The specialist doctor for fetal diagnosis and treatment has arrived: Xinhua Hospital releases the English monograph "Intrauterine Pediatrics" in Pediatrics | Health | Specialist Doctor

From the beginning of life, the health status of the fetus may determine the health code for a lifetime, and many diseases can actually be traced back to the fetal period. Who can diagnose, treat, and recover early when the fetus is sick? Nowadays, specialized doctors for fetuses have arrived: Shanghai Jiao Tong University School of Medicine Affiliated Xinhua Hospital has extended the scope of diagnosis and treatment of the pediatric team to intersect with obstetrics, forming a new discipline - intrauterine pediatrics.

Today, at the 2023 Medical Frontier Forum and the 14th China Women and Children's Health Development Promotion Summit, the world's first English monograph on intrauterine pediatrics was officially released. Editor in Chief and Director of Xinhua Hospital, Sun Kun, introduced, "We will face the youngest 'patients' and focus on pediatric diseases originating from the uterus, including all fetal structural abnormalities, growth and development abnormalities, and congenital organ functional defects. From fertilized eggs to adolescence, we will continuously screen, diagnose, treat, and prevent these diseases, ultimately helping them become full potential adults."

Previously, the intrauterine pediatrics team of Xinhua Hospital also published a commentary on "Promoting Prenatal Pediatric Nursing" in the Frontiers of Medicine column of the Journal of the Chinese Academy of Engineering, elaborating in depth on the necessity, definition, and scope of establishing intrauterine pediatrics, and proposing the reconstruction of the pediatrics system.

Earlier health intervention: focus on fetal disease prevention

Early health intervention: focusing on preventing fetal diseases

In fact, embryonic development is a programming process that involves the interaction between genetic information and environmental factors. When embryonic development programming is influenced by dietary or environmental factors, epigenetic modifications change, thereby affecting its phenotype and even increasing susceptibility to adult diseases.

The pediatric team at Xinhua Hospital believes that the developmental origin theory of health and disease emphasizes the importance of early life events for later health. This concept has prompted pediatricians to pay attention to fetal health and pushed the forefront of pediatrics to the fetal, embryonic, and even preconceived stages.

For example, gestational diabetes is a common complication of pregnancy, affecting more than 10% of pregnant women in the world, and an important risk factor for childhood obesity and neurodevelopmental disorders. Early intervention and control of diabetes in pregnancy can avoid harmful effects on the long-term health of offspring. Similarly, fetal exposure to environmental pollutants and other substances is related to developmental disorders. The role of pediatricians in studying and understanding the environment in which fetuses come into contact is crucial for screening and milestone assessment of children. Such intervention measures can also initiate immunization in the uterus.

Professor Zhang Jun from the intrauterine pediatric team introduced that vaccinating mothers against tetanus, diphtheria, and pertussis can protect children from pertussis. There is also evidence that vaccination with COVID-19 vaccine can transfer protective antibodies to newborns. Long term research on these interventions is crucial for determining their safety and effectiveness.

The developmental characteristics of the fetal period determine that some special diseases, if intervened or even operated from the fetal period, can improve the efficiency and probability of success, improve the long-term prognosis, and have almost no sequelae. Sun Kun led intrauterine pediatricians to continue to treat the severe congenital heart disease fetus in the mother's belly after completing the first single-center interventional therapy for severe aortic valve stenosis fetus in Asia in 2018. So far, the single-center intrauterine interventional therapy for severe congenital heart disease has achieved the highest number of diseases in the country, with both pregnant mothers giving birth at full term and zero fetal death, breaking the monopoly of this technology in Europe and the United States for nearly 20 years. Timely intervention of fetal aortic stenosis can not only improve myocardial development and ventricular function, but also increase the possibility of biventricular repair after birth.

Early intrauterine treatment provides a chance for fetal rebirth

The developmental characteristics of the fetus determine that intervention or even surgery for certain special diseases from the fetal stage can improve the efficiency and likelihood of success, improve long-term prognosis, and have almost no sequelae. Sun Kun led intrauterine pediatricians to complete the first single center severe aortic valve stenosis fetal intervention treatment in Asia in 2018, and continued to treat severe congenital heart disease in the mother's womb. So far, the single center severe congenital heart disease intrauterine intervention treatment has achieved the highest disease type in the country, with all mothers giving birth at full term and zero fetal death, breaking the monopoly of this technology in Europe and America for nearly 20 years. Timely intervention in fetal aortic valve stenosis can not only improve myocardial development and ventricular function, but also increase the possibility of postnatal biventricular repair.

In addition, Xinhua Hospital has also taken the lead in creating a domestic expert consensus on the diagnosis and perinatal management of fetal congenital heart disease, improving the accuracy of fetal congenital heart disease diagnosis to over 90%, benefiting more than 600000 pregnant women and fetuses annually.

At the same time, in recent years, Xinhua Hospital has widely applied umbilical surgery, ectopic delivery treatment, and other treatments in the delivery of fetal large neck masses, fetal diaphragmatic hernia, severe lung lesions, and severe pleural effusion. Pediatricians are increasingly involved in genetic counseling and multidisciplinary diagnosis and treatment during the fetal period, and develop early treatment plans to more accurately participate in fetal disease management and improve children's health index while ensuring maternal and fetal safety.

How to promote the high-quality development of the population? The team of intrauterine pediatrics at Xinhua Hospital believes that unlike the current fetal medicine and pediatrics, intrauterine pediatrics is still a branch of fetal medicine and pediatrics. Intrauterine pediatrics is the re-development of perinatal medicine, fetal medicine is the general practitioner of the fetus, and intrauterine pediatrics is the Junior College doctor of the fetus. Intrauterine pediatric experts will seamlessly connect the existing system of pediatrics, and integrate the advantages of prevention, treatment, rehabilitation and other disciplines from embryo to adolescence.

A More Friendly Reproductive Environment: From Embryo to Adolescence

Due to the declining birth rate and aging population being a major challenge faced by many countries, reform and innovation to promote high-quality population development and the construction of a fertility friendly society have become new responsibilities and challenges for the pediatric community.