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."

Tian promptly assisted the local team in replacing the inappropriate devices with neonatal ventilators and began training them on how to correctly set up and calibrate the machines.

"Although I provided foundational knowledge in the form of lectures, I found that the most effective teaching method is hands-on demonstration at the bedside," he said.

"Showing them how to adjust oxygen flow settings in real time based on each baby's condition proved far more effective. Now, the local doctors have become highly proficient in operating these new ventilators independently," he added.

In recent years, local pediatricians have progressively mastered a range of advanced neonatal treatment techniques thanks to the medical assistance program.

These include blood exchange transfusion, pulmonary surfactant replacement therapy — a standard treatment for neonatal respiratory distress syndrome — and umbilical venous catheterization, which involves placing a thin, flexible tube into a blood vessel to allow the safe delivery of intravenous nutrition and medications.

One of the most memorable cases for Tian was that of a newborn weighing just 1,000 grams who had multiple life-threatening conditions, including respiratory failure, sepsis and internal bleeding.

"One day, the infant's blood oxygen saturation levels suddenly became highly unstable. A chest X-ray confirmed pneumothorax, or collapsed lung," Tian said. "We immediately switched the ventilator to high-frequency mode and performed an emergency air extraction procedure.

"I could feel myself trembling slightly throughout the intervention. We drained about four to five liters of air before the baby's heart rate and breathing finally stabilized," he said. "That baby has since been discharged. It was an intense fight."

Tian said that the hospital is now capable of performing the majority of advanced neonatal intensive care procedures. The current focus is on refining the precision of ward management and optimizing clinical protocols.

"For instance, we introduced point-of-care ultrasound for newborns this year," said Tian. "This allows us to perform essential ultrasound examinations right at the bedside, eliminating the need to transport these vulnerable infants to separate imaging facilities."

Jigme Dorje, the senior local pediatrician, said that he has personally performed umbilical venous catheterization on four patients since observing Tian's technique last year.

Beyond surgical skills, Jigme Dorje emphasized that he has gained a broader, more systematic understanding of neonatal care management — including specialized feeding and weight monitoring methods.

"We've learned how to calculate the precise amount of feeding required based on a curve that correlates with the baby's age and weight," he said. "This knowledge has been crucial in helping premature infants maintain healthy growth patterns, thereby reducing their length of stay in the hospital and lowering the risk of hospital-acquired infections."

Official data shows that between 2017 and 2022, the infant mortality rate in Xizang fell by some 33 percent to seven deaths per 1,000 live births, and the mortality rate for children under 5 years old decreased by 40 percent to 8.2 per 1,000.