Born eight weeks before his time, the tiny baby lay in a tangle of wires and tubes, struggling to breathe.
Food and medicine dripped steadily into his veins. He sucked hard on the oxygen, his lungs too small to work properly. An electronic monitor kept watch while he slept on a cushioned warming bed at Harbor Hospital in Baltimore.
A month later, saved by a new drug and intensive care, Jeffrey Towler Randall came home to his family in Brooklyn Park. He survived, but remains 38 times more likely to develop fatal complications than an average newborn in Anne Arundel County.
In Brooklyn Park and Curtis Bay, 15 out of every 1,000 babies die before age 1. The neighborhoods straddling the city border have a worse infant mortality rate than the rest of the county and much of Maryland, which has the ninth-highest rate in America.
Although the county is in line with the national average, the infant death rates in four ZIP code areas that have larger poor and working-class communities are alarmingly high.
Babies born in Brooklyn Park, Glen Burnie, Severn and Annapolis are much more likely to perish in their first year than those in other regions of the county, said Dr. Leland Spencer, who is studying the problem for the county Health Department.
A sharp disparity exists between those neighborhoods and the county's more affluent communities. In Severna Park, Crofton and South County's horse country, the death rate is only a third of that in those four neighborhoods, averaging five per 1,000 births from 1985 to 1987.
In the neighborhoods with the highest death rates, infants also are far more likely to be born prematurely and underweight. The two go hand-in-hand, Spencer said. He has found that, after birth defects, low birth weights are the leading cause of infant deaths inthe county.
"It's clear that poverty is the major contributing factor," he said. "If you're poor and live in Anne Arundel County, you're four times more likely to have your baby die."
What disturbs Spencer and other county health officials most is that many of the infant deaths could have been prevented.
Prenatal care, nutrition counseling and financial assistance are available at the three regional health clinics in the county.
The statealso offers medical insurance to pregnant women in income brackets up to 185 percent of the poverty level. Single expectant mothers can earn up to $16,790 a year and qualify for full insurance coverage. Thescale increases based on family size.
Still, many women living inthe county's poorer areas fail to get prenatal care until late in their pregnancy. Without counseling, they're also likely to continue unhealthy habits -- smoking cigarettes, skipping meals, drinking or using drugs.
Dana, a 22-year-old from Linthicum who just had twins inJuly, smoked heavily during the first three months of her pregnancy.She knew little about prenatal care. If a nurse and social worker hadn't intervened, Dana said, she would have continued smoking a pack of Marlboros a day and nibbling on doughnuts for lunch.
"If you're not eating enough or smoking during your pregnancy, your baby is not getting enough food and oxygen," said Anita Lasswell, who runs the Health Department's nutrition programs.
"A lot of people think they're all right if they're gaining weight and taking their vitamins. Butwe know if you're smoking, you have a big chance of having an underweight baby. If you're smoking crack, you're in danger of having a developmentally disabled child."
Blacks, Hispanics and teen-agers are in a higher risk group. But the infant mortality problem isn't limited to minorities and youths in Anne Arundel County. Many older, working-class whites are also likely to have premature and underweight babies.
When the state Department of Health and Mental Hygiene set up an innovative program in 1989 to get pregnant women proper health care, officials chose four areas in the state. Baltimore, which rivals Third World nations in infant deaths, was one. Glen Burnie was another.
Unlike the targeted neighborhoods in Baltimore and Prince George's County, Glen Burnie is a predominantly white area, and it has fewer women on welfare than those areas.
Yet the 21061 ZIP code has the county's second-highest infant mortality rate, an average of 14 deaths per 1,000 births. Seventy of every 1,000 babies born in Glen Burnie weigh less than 5 1/2 pounds, the standard for healthy newborns. In other Anne Arundel neighborhoods, the number of underweight infants averages less than 50.
"People usually think of black teen-age moms when they think of infant mortality," said Karen Kirkpatrick, a social worker with the Healthy Generations project in Glen Burnie. "We have a lot of older women who are working, but not getting medical insurance. They don't know what's available and they're afraid ofasking -- they think it's welfare."