Why Babies Die

Of the 70,000 babies born in the U.S. last week, the great majority will grow into normal, healthy children. But 1,600 or so will die before their first birthday--an annual total of 80,000. Anxious to reduce that toll, the Federal Government's National Institute of Child Health and Human Development chose last week--when baby-food manufacturers were celebrating National Baby Week--to stage an Atlantic City seminar with the somber title "Why Babies Die."

On one point there could be no disagreement. By far the commonest cause of premature death is premature birth, the reason for which is usually unknown except in cases of maternal illness. Prematurity as now defined is not necessarily birth before an elapsed gestation time of 280 days but birth, at any time, with a weight of 5 1/4 Ib. or less. For preemies, the first 28 days are especially hazardous. To care for them, University of Louisville Pediatrician Billy Andrews has devised an incubator setup so complex that medical students call it his physiology lab. Andrews maintains an around-the-clock watch on the preemies by taping up each one with yards of plastic tubing and electrodes that monitor the heart rate, the blood's oxygen concentration and temperature. Forced Uphill. Among preemies, a common cause of death is formation of a glassy membrane in the lungs, which prevents oxygenation of the blood. This hyaline membrane disease carried off Patrick Bouvier Kennedy, the late President's son, in the 40th hour of his life, and is to blame for at least 25,000 infant deaths in the U.S. each year. Despite years of research, the immediate cause of the disease is still unknown.

Regardless of just what may ail the newborn baby, the place to begin improving his chances for survival is in the delivery room, said Dr. Karlis Adamsons of Columbia University. As long as obstetricians use anesthetics and other drugs for the mother's (and their own) convenience and comfort, he said, they must improve surveillance of the infant during delivery. This means that they must use new techniques of sampling the baby's blood and monitoring its heart rate even before birth.

It should also be the obstetrician's responsibility, added Adamsons, to minimize the danger that the baby will be deprived of oxygen during labor and delivery. At present, he said, 20% to 25% of all U.S. babies suffer some oxygen deficiency during birth; 3% to 4% are "severely afflicted" and may develop cerebral palsy or other handicaps.

Most surprisingly, Adamsons berated obstetricians for "their ritualistic tradition that the most convenient position for a woman during labor is lying on her back." This, he said, "actually forces the baby to move uphill." Lying on the side is more natural, and squatting --as any midwife knows--is best of all, since it allows gravity to help.

Reducing the Rate. The answer to the question of why babies die is that the techniques and knowledge that exist are simply not used in many cases. Dr. Mary Ellen Avery, the new head of pediatrics at Montreal's McGill University, said that the application of knowledge that is now available would reduce the infant-mortality rate in America by 50%. That would give the U.S. the lowest rate of any major nation. It now ranks 14th, behind New Zealand, Australia, Japan, Scandinavia and most other countries of Western Europe.

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