Doctors Take Aim at Infant Mortality : Health: Obstetricians and gynecologists will set up panels to study reasons for the nation’s high death rate among children under age 1.
The country’s largest organization of obstetricians and gynecologists is setting up a nationwide system to review infant deaths in hopes of pinpointing the medical, social and economic conditions responsible for the nation’s troubling infant-mortality rate.
The program, to be announced today in San Francisco, would establish for the first time regional committees of physicians and lay people that would systematically scrutinize many of the more than 38,000 infant deaths that occur in the United States each year.
The federally supported system is modeled in part on the so-called maternal mortality reviews done in the United States earlier in this century. That program is credited with helping bring dramatic reductions in the rate at which U.S. women die during childbirth.
“Once you identify the major contributing causes, that in itself stimulates action,” said Dr. Ezra Davidson, chief of obstetrics and gynecology at Martin Luther King Medical Center in Los Angeles and the driving force behind the infant-mortality review plan.
“We really are too generic, too general about the problem, which disables people from doing anything about it,” said Davidson, who intends to announce the plan today in his inaugural address as president at the annual meeting of the American College of Obstetricians and Gynecologists.
Davidson is the first black president of the college. His hospital, in Watts, has had one of the highest death rates for newborn babies of all California hospitals.
Under the review system, to be administered by the physician group, the committees would examine many or all of their area’s infant and fetal deaths in an attempt to identify patterns, recognize causes and come up with ways of reducing deaths.
As a hypothetical example, Davidson said a committee might find that a significant percentage of the deaths in a particular region were traceable to poor access to medical care. If so, physicians in that area might press to open up care for pregnant women.
In other areas, contributing factors might include drug use during pregnancy, cigarette smoking, alcohol abuse or poor nutrition. Committees may find a need for public education for mothers to teach them the signs of potentially fatal pneumonia.
“If we do perinatal death reviews and find that 90% of the deaths in one hospital come from women not having access to prenatal care, that will say that emphasis on prenatal care in that hospital should be a priority, as opposed to buying yet another incubator,” said Rae Grad, executive director of the National Commission to Prevent Infant Mortality.
Infant mortality, the rate at which babies die before age 1, is seen as a telling measure of a country’s health-care system. In the United States, progress in reducing the infant death rate has ground almost to a halt in recent years. It is now 10.1 deaths per 1,000 births, which ranks 29th among developed countries.
In some cities, the rate is nearly twice the national average--a fact that health officials attribute generally to shrinking access for lower-income women to prenatal and pediatric care as well as the spread of drug use and infectious diseases.
In Los Angeles County, the infant mortality rate among blacks and Latinos rose 29% in 1988 over 1987 to a rate of 21.1, while dropping 12% to a rate of 8.8 among Anglos. The percentage of babies born weighing less than five pounds--a key predictor of mortality and disability--rose 17% overall and 32% among blacks.
“We just can’t go on having this level of mortality and morbidity (illness),” said Dr. Gary Richwald, a professor of public health at UCLA, in an interview this week. “Mortality is only the leading edge of the morbidity.”
The review system is to be overseen by the college, which represents 29,000 physicians nationwide. It will be based in Washington, D.C., and already has some financial and administrative support from the U.S. Department of Health and Human Services.
According to Davidson, a national review committee will be formed. It will enlist the medical community and other health professionals in the review process, and draw up standardized guidelines.
Within the next two years, Davidson hopes to have in place 20 local committees to examine infant and fetal deaths on a state and regional level. The national program staff will track the committees’ findings and evaluate their success in improving local death rates.
Funding for the national staff is coming initially from the maternal and infant health branch of the U.S. Department of Health and Human Services. It is unclear how much the project will cost, but other physician groups have tentatively offered support.
The system is modeled in part on the maternal mortality reviews begun by the medical community in the 1930s. Since that time, the maternal death rate has dropped from 636 to just seven maternal deaths per 100,000 births.
According to Davidson, the maternal death reviews were one of many factors, including antibiotics and blood banking, that helped bring down the death rate. The reviews helped identify the major role played by infection, hemorrhage and toxemia in maternal death as a result of childbirth.
Specialists in the field of infant mortality this week strongly endorsed the program. Some emphasized the importance of examining more than merely medical causes, saying social and economic factors such as poverty and race play a complex role in infant death.
“These conditions make medical policy-makers anxious,” said Richwald, commenting on why a nationwide death-review system has not been tried in the past. Social and economic factors are “not well defined and they potentially involve large budgets. And somebody’s ox is going to be gored.”
