[Perimeters of the arm and the thorax as indicators of low birth weight]. / Perímetros de brazo y de tórax como indicadores del bajo peso nacimiento.

In a group of 317 newborns, measurements of the perimeter of the arm and the thorax were taken as an indicator of low birth weight. The perimeters of both the arm and the thorax had a high correlation with low birth weight (LBW) (0.88-0.80 respectively). In the sample group, the cut-off point to define low birth weight in the case of perimeter of the arm was 9 cm and was 29-30 cm for perimeter of the thorax. Applying these measurements facilitates early detection and treatment of low birth weight babies who are at risk for infant mortality in situations where it is not possible to weigh the baby at birth.

[Feeding of healthy premature infants with milk of their own mothers]. / Alimentación de prematuros sanos con leche de su propia madre.

An experience of feeding healthy premature infants (< 1,800 g) on their mother's milk is communicated. Feeding starts at an early time (15 hours); achieving maximum volumes at the 12th day. Loss of weight is 10% less than the birth weight and recovery occurs at the 12th day. In this way, a postnatal speed growth of 26 g/day can be obtained; which is similar than that observed during the third of the pregnancy. 75% of the calories provided to more of the 66% of the infants attended by our Unity, is based on their own mother's milk at the time of discharge.

[Early puerperium rooming-in: an alternative of optimization of maternal-child care]. / Puerperio inmediato conjunto: una alternativa de optimización de la atención materno infantil.

The observation that in Chilean Maternities, newborn infants are separated from their mothers during their first hours of life, originated this experience, destined to strengthen the early and permanent mother-infant bonding, where both of them were attended by the same assistant nurse, in a joined observation room. The influence of this method on the neonatal cardiorespiratory adaptation, as well as the initial moment of the lactation, was evaluated. In three groups of healthy newborn infants, full term newborn infants appropriate for gestational age (250), full term newborn infants small for gestational age (94) and preterm newborn infants (38), both vital signs and the initial moment of lactation were registered, during the first hours of life, period in which they remained with their mothers. Cardiac and respiratory frequency remained constant and temperature regulation was reached from the first hour of life. No significant constant differences were observed between groups in relation with the clinical parameters studied. The 77.7% of the children began their lactation in this period. Finally, the advantage of a whole nursing attendance and with a lesser demand of personal is emphasized.

The use of oral hydration in the treatment of children with acute diarrhea in primary care.

The use of oral rehydration solutions (ORSs) for treating children with diarrhea is spreading in hospitals in Chile, but it has not yet been incorporated into routine primary care programs. We sequentially compared the effectiveness of an ORS, with 60 mmol/L of Na+, with the standard treatment for diarrhea used in primary care centers, in a study with 285 diarrheal children under 2 years of age who consulted a health center in a low-income periurban neighborhood of Santiago. When compared with the control group, the patients treated with ORS showed a significantly higher percentage weight gain in the first few days after treatment was begun, required fewer medical visits for follow-up treatment at other facilities (8.4 vs. 15.5%; p less than 0.05), and experienced fewer episodes of subsequent clinical dehydration that needed rehydration (oral or intravenous) in emergency services (2.8 vs. 10.6%; p less than 0.01). In addition, there were no metabolic complications in either group. Our results reinforce the feasibility, efficaciousness, and safety of programs that use ORS at the primary care level and indicate that this is an effective method of preventing metabolic complications and reducing hospitalizations of children with acute diarrhea.

PIP: The use of oral rehydration solution (ORS) for treating children with diarrhea is spreading in hospitals in Chile, but it has not yet been incorporated into routine primary care programs. The authors sequentially compared the effectiveness of an ORS with 60 mmol/L of Na+ with the standard treatment for diarrhea used in primary care centers. This was done with 285 diarrheal children under age 2 who consulted a health center in a low-income periurban neighborhood of Santiago. When compared with the control group, the patients treated with ORS showed a significantly higher % of weight gain in the 1st few days after treatment was begun, required fewer medical visits for follow-up treatment at other facilities (8.4 vs 15.5%; p0.05), and experienced fewer episodes of subsequent clinical dehydration that required rehydration (oral or intravenous) in emergency services (2.8 vs 10.6%; p0.01). In addition, there were no metabolic complications in either group. These results reinforce the feasibility, efficaciousness, and safety of programs that use ORS at the primary care level and indicate that this is an effective method of preventing metabolic complications and reducing hospitalizations of children with acute diarrhea.

Emphasis on preventive perinatology: a suitable alternative for developing countries.

PIP: The potential efficacy of preventive interventions in Latin America to reduce perinatal morbidity and mortality is reviewed. The most important perinatal risk factors associated with pregnancy and delivery are young age of the mother, low socioeconomic status, low education, malnutrition, lack of prenatal care, pregnancy-induced-hypertension, perinatal infections, alcohol, smoking, and iatrogenic causes. Adequate data are lacking to determine the magnitude of these factors in Latin America. Iatrogenic causes of perinatal morbidity are increasing because of the tendency to institute neonatal intensive care before improvement in medical and nursing staff and procedures. Specific programs that have been effective include the 30-year effort in Chile to reduce the incidence of low birth weight. Infant death rates in Latin America fell between those in Asia and the West, correlated with the occurrence of low birth weights. Nutritional programs are mixed in their effect: they do not necessarily help unless targeted at women with clinical malnutrition or history of LBW or IUGR; they can harm overall food production in the community. Increasing institutionalization of labor and delivery is a mixed blessing. Efforts in Guatemala to reverse the worst aspects of hospital delivery have improved pregnancy and labor outcomes. These include permitting fathers to attend births, allowing women to deliver in kneeling position, and encouraging infant bonding and breast feeding. Other effective interventions include mothers meetings to encourage prenatal care, and detection and referral of high risk cases in a regionalized system of care.^ieng