-sized portable oxygen concentrator at all times.

"Long-term oxygen deprivation in this environment can slow down my cognitive reactions," said Tian. "Saving newborns is a race against time and often requires making critical medical decisions in the blink of an eye."

Tian, 47, from the First Affiliated Hospital of Dalian Medical University in Dalian, Liaoning province, is a member of the seventh medical aid team dispatched from Liaoning to Nagqu.

He serves as the head of the neonatal intensive care unit at Nagqu City People's Hospital, the nation's highest-altitude tertiary-level (top-tier) public hospital.

Since 2015, central authorities have sent teams of medical experts to Xizang to raise the overall level of local healthcare.

The northeastern province of Liaoning has paired up with Nagqu, and has sent seven teams comprising over 130 medical workers to the city. They have introduced 291 new medical technologies previously unavailable in the region, making it possible to treat an extra 23 severe diseases and 435 major illnesses locally.

Tian is the first medical aid professional specializing in neonatology — the diagnosis and treatment of infants within the first 28 days of life — to work at the hospital.

"While still in Dalian, I learned from a colleague that the Nagqu City People's Hospital had established a regional critical neonatal treatment center in recent years," he said. "I believed my expertise could be valuable here and truly make a difference, so I applied for the aid program without hesitation."

Jigme Dorje, a local doctor who has worked in the hospital's pediatric department for more than two decades, was thrilled to learn of Tian's arrival.

"Thanks to outside support, our department had already seen significant improvements over the years," Jigme Dorje said. "But we were still in critical need of specialized training in neonatal care. I had been looking forward to a specialized neonatologist for a very long time."

Neonatology focuses on the care of premature infants and newborns with severe congenital disorders. Compared with general pediatrics, treating tiny newborns — some weighing as little as 1,000 grams — requires a meticulously controlled clinical environment and more delicate and precise medical interventions, according to Tian.

Inside the hospital's neonatal intensive care unit, dozens of incubators — each draped with soft pink cloth to soften lighting — create a cocoon-like environment for fragile infants connected to tubes and wires.

The unit is hushed, punctuated only by the steady beeping of monitors and the occasional clatter of medical instruments and doctors' voices.

"Previously, parents were permitted to enter the unit rather freely to visit their babies and even chat, which violated standard protocols," Tian said. "Therefore, one of our first steps was to reinforce entry policies and ensure the unit remains quiet and well-organized."

In Nagqu, the oxygen content in the air is only 58 percent of that at sea level even during the summer months.

Consequently, newborns in the region face a higher risk of hypoxic-ischemic encephalopathy — a type of brain injury caused by insufficient oxygen and blood flow around the time of birth. Other common conditions include jaundice, infections and premature birth, said Tian.

One of the first technical skills Tian introduced to the local medical team was the use of specialized neonatal ventilators. These devices are engineered to allow precise adjustments of air flow tailored to the low tidal volumes of newborns — the amount of air moved with each breath — which differ significantly from those of adults.

"When I first arrived, I found that many infants in need of respiratory support were connected to pediatric or even adult ventilators," Tian said. "Meanwhile, the dedicated neonatal ventilators remained unused in storage simply because no one knew how to use them."