Worried by a sharp increase in infant mortality in the Baltimore area, state health officials are reviewing the deaths of babies who suffered from congenital anomalies, infections and heart disease.
The 18 percent jump in deaths from 1996 to 1997 runs against the trend in the past several years, in which infant mortality rates in the city, the state and the nation have dropped. While physicians know the medical reasons for the deaths, they want to determine the circumstances and what medical care was provided.
"We're going to see if there is anything that could have been prevented by anyone," said Dr. Georges Benjamin, the state's deputy secretary for public health services. The most striking increase was among blacks, whose infant mortality rate in the Baltimore area rose 36 percent from 1996 to 1997.
But since the increase is over only one year, physicians may find it's a fluke: a year when more babies were born with congenital problems such as spina bifida, and when more women had triplets, who are smaller with less chance of surviving. Among blacks in the metro area, for instance, the number of triple or more births increased from six in 1996 to 31 in 1997.
But doctors are concerned that in the midst of a quickly changing health care system, women may not be getting adequate prenatal care, or care at all. That's where infectionsand congenital anomalies typically would be picked up.
"It makes me wonder what's happening to prenatal care in the state," said Dr. Ira Gewolb, chief of the division of neonatology at the University of Maryland Medical Center. "The question is, has something changed about the health care delivery, access or how we're taking care of pregnancy?"
Many experts see infant mortality as perhaps the most sensitive indicator of society's overall quality of life. That's because so many factors -- violence, poverty, inadequate housing, pollution, child abuse -- all contribute to it.
In the Maryland cases, investigators have studied birth and death certificates for the 308 deaths in Baltimore and Anne Arundel, Carroll, Harford, Howard and Baltimore counties. Next, Dr. Peter Beilenson, city health commissioner, said health officials will screen out babies who were victims of car accidents or guns, and focus on those who were ill.
Physicians plan to ask hospitals for the medical records of these children. Dr. Russell Moy, director of the Office of Maternal Health and Family Planning at the state Department of Health and Mental Hygiene, said the records may contain sensitive information such as a mother's substance abuse or her infection with sexually transmitted diseases like gonorrhea or syphilis. All those could lead to a baby's death.
"Some of these things, they may be fate," Moy said. "But it also could be any infection. If these women are getting care, there should be vigilant screening and follow-up."
In the black community, there is mounting concern.
"This is just another nail in the coffin," said Dr. Willarda Edwards, the immediate past president of the Monumental City Medical Society, a local group of black physicians. She spoke with NAACP President Kweisi Mfume yesterday about the persistent gap nationally in health between whites and blacks, and what can be done about it.
"The things that are really killing people are cancer, AIDS. It's just trending down to the infants," Edwards said of diseases that are hitting the black community hard. "If this were in any other population, you would see people declaring war on it."
The state has taken steps to address the racial gap in infant mortality. In December, a blue-ribbon commission released a report with several recommendations, including better screening for domestic violence and substance abuse, and more aggressive follow-up of patients with infections.
An effort is under way to make sure women with high-risk pregnancies deliver at hospitals experienced in those cases, Benjamin said. To stop the spread of syphilis, which has reached epidemic proportions in Baltimore, officials have begun screening and treating women at the jail. And under a new state insurance program, more than 1,000 pregnant women around the state will get health insurance.
In the past year, about 330,000 poor Marylanders on Medicaid, half of whom live in Baltimore, have been moved into managed-care organizations to give them more coordinated care at less expense. Edwards said she knows many patients who see a neighborhood doctor but must take two buses to get X-rays or blood drawn. And she said that's causing problems.
But state officials said the Medicaid switch can't be the cause. The infant mortality rate increased to a greater extent among non-Medicaid recipients than among those on Medicaid. It wasn't clear if those non-Medicaid recipients included the uninsured, whose numbers are growing.
Beilenson suspects that if the numbers don't turn out to be a one-year fluke, there will be more than one answer, a combination of more women with multiple births, a few more with congenital anomalies, and so on.
State officials expect to have the results of their review in about a month.
Pub Date: 7/23/98