High-Tech Medicine Saves `Preemies'
Medical science has made great leaps in reducing infant mortality over the past 20 years. Its major weapon: high technology for premature babies in their first two months of life.
The U.S. ranks 25th among developed countries for overall infant mortality - mostly because of the number of women who don't get basic prenatal care, many experts say.
High tech is the major reason, many say, that the United States does not have a worse infant mortality rate, especially for black infants.
"It's horrible," says Dr. David Eschenbach, director of obstetrics and gynecology at Harborview Medical Center. "We'd probably be in 50th place if we didn't turn loose all this high-tech medicine that we're able to do."
At the University of Washington Medical Center's neonatal intensive care unit, a tiny "preemie" - a week-old, 2-pound baby boy - gets the "full court press" with high-tech equipment. Lying on his stomach, an array of tubes and cords extend from his plastic cubicle: lines for four intravenous fluid pumps, a respirator and three monitors.
"There's a growing body of knowledge in the hour-to-hour care of these babies," says Dr. Bill Truog, UW professor of pediatrics and a specialist in neonatal care and respiratory diseases.
Much of the effort has focused on the miniaturization of equipment and its functions: smaller tubes and lines, the ability to deliver the smallest amounts of medications and fluids and measurement of minute quantities of bodily fluids such as blood.
A more recent innovation is artificial surfactant - the liquid needed by the lung's tiny air sacs - given to preemies soon after birth when they lack enough of the natural substance. A new machine oxygenates the blood of full-term babies when their lungs are having problems and need a rest.
Such equipment and experts in prematurity - doctors, nurses, respiratory therapists - now tend to be concentrated in one or two medical centers in a city. Women with high-risk pregnancies deliver their babies there, then have the infant care available at the same hospital.
When such technology helps save babies smaller than some dolls, it still astonishes even some doctors. But its expense is also breathtaking.
Charges in a neonatal intensive care unit average $1,000 to $1,200 a day, and premature babies often live there for up to two months.
Those expenses and the greater emphasis on technology rather than the underlying causes of infant death frustrates many physicians.
Nationwide, few health departments have been really aggressive at getting more disadvantaged young women into prenatal care.
Few districts have public-health nurses to seek out those who don't come for care for themselves. Few states are willing to spend the kind of money that can rescue black children and other disadvantaged infants from dying before they're 1 year old.
"Pediatricians are taking very good care of very little babies, but just as many very little babies are being born . . . and the cost is increasing dramatically," says Eschenbach, the Harborview obstetrics director.
"To me that symbolizes what's wrong with medicine in this country. We'll take care of your baby by going into high-tech gear."
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