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."
Financed with about $300,000 in state and federal money each year, the project has won the supportof Gov. William Donald Schaefer, who has emphasized the need for prevention efforts to stem the soaring costs of public health care.
Many of the pregnant women Kirkpatrick visits are in their early to mid-20s. They often work at entry-level jobs or in fast-food restaurants and convenience stores. They can't afford insurance on their own and don't realize they qualify for medical assistance.
The majority didn't plan to get pregnant, said Mary O'Malley, a public health nurse who runs Healthy Generations with Kirkpatrick.
Their families aren't always supportive. Mothers cry; fathers kick out their pregnant daughters. Some boyfriends stick around, but many others leave.
Healthy Generations is an outreach program for women who would otherwise skip prenatal care. O'Malley and Kirkpatrick knock on doors and pass out fliers advertising their help. They hook pregnant women up withmedical insurance, line up doctor's appointments, give nutrition advice and listen to problems.
"If you're about to be evicted, or youwere sexually abused, or you're drinking, you have so much going on already," Kirkpatrick said. "You need somebody first who's going to listen and offer some solutions."
Ninety percent of their clients don't use drugs, but some are addicted to crack cocaine, the most popular street drug among poor women, O'Malley said. She tries to get them off drugs and into counseling.
Even with this support and guidance, some women wind up with underweight babies. The Healthy Generations team then drops in to check up on the child and make sure the mother knows how to provide extranutrition and care.
"Our effort is prevention," O'Malley said. "We try to help empower them to become independent enough that when the baby's here, they take off and are OK."
Eighteen-year-old Catria Pack picked out her daughter's name in June, a month before she was born.
She wasn't planning to have a child. But when she forgot to use birth control and got pregnant, Pack found help down the street at the Freetown Health Center.
Determined to have a healthy baby, she followed the nutritionist's adviceand began taking vitamins, eating breakfast and drinking milk instead of tea.
On July 29, she gave birth to Jakia, a bright, bouncing baby weighing 6 pounds 14 ounces.
Other women her age have been less lucky. Anne Arundel teen-agers are three times more likely than older women in the county to get little or no prenatal care and to havelow birth-weight babies.
Black and Hispanic teen-agers are even more at risk, Spencer said. Though it's dropped in recent years, the infant death rate among minorities in the county has reached 18 to 22 per thousand births, the same as Baltimore's.
Teen-agers often areundernourished and unable to cope with the pregnancy, said Marianne Degnan, manager of the Freetown clinic.
"We go from as basic as getting the right food to trying to get the girls to get some insight into their situation," she said. "We try to get them to think about the future -- what happens next. A lot of times they feel helpless at first."
Carole B. Baker, a former county councilwoman who chaired atask force on teen pregnancy in 1989, said teen-agers sometimes dietheavily because they don't want their friends and family to know they're pregnant.
"They're anemic. They don't take care of themselves. They're in turmoil," she said.
Anne Arundel County has a higher teen pregnancy rate than most other suburbs in the Baltimore-Washington region. It ranks second behind Baltimore City, with Howard, Montgomery, Prince George's and Baltimore counties trailing behind.
Although Maryland only is 25th in the nation, Baltimore has one of the highest teen pregnancy rates among large urban cities. In 1986, the Children's Defense Fund released statistics showing the city had the most births among women younger than 20 in America. The figure has been challenged by other studies, but Baltimore still has one of the worstteen pregnancy rates in the United States, said Marisa Mirajafary, aresearcher with the Governor's Council on Adolescent Pregnancy.
Anne Arundel County neighborhoods that have the highest infant mortality rate also have the largest number of teen pregnancies, Spencer hasfound. Glen Burnie is an exception. Poverty plays a more significantrole than teen pregnancies there, he said.
Every couple of days, a sick or underweight infant lies surrounded by tubes and flashing, high-tech machines in Harbor Hospital's neonatal intensive care unit.
Many are from Anne Arundel County. Women from the northern and western neighborhoods go to Harbor Hospital to deliver because North Arundel Hospital doesn't offer obstetrics. Anne Arundel Medical Center advises at-risk women to deliver at a Baltimore hospital because its nursery isn't equipped to cope with underweight or drug-addicted babies.
Lying in warming beds called ventilators, the tiny babies at Harbor Hospital breathe oxygen through a tube and get food and medication pumped into their veins. An electronic monitor keeps track oftheir vital signs, beeping loudly every time their hearts start racing.
Underweight infants not only are at greater risk of dying, butthey're also prone to mental retardation and serious diseases. Some are born blind or hearing impaired. Others have jaundice, diabetes and, more frequently, respiratory problems.
"You can have a low birth-weight baby that's quite healthy, but there's a much bigger risk for the little ones," said Dr. Larry G. Yap, a neonatal specialist who recently joined the hospital and expanded its care for premature infants.
Babies born more than a month too early used to be transferred from Harbor Hospital to other city units that have specialized equipment. With Yap's appointment, the hospital began offering care for infants as young as 32 weeks (full term is 40 weeks) and for those with respiratory problems. Infants born to drug-addicted mothers suffer the most, Yap said. They twitch and shake uncontrollably in their beds. Often, they run high fevers and vomit. They cry disconsolately.
Yap began tracking the number of drug-addicted infants born at Harbor Hospital last month. One was born every three days, he said.
Thecost of saving their lives can be staggering. Intensive neonatal care usually runs $122 a day at Harbor Hospital and up to $200 a day at other Baltimore hospitals. Medicine, tests and draining mucus from tiny, impaired lungs rapidly raises the bill.
A baby born last monthto a mother with a long history of abusing crack and and other drugsbegan going through withdrawal soon after he was taken to the nursery, Yap said. He needed sedatives, special nutrition and oxygen for two weeks. The cost easily reached several thousand dollars, Yap estimated.
Once cleansed of the drugs, the baby was released from the hospital and placed in special foster-care home until social workers determined whether the mother could care for him.
Health officials are redoubling their efforts to get pregnant women into medical care earlier to prevent those costs, often shouldered by the public. Most of the expectant mothers who receive poor prenatal care and continue harmful habits are on medical assistance.
Spencer, Lasswell and other experts in Anne Arundel County want to encourage women to stop smoking and abusing drugs before they even get pregnant. They're also mapping out strategies to better advertise what medical care is available.
Yap supports these efforts, though he considers no price too high to save a baby like little Jeffrey Randall. He and the nurses in the intensive-care unit were proud when they gave Jeffrey to his mother to take home in early August.
On a sunny afternoon a few weeks later, Yap walked through the special-care nursery and paused at the two warming beds, empty for once. Here is his calling.
"When you save an infant," he said firmly, "you save a lifetime."
Help is available for pregnant women and mothers with low birth-weight babies.
* Healthy Generations serves pregnant women and mothers of newborns in the Glen Burnie area. Call 222-7244 and ask for either Karen Kirkpatrick or Mary O'Malley.
* The county also offers prenatal care, financial advice and counseling at three regional maternity clinics:
Freetown Health Center: 222-6625.
Annapolis Health Center: 222-7381.
Odenton Health Center: 222-6660.