They show up in a doctor's office or a clinic or a hospital ward with infections that hang on and on. Doctors try one thing, then another, but the babies stay sick.
Sometimes, their first serious illness is also their last. They are children at the mercy of HIV, the human immunodeficiency virus that causes AIDS.
Concerned that these HIV-infected babies and their mothers need earlier care than they are getting, Los Angeles doctors who specialize in pediatric AIDS are calling for routine voluntary testing of all pregnant women in Los Angeles County for infection with the AIDS virus.
Not just prostitutes or poor women whose sexual partners use drugs, but, for example, middle-class women who had several partners before marrying.
It is an idea whose time has come, these doctors say, because for the first time--through a network of federally established drug trials--doctors can offer mothers and children treatments that they hope will slow the progression of the devastating disease.
"To find just one mother at this early stage and do something about it would save so much in the long run," said Dr. Yvonne Bryson, a UCLA professor who directs the Los Angeles Pediatric AIDS Consortium. "If we could prevent transmission to the baby, the actual cost and human cost couldn't be compared."
The Consortium, a coalition of Los Angeles hospitals and the County Department of Health, will begin trials within the next month to test whether giving the anti-viral drug AZT to newborns will prevent the AIDS virus from establishing itself in the children.
The drug is already being given to older children who are infected but asymptomatic, and to pregnant women to try to prevent transmission to their children. Other drugs also are being tested.
Currently, a third to half of the children born to HIV-infected mothers come down with AIDS. It usually appears within the first year of life, and death occurs sooner in children than in adults.
To Bryson, testing women routinely for AIDS is the best way to assure that they and their babies get the best possible health care--even if no one can offer them a cure for the fatal disease that has killed more than 68,000 Americans--1,059 of them children--since 1982.
But the idea of routinely testing all pregnant women for HIV infection does not come without controversy, even in areas of the country where the childhood AIDS problem is much greater than in the Los Angeles area.
In Miami, which has twice as many HIV-risk births every year (as does Los Angeles), Dr. Mary O'Sullivan is concerned that asking women to be tested for infection with the AIDS virus is asking them to take the chance of serious social discrimination if the test comes back positive.
"Why isolate them out just because they're pregnant? Do you have any proof that what you have to offer is going to decrease the incidence of infection in the newborn?" asked O'Sullivan, professor of pediatrics at the University of Miami.
And drug trials in pregnant women are not far enough along to answer that question.
State AIDS office epidemiologist Frank Capell takes a middle ground. He suggests that public health dollars might be best spent in pushing HIV testing only in the specific urban areas where the number of HIV-infected, or seropositive, women is highest.
"The seropositives we saw in L.A. County were not just randomly distributed," Capell said. "Probably three-fourths of the county had no seropositive women at all."
The epidemiologist oversaw a study of every California birth during three-month period last year. Using blood samples routinely taken from babies to screen for genetic diseases, the study found evidence of HIV-infected mothers mainly in the poorer, high drug-use areas of Los Angeles, San Francisco and Alameda counties.
While the overall incidence rate in pregnant women in Los Angeles County was about 1 in 1,000--a rate considered high--among black women it was 1 in 344. Among Latino women it was 1 in 1,232.
Nationwide, the highest rates in the nation are in drug-abusing communities in northeastern cities--as high as 1 in 25.
Los Angeles County's overall rate is high enough to justify recommending screening for every woman in the county, not just in public health clinics but also in private doctors' offices, said Dr. Laurene Mascola, deputy chief of acute communicable disease control for the L.A. County Department of Health.
"I personally think that if there's a disease you can screen for and have some impact on the outcome for fetus and mother, you should do it," Mascola said. "It's not as 100% as syphilis, where you can give a shot of penicillin and prevent the disease. But we are actively trying different strategies to reduce the risk."