Helping Hand for the Newborn

A bold experiment in regional care reduces infant mortality

Mary Herrera, a Glendora, Calif., housewife, had long been discouraged from having babies. She had under gone open-heart surgery at age 8, and the physicians feared that her heart might not be able to withstand the strain of pregnancy. Yet, at 31, she has just given birth to her second child at Los Angeles County Harbor General Hospital. The infant boy weighs only 2 Ibs, and is being kept in an incubator, but he is given a good chance to survive. Says Herrera of her doctors and nurses: "They're doing a fantastic job. They really are."

-- Mary Drumm, 32, of Erie, Pa., and her husband are self-confessed "baby freaks." Though they have two children of their own and have adopted three others, they wanted still more. But Mary has had three miscarriages, possibly because of blood disorders. So when she became pregnant again, she decided that "we're not just going to sit back and lose another baby." Now, she has given birth to a 7-lb. girl at the University Hospitals of Cleveland. While the baby may still need an exchange transfusion, mother and daughter should be discharged shortly.

-- When Shirley Aranda, 34, of Phoenix, lost her first child shortly after birth, doctors found she had a congenital uterine problem. In the past, they might have dissuaded her from becoming pregnant again. Instead they performed corrective surgery and encouraged her to try once more. Twice she gave birth--once to a baby weighing only 1 Ib. 13 oz. Both infants survived and are now, at ages 5 and 2 1/2, healthy, normal youngsters.

Such difficult, yet successful pregnancies are no longer unusual-- thanks to better medical understanding, new drugs and such sophisticated monitoring and screening techniques as ultrasonics and amniocentesis. Yet while the U.S. helped start this revolution in perinatal and neonatal* care, it still lags behind a dozen other countries in infant-survival rates. To help solve this problem, the Robert Wood Johnson Foundation of Princeton, N.J., allocated $20 million for a five-year experiment that established or expanded regional networks--three in California, two in New York and one each in Ohio, Texas and Arizona. All deliver specialized care for high-risk pregnancies, that is, those that pose danger to mother or child.

Such pregnancies are disturbingly common. Of 3.1 million babies born in the U.S. each year, nearly 30,000 do not survive their first week. Many are born prematurely and weigh less than 5 1/2 lbs. Another 20,000 die in the uterus late in pregnancy. While the number of doctors and nurses with the skills needed to deal with such cases is growing, they are often situated at scattered medical centers not easily accessible to women and infants who most need them.

Now entering its fourth year, the experiment seeks to correct those inequities at a reasonable cost. Each network may consist of several hospitals and cover a population area with tens of thousands of births a year. Each also has one or more fully staffed and equipped regional perinatal centers, complete with neonatal intensive care units for very tiny and very weak infants. The key to the system's success is to identify and treat women, while they are still pregnant, who are likely to have preemies or sickly babies, rather than rushing the problem infants to the centers after birth. Participating physicians conduct coordinated screening programs, looking especially for women with histories of problem pregnancies, hyper tension, diabetes, kidney disease and alcohol or drug abuse, all of whom are likely to be high-risk patients. Common communications and transportation facilities help ensure quick response in crises.

The program seems to be succeeding. Infant mortality rates have declined in each of the regions served by the project. At New York's Columbia-Presbyterian Medical Center, the hub of a 16-hospital network in Manhattan and New Jersey that handles 16,000 births a year, the incidence of stillbirths, and deaths within seven days of life in infants weighing 2.2 lbs. or more has dropped from 22.8 per thousand births in 1967 to 9.6 per thousand in 1977. Many of these problem births were from the Harlem ghetto, and Administrator Dr. Solan Chao points out that quite a few of the high-risk patients were drug addicts or alcoholics who had not been to a doctor for prenatal care. The Los Angeles networks face a similar situation, caring for a largely black and Chicano population. Yet infant mortality has also plummeted.

Perhaps the most unusual network is Arizona's. Covering all 114,000 sq. mi. of the state, it relies on airplanes, helicopters and ambulances to ferry patients, some of them rural Indians, to perinatal centers. Nearly 1,200 women have been transported in the last 2 1/2 years, and more than 60% of the babies born needed intensive care.

Though regionalization saves lives, a newborn's stay in an intensive care unit can run into tens of thousands of dollars. Balanced against this is the nearly $1 million it can cost over a lifetime to support a child handicapped in birth, or the in calculable emotional toll on the family with a dead baby. Declares the director of the Ohio network, Cleveland's Dr. Irwin Merkatz: "Regionalization is the cheapest new advance in medicine that we've ever had. "

*Perinatal refers to the period before, during and just after birth; neonatal to early infancy.

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