ABSTRACT
La malnutrición afecta a más de 50 millones de niños de menos de 5 años en los países en desarrollo. Pese al tratamiento, la tasa de mortalidad llega al 50 % en algunos países. Hasta 1990, uno de cada cuatro niños con malnutrición grave fallecía durante el tratamiento. La tasa de letalidad no se modifi có durante los cinco últimos decenios (estudio de más de 60 países). Actualmente hay principios de tratamiento con fundamentos científi cos indiscutibles y la aplicación del protocolos recomendado por OMS - motivo de la presente actualización- reduce costos, letalidad hospitalaria, logra una rehabilitación integral y su aplicación ha originado una caída de la mortalidad a menos del 5% 1 .Se destaca la mortalidad asociada a desnutrición severa, aún pese al tratamiento y realizamos una actualización del tratamiento del desnutrido edematoso grave, presentando el caso de un niño de 1 año de edad, ingresado a la Unidad de Gastroenterología del Hospital del Niño de la Ciudad de La Paz, cuyo cuadro clínico tiene tres semanas de evolución con una enfermedad diarreica aguda (EDA), que se asocia a marcado compromiso del estado general y edema generalizado. El examen físico de ingreso clasifi ca al niño como desnutrido edematoso grave complicado y por su estado clínico crítico e inestabilidad hemodinámica, es transferido a la Unidad de Terapia Intensiva (UTI), donde pese al manejo especializado y oportuno, el niño fallece.
Malnutrition affects more than 5 million children under 5 years of age in developing countries. In spite of treatment, the mortality rate reaches 50% in some countries. Until 1990, one out of each of four children with severe malnutrition died during treatment .The rate of lethality did not change during the last fi ve decades (studies from over 60 countries). At the present, there exist principles of treatment with indisputable scientifi c bases, and the application of the protocol recommended by WHO - reason for the present actualization - reduces costs, lethality in the hospital, reaches a complete rehabilitation, and its application has originated a fall in mortality to less than 5%.We present the case of a one year-old little boy, admitted to the Gastroenterology Unit of the Childrens Hospital in La Paz whose condition had an evolution of three weeks with an acute diarrheic disease (EDA), associated to a very poor overall state and generalized oedema. The physical exam upon admission, classifi ed the child as mixed undernourished, and due to his critical condition and hemodynamic instability he was transferred to the Intensive Care Unit (UTI), where in spite of the specialized and appropriate treatment, the child died. We publish this case in order to point out the mortality associated withsevere malnutrition in spite of the treatment in the UTI, and we present an actualization of the treatment.
Subject(s)
Humans , Male , Infant , Child Nutrition Disorders/diagnosis , Child Nutrition Disorders/etiology , Child Nutrition Disorders/physiopathology , Child Nutrition Disorders/bloodABSTRACT
BACKGROUND: Pediatric societies throughout the world recommend breastfeeding as the optimal form of infant nutrition. This recommendation is based on extensive epidemiologic research that documents the health, developmental, psychological, social, economic, and environmental benefits to infants, mothers, families, and society. The purpose of this study was to examine breastfeeding information and emotional support received by mothers prenatally, hospital breastfeeding practices, and the relationship between information and support received and breastfeeding initiation and planned feeding method post discharge from the hospital. METHODS: A 36-item questionnaire was distributed during the Spring 2000 to mothers who delivered babies at maternity centers in Seoul, South Korea. A sample of 52 mothers was surveyed at the time of hospital discharge. The questionnaire was developed based on the literature and reviewed by experts including internationally board certified lactation consultants, a nutritionist, and perinatal nurses. The survey instrument consists of five components: sociodemographic information, breastfeeding information received by mothers prenatally, emotional support regarding the mothers' infant feeding choice, breastfeeding initiation and supplementation, and hospital breastfeeding practices. RESULTS: Fifty-two breastfeeding mothers at three hospitals completed the survey. The majority of the mothers were 26 to 35 years of age, college graduates, married, had uncomplicated vaginal or planned cesarean deliveries, and primiparas. Forty-nine mothers responded that they decided to breastfeed during their pregnancy. Mothers reported that the information they received during pregnancy was provided primarily by their mothers, or friends and other relatives. The majority of mothers reported that others influenced their infant-feeding decision. Forty mothers reported receiving emotional support for their infant feeding choice during their pregnancy with mothers or mothers-in-law and friends providing the greatest support. DISCUSSION: Women obtain information prenatally about breastfeeding from many sources-family, friends, written materials, prenatal classes, and health care professionals. There are benefits and drawbacks to information received from multiple sources. Additionally, research has shown that a woman's infant-feeding decision is affected by the type of professional and social support the mother receives. Postpartum professional support for new breastfeeding mothers encompasses multiple dimensions ranging from a follow-up telephone call from the hospital nursing staff to referral to a community resource. Prenatal breastfeeding education on a community-wide basis can provide essential information for future mothers, families, and community support networks. Additional research needs to be done exploring the impact of prenatal, postpartum, and post-discharge support for women on breastfeeding initiation and duration rates.