Premature infants are costly in money, misery BORN TOO EARLY

August 05, 1991|By Thomas W. Waldron and Laura Lippman | Thomas W. Waldron and Laura Lippman,Evening Sun Staff

The 18-year-old woman was a mystery when she arrived late in July to deliver her baby.

Doctors at the University of Maryland Medical Center knew nothing about her. By all indications, she had not seen a physician even once during her pregnancy.

Her baby was three months premature, but her body was ready to deliver. The baby was tiny -- only 1 1/2 pounds -- and his lungs weren't working yet. His life lasted about 23 hours.

A few hours after that, his mother was gone, too upset even to talk about the death or her medical future.

At least four times a week, somewhere in Baltimore, a baby dies. Eighteen out of a thousand infants here will die before they reach the age of 1 -- one of the worst infant-mortality rates in America.

But dead babies are only part of the picture. Every five hours, an underweight baby is born in Baltimore. While some will die prematurely, most will live, and their lives will often be troubled.

The tiny babies are far more likely to be mentally retarded or to develop cerebral palsy. They will also be prone to blindness, hearing ailments and seizure disorders. Some are born addicted to drugs. Aside from the individual suffering, they will be a drain on the public pocketbook for years.

Behind the discouraging numbers is a troubling fact: Many of the infant deaths and low birth weights could be prevented.

Given the chance, doctors can often spot and take care of problems such as bad nutrition, diabetes or high blood pressure in early pregnancy.

Medical care for pregnant women is generally available. So is government-funded insurance. Even so, getting Baltimore's poor women into medical care -- and out of harmful habits such as drugs and cigarettes -- has often eluded the city's medical community.

Commissions study the problem and make recommendations, but programs go underfunded or underused, according to experts. As a consequence, a wave of children with physical and developmental problems continues to flood the city.

Meanwhile, a staggering amount of money is spent saving the tiniest and sickest babies in the city's high-tech neonatal intensive care units. Even more is spent afterward, dealing with the children's lingering medical problems.

Experts across the city wonder why the same commitment cannot be made to women before they give birth.

"We see a picture of fragmented services and separate, small, uncoordinated programs which are severely understaffed," reads a recent report by Advocates for Children and Youth Inc.

"This situation is exacerbated by limited funding, difficult working conditions in the inner city, [and] a civil service hiring system which causes long delays in filling vacancies."

a scandal," says Dr. David Paige, a pediatrician and professor at Johns Hopkins Hospital. "I'm still taken aback, after working in the field for 20 years, that the rate of infant mortality is as high as it is."

3RD-WORST OF BIG CITIES

After dropping in the late 1970s and early 1980s, infant mortality has begun to climb again both in Baltimore and across the country.

Overall, Baltimore's infant death rate in 1987 (the last year for which comparative figures are available) was 19.2 per thousand, giving the city the third-worst rate among big American cities. Baltimore's mortality rate was almost double the national average of 10.1 per thousand.

The death rate for Baltimore's white infants was 14.0, the worst in the country. For blacks, the rate was 21.1, seventh-highest.

That same year, Baltimore had the third-worst rate of low birth weight babies -- behind only Detroit and Washington, D.C.

Infant mortality and low birth weight go hand-in-hand with poverty. Baltimore consistently trails its suburban neighbors in both infant mortality and low birth weight rates. And, within the city, there are great disparities.

In the predominately affluent communities of Roland Park, Homeland and Guilford, the infant mortality rate was eight per 1,000 live births between 1984 and 1988, the last years for which statistics are available. Only 4.9 percent of newborn babies were underweight -- below 5 1/2 pounds.

A few miles to the west, in low-income Central Park Heights neighborhoods, the infant mortality rate was 17.5 per thousand, twice the Roland Park/Guilford rate. The low birth weight rate was about 16 percent, more than triple the average of the more affluent areas.

In one relatively poor area of South Baltimore that includes Westport and Cherry Hill, the infant mortality rate reached a staggering 24 per 1,000 births over the same period.

PROBLEMS ABOUND

Caring for poor urban mothers-to-be is not easy. While there are theoretically enough places for women to get prenatal care, experts say, there are other issues to be addressed:

* Drug use can cause devastating problems for the fetus, as well as premature delivery. Moreover, women who are using drugs or drinking heavily may not even realize they're pregnant or may be too stoned to get to the doctor.

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