Growth and development is considered the best positive indicator of children’s quality of life and well-being. Studies have been carried out in Cuba since the early 20th century and large scale, periodic anthropometric surveys have been regularly conducted by its National Health System to chart modifications in growth patterns of children and adolescents. These surveys have produced national references for the anthropometric indicators most commonly applied in individual assessment of the health and nutritional status of children and adolescents in health care settings. These have also provided data for estimating the magnitude and characteristics of secular growth trends, and for comparing growth of Cuban children with that of children in other countries and with WHO’s proposed growth standards. The data have also served as evidence of persisting social gradients. The most important results include, as positive data, the positive secular trend in school-aged children’s growth of 9.7 cm between 1919 and 2005, with an average increase of 1.1 cm per decade, and, in preschool children, 1.9 and 1.8 cm in boys and girls, respectively, between 1972 and 2015. More recent studies have detected unfavorable changes associated with a marked increase in adiposity and, therefore, in the prevalence of excess weight and obesity. Another interesting result is the gradual movement toward WHO height-for-age standards in preschool children in Havana, verified in surveys conducted in 2005 and 2015.

KEYWORDS Growth and development, growth, child development, children, adolescents, nutrition, obesity, pediatrics, Cuba

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.

KEYWORDS Growth and development, child development, child health services, preventive health services, primary health care, pregnant women, children, child rearing, intersectoral collaboration, Cuba

INTRODUCTION Acute respiratory distress syndrome is a complex heterogeneous disorder with low incidence but high case fatality in children. Treatment with pulmonary surfactants is a possible option. Surfacen, a Cuban exogenous pulmonary surfactant, has been proven safe and effective in premature newborns with hyaline membrane disease, but evidence regarding its efficacy in older children is still inconclusive.

OBJECTIVE Determine Surfacen’s efficacy in improving oxygenation and increasing survival in children with acute respiratory distress syndrome.

METHODS A multicenter (five pediatric intensive care units in four provinces), open-label, controlled, randomized phase III clinical trial with two treatment groups was conducted from November 2009 through August 2013, with 19 girls and 23 boys aged 1 month to 18 years. The experimental group (20 patients) received conventional treatment (oxygenation and mechanical ventilation) plus intratracheal instillation of Surfacen (100 mg/4 mL) every eight hours for three days. The control group (22 patients) received only conventional treatment. The primary dependent outcome was patient vital status (alive or deceased) 28 days after study enrollment. Other variables and outcomes analyzed were age, sex, ARDS presentation, Kirby index (arterial oxygen tension over inspired oxygen fraction), oxygenation index, static lung compliance, transcutaneous oxygen saturation, radiographic course, mechanical ventilation time and length of stay in neonatal intensive care. Statistical tests used were the chi-square test and Fisher exact test.

RESULTS On day 28, there was 80% survival in the experimental group versus 38.1% in the control group. There were significant differences between the experimental and the control group in Kirby index, oxygenation index, static lung compliance and radiographic course, all favoring the experimental group. For every 2.38 patients treated in total, there was one additional survivor in the experimental group.

CONCLUSIONS When combined with conventional therapy in the regimen employed, Surfacen improves oxygenation and increases survival in children with ARDS.

KEYWORDS Exogenous pulmonary surfactant, acute pulmonary distress syndrome, ARDS, children, intensive care, Cuba