The first 1000 days of life constitute a short and exceptionally important period when the foundation is established for children’s growth, development and lifelong health. Cuba has a comprehensive care system for this population that aims to promote the best start in life so that children can reach their highest development potential. This is carried out through the national public health and education systems and also includes elements of health protection, prevention of harm and disease and social welfare for children. Cuba’s infant mortality rate has remained <5 deaths per 1000 live births for 10 consecutive years, and in 2017 reached 4 per 1000, the lowest rate to date. The mortality rate for children aged <5 years in 2017 was 5.5 per 1000 live births, with a survival rate of 99.5%; low birth weight was 5.1% and vaccination coverage >95%. Among children aged 1 year in Cuba’s Educate Your Child program in 2014, >90% met age-specific indicators in all four developmental domains (intellectual, motor, socioaffective and language). Cuba has universal coverage for antenatal care and, in 2017, 99.9% of births occurred in health institutions. All working mothers receive paid antenatal leave from 34 weeks of gestation, continued through the child’s first year, to facilitate breastfeeding and child care. In 2018, the Cuban government allocated 27% of its national budget to health and social welfare and 21% to education.
Se realizó una actualización sobre el uso de las sustancias más utilizadas en el reemplazo de volumen. Se plantea que la controversia entre el uso de cristaloides/coloides aún mantiene vigencia, aunque se trata de hallar la sustancia ideal que restablezca la volemia de forma adecuada, con el mínimo de reacciones adversas y costo. Dentro de los coloides se enfatizó en las desventajas del uso de la albúmina y su sustitución por otros expansores de volumen de tipo coloide, donde se encuentran las gelatinas y los almidones. Otro tipo de sustancias transportadoras de oxígeno están en fase de ensayo clínico, como son los fluorocarbonos y las hemoglobinas sintéticas, sin que se haya encontrado superioridad de tipo terapéutico.
An updating on the most used substances in volume therapy is made. It is stated that the controversy aroused by the use of crystalloids/colloids is still standing, although efforts are made to find the ideal substance to reestablish volemia in an appropiate way with the minimum of adverse reactions and cost. As regards colloids, emphasis is made on the disadvantages of the use of albumin and its substitution by other colloid volume expanders, such as gelatins and starches. Other types of oxygen transporting substances as fluorocarbons and synthetic haemoglobins are under clinical assay. No therapeutic superiority has been found yet.