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COVER STORY : Critica Care : In Hospitals Around Central Los Angeles, the Majority of Sickly Infants in Neonatal Intensive Care Are Born to Economically Disadvantaged Mothers. Many of the Babies are Premature and Underdeveloped. But the Commonly Held Perception that Most of Them Are the Result of Mothers Abusing Drugs Is No Longer the Case, Say Neonatalogists, Who Cite the Widespread Lack of Prenatal Care. "There's No Doubt That If You're Underprivileged, You're Going to Have a Baby With a Low Birth Weight," Says One Doctor. "And the Chances of Your Baby Going Into ICU Are Going to Be High."

March 13, 1994|LUCILLE RENWICK

Isis Thomas lay cradled in her mother's arms in the neonatal intensive care unit at Childrens Hospital, IV lines piercing her tiny arms and stomach and a breathing tube down her throat.

Every incubator and crib in the small 10-bed ICU is occupied with babies like Isis--underweight, underdeveloped infants, many born premature and with several complications.

In hospitals around Central Los Angeles, the vast majority of these tiny, sickly infants in neonatal intensive care units are born to economically and socially disadvantaged mothers, many of whom have limited access to or are unaware of the importance of proper prenatal care, doctors say.

Although drug abuse by pregnant women was once among the most common causes of infants in need of critical--and expensive--neonatal care, other factors are now becoming more prevalent in cases of severely ill newborns, some of whom will be afflicted with minor problems for most of their lives. And those factors--most of which are avoidable--are taking their toll on hospitals, taxpayers and, most important, young lives.

An approximate bill to care for one child for two weeks in a neonatal ICU in a Central Los Angeles hospital runs about $21,000, most of which is paid for by taxpayers because the majority of the parents are poor. While most of the neonatal ICU patients live long and somewhat normal lives, a good portion of them could have avoided ending up in the intensive care units had their mothers taken proper preventive care that costs thousands less, doctors and advocates say.

"There's no doubt that if you're underprivileged, you're going to have a baby with a low birth weight and the chances of your baby going into ICU are going to be high," said Dr. Gabriel Escobar of the Permanente Medical Group Division of Research in Oakland. "But the issues that lead up to that are not so black and white, there are many gray areas."

Isis falls into one of those gray areas. The baby was born full term, and doctors found problems while her mother, Clarice Thomas, was pregnant.

"They took an ultrasound and found out that the baby's spine was crooked and that I would have to have a (Cesarean) section because she wouldn't make it through the birth canal," said Thomas, 39, of Watts.

Four-month-old Isis now suffers from a bad kidney and deformity of her right arm, among other ailments. She must be fed through a tube in her stomach and requires a tracheal tube to breathe, two of several problems that will remain with her for her entire life.

Dr. Arnold Platzker, head of neonatology and pediatric pulmonology at Childrens Hospital, said it is uncertain what could have caused so many complications in the baby. It is a rare case, he said. Most infants in neonatal intensive care units are born premature, with birth weights as low as 1 pound, 4 ounces and multiple problems that sometimes continue with them through life, Platzker said.

The reasons for prematurity in infants are myriad, doctors say, and are not genetically or ethnically dictated. It is partly attributable to lifestyle, poor diet, youth of mothers, drug abuse, health problems such as diabetes, rare genetic problems and lack of prenatal care.

Neighborhood health clinics and agencies face an uphill battle in spreading the word about the necessity of proper care.

Ana Bevilacqua, a health care worker at La Clinica Sunol in East Los Angeles, said the center has a constant flow of more than 200 women from the community who seek prenatal services, many of whom are illegal immigrants. However, Rodolfo Diaz, executive director of the Community Health Foundation of East Los Angeles, said it remains difficult getting some illegal immigrants to seek care because some believe that workers will turn them in to authorities.

Zola Jones of the Crenshaw-based Great Beginnings for Black Babies said that many of her predominantly African American clients who manage to make their way to one of her agency's two locations often bring a deficient history of medical care with them.

"There is more of a lack of knowledge about prenatal providers," Jones said. "Women, all women, who are without insurance or not accustomed to getting regular medical care don't usually know where to turn."

Great Beginnings' workers have started going door to door in neighborhoods, canvassing at-risk pregnant women at check-cashing shops and on the streets to get them to seek care.

"There are definitely people out there who need to come in for help, because the infant mortality rate is still too high," Jones said. "So we're trying to get the word out."

One recurrent problem is that mothers who are in pre-term labor often do not go to the hospital until it is too late to save the baby from serious complications, said Dr. Xylina Bean, a neonatologist and director of the Rosa Parks Neonatal Intensive Care Unit at Martin Luther King.-Drew Medical Center.

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