Jiang Lu

Background: The global burden of malnutrition in children with congenital heart disease (CHD) is substantial, yet whether surveillance modality—the clinical pathway of initial CHD detection—influences nutritional status remains unexplored. We aim to compare nutritional status and complex CHD between children with CHD detected through active versus passive surveillance. Methods: This cross-sectional study included 9,355 children aged 0–18 years with confirmed CHD admitted to Fuwai Yunnan Hospital (China) between September 2017 and June 2025. Active surveillance was defined as detection through systematic screening (prenatal echocardiography, newborn pulse oximetry, routine health check-ups, or school-based echocardiography), while passive surveillance included symptom-driven diagnoses. Undernutrition was assessed using the WHO growth standards. Complex CHD was classified per the AHA anatomic criteria. Multivariable logistic regression examined associations of surveillance type with undernutrition and complex CHD. Results: Of 9,355 children (63.4% active, 36.6% passive), the admission undernutrition prevalence was 31.8%. Marked heterogeneity emerged across active surveillance subtypes ( p < 0.001): prenatal screening showed the highest undernutrition (45.3%) and complex CHD proportion (26.4%), whereas school-based screening had the lowest (27.3 and 2.2%, respectively). Compared with passive surveillance, prenatal screening was associated with higher odds of undernutrition (adjusted OR = 1.48, 95% CI:1.19–1.85, p < 0.001) and complex CHD (OR = 2.89, 95% CI:2.19–3.81, p < 0.001), whereas school-based screening was associated with lower odds (OR = 0.81, 95% CI:0.72–0.91, p < 0.001 and OR = 0.27, 95% CI:0.20–0.36, p < 0.001). Biochemical parameters independently associated with undernutrition included lower hemoglobin (OR = 0.99, 95% CI:0.98–0.99), lower albumin (OR = 0.94, 95% CI:0.92–0.96), higher blood urea nitrogen (OR = 1.11, 95% CI:1.07–1.15), lower creatinine (OR = 0.94, 95% CI:0.93–0.95), higher uric acid (OR = 1.01, 95% CI:1.00–1.02), and higher triglycerides (OR = 1.24, 95% CI:1.15–1.34) (all p < 0.05). Conclusion: CHD detection pathways are independently associated with nutritional status. Prenatally detected children may benefit from proactive nutritional surveillance from birth, while the expansion of school-based screening should be prioritized in underserved areas. These findings advocate for a stratified, pathway-aware malnutrition surveillance framework to optimize outcomes across the full CHD spectrum in settings with comparable screening infrastructures. While healthcare systems vary across Global South regions, this study provides a novel perspective that may inform policy discussions and guide future research in other middle-income countries.

Background: School-based screening is a critical strategy for detecting congenital heart disease (CHD) in resource-limited regions, yet single-round programs may miss a substantial number of treatable cases. The value of repeat screening in identifying these missed cases remains underexplored. Methods: As part of the Yunnan Provincial Comprehensive Plan for CHD Prevention and Control, we conducted two rounds of community-based CHD screening using cardiac auscultation followed by portable echocardiography in 23 counties. The first round (2017–2020) screened 1,024,998 children aged 3–18 years, and the second round (2021–2025) screened 1,059,156 children after intervals of 4, 5, 6, or 7 years. Children with CHD requiring treatment were identified and categorized by screening history. Results: The first screening detected 938 cases (prevalence: 0.92/1000), while the second screening detected 557 cases (prevalence: 0.53/1000). Of note, a significant proportion of cases identified in the second round represented missed diagnoses from the first screening. When comparing these missed cases (“previously covered”) to the true new cases identified in the second round (“newly covered”), the “newly covered” cases were younger and had lower odds of moderate or great anatomical complexity [adjusted odds ratio (OR) for moderate complexity: 0.58, 95% confidence interval (CI) = 0.36–0.92; adjusted OR for great complexity: 0.29, 95% CI = 0.11–0.71]. Conclusions: Repeat school-based screening identifies a distinct group of previously missed and newly covered CHD cases, many of which are of higher anatomical complexity and would otherwise remain undiagnosed. These findings underscore the necessity for periodic rescreening to mitigate diagnostic gaps and improve CHD outcomes in resource-limited populations.

Objective: This large-scale, multi-ethnic screening of over 1.02 million school-aged children in China aimed to evaluate the real-world impact of recent congenital heart disease (CHD) screening policies by determining the community-based prevalence and clinical management status. Using a novel four-category framework (needing treatment, not needing treatment, postoperative, requiring follow-up), the study sought to identify persistent unmet needs and ethnic disparities in care access following policy implementation. Methods: Between 2024–2025, a cross-sectional screening of 1,024,531 school-aged children (3–18 years) was conducted across 12 ethnically diverse counties in Yunnan, Xinjiang and Chongqing, China. All participants underwent cardiac auscultation and confirmatory echocardiography. CHD cases were classified into one of four categories: Needing treatment, not needing treatment, postoperative, and follow-up. Multi-ethnic disparities in prevalence and defect types were analyzed. Results: A total of 3,376 children were diagnosed with CHD, yielding an overall prevalence of 3.30 per 1,000. Critically, the four-category stratification revealed: 48.7% were postoperative cases, 35.5% required no intervention, 14.3% needed treatment unmet, and 1.5% required further follow-up. Notably, substantial ethnic disparities were observed: Uyghurs had the highest postoperative rate (55%), whereas the Tujia minority group had the highest proportion of untreated but treatable cases. Conclusion: The findings revealed the achievement and underscored gaps in early diagnosis and equitable access to CHD care, particularly among ethnic minorities after CHD screening and care policy implementation, advocating for improved sustainability health policies to reduce unmet CHD needs in multi-ethnic populations.

Background: Congenital heart disease (CHD) represents a major contributor to the global burden of childhood disease. However, its burden across diverse socioeconomic and healthcare contexts in Asia remains poorly understood. This study compared CHD prevalence and its associations with socioeconomic conditions and health service capacity among school-age children in Nepal and two Chinese provinces (Yunnan and Xinjiang). Method: Cross-sectional studies were conducted in Nepal to two provinces in China (Yunnan Province and Xinjiang Uygur Autonomous Region) from June 2024 and May 2025. CHD screening consisted of cardiac auscultation followed by echocardiography for suspected or previously diagnosed cases. Children’s CHD prevalence, socio-economic levels and health service capacity in three regions were compared. Ridge regression was performed at the district/county level to examine the association between socioeconomic and health service capacity factors and the risk of CHD. Results: A total of 429,204 school-age children were screened, identifying 1,771 children with CHD. Marked interregional differences in CHD prevalence were observed: Nepal exhibited the highest prevalence (5.99 per 1,000 children), followed by Xinjiang (4.51 per 1,000 children) and Yunnan (3.42 per 1,000 children). Substantial disparities in socioeconomic and healthcare indicators were also evident across regions. GDP per capita (USD) ranged from 1,378 in Nepal to 8,751 in Yunnan and 10,071 in Xinjiang, while hospital bed density (per 1,000 population) was 0.39 in Nepal compared to 7.70 and 7.60 in Yunnan and Xinjiang, respectively. Ridge regression analysis revealed that hospital bed density was significantly negatively correlated with CHD prevalence. Conclusion: Substantial differences in CHD prevalence, socioeconomic conditions, and health service capacity were observed across the three regions. Children’s CHD prevalence was associated with health service capacity, suggesting that greater access to health service capacity may correspond with lower CHD prevalence at the population level.

Congenital heart disease (CHD) is a leading cause of birth defect-related morbidity and mortality globally. While neonatal screening programs exist, the un