In all, the cart can keep a close watch on a newborn baby's heart, lungs, arteries, veins, and other critical body systems. "We believe this can play an important role in our overall effort to reduce infant mortality," said Dr. Arnold Leonard, chief of pediatric surgery and head of the development effort. The cart is so new that only two infants have been monitored on it so far. One was a boy born with a bad heart, the other a girl with the dread lung disorder called hyaline membrane disease. This is the lung problem that took the life of Patrick Kennedy, the late president's son. In addition, the cart had been used to monitor a 5-year-old girl while catheters were threaded into her ailing heart. All three patients are making good progress. "We expect to use the cart with many of our critically ill infants now," Dr. Leonard said. He said he has high hopes that the concept will be picked up by other major medical centers. The monitoring system watches an infant's respiration, temperature, and blood pressure. It takes a continuous electrocardiogram of the heart. And very importantly, thanks to the new blood-flow technique, it checks cardiac output-how much blood the heart is pumping. "All the information is printed on a sheet of paper" that comes out of the cart, and it also can be displayed on a cathode-ray-tube screen, Dr. Leonard noted. Similar monitoring equipment exists for adults. In fact, the new cart is based on a monitoring unit for adult shock patients developed by Dr. Richard Lillehei, another surgeon at the university. The problem in monitoring a baby's cardiac output is this: In adults, a small amount of blood is removed from the patient during the monitoring process (to see how rapidly dye injected into the bloodstream is pumped through the heart). But newborn babies have so little blood in their bodies that this would be very risky. Working in Dr. Leonard's laboratory, Dr. Luis Urdaneta helped develop the miniaturized closed-loop system that allows a baby's blood to be monitored “almost without losing a drop." The computer is very important to any such monitoring process, the doctor explained. It calculates for the doctors not only how well the patient's heart is working, but also how much resistance the arteries and veins are giving to the flow of blood. Dr. Leonard said the problem involved in infant monitoring could never have been solved without the help of two pediatric cardiologists, Dr. Russell Lucas and Dr. Gary Gathman. A year's work in the lab, including much animal testing, was involved. The basic reason for the monitoring is to detect trouble in the baby early so that action can be taken quickly. For instance, Dr. Leonard noted that mental illness can result when blood supply is denied to the brain. Thus one key hope is that mental illness can be prevented in some ill infants by correcting the blood supply problems in time. Also, he explained, the monitoring will allow doctors to see precisely how well drugs and other types of treatment are working for an infant. In addition to monitoring, Dr. Leonard said, it's very important to get critically ill youngsters to a major medical center in time. Thus he also has pioneered a "flying incubator" service to serve the region. It is heavily supported by the U.S. Public Health Service. In recent months university doctors have flown in chartered light planes to pick up about 30 seriously ill newborn children. The infants have come from spots in North Dakota, South Dakota, Montana, Wisconsin, and Minnesota that are not near major medical centers. Dr. Leonard developed a special incubator for them to ride in inside the aircraft. In a number of cases, time has been so important that, after the plane landed at the airport, a helicopter picked up the tiny patients for the ride to the hospital. While many big-city hospitals have facilities for treating seriously ill newborns, the doctor said, this seldom is true in more rural areas. "Our air service is making our hospital's services available to babies throughout a 5-State area who need them, regardless of financial circumstances," Dr. Leonard said. He said the computerized monitoring cart is just one of the ways those hospital services are being improved. FROM WISCONSIN TO CITIES-PLANE, COPTER RUSH TWO INFANTS TO HOSPITAL A small mercy-mission helicopter, carrying seriously ill twins born only the night before, whirled to a landing on the University of Minnesota campus Thursday afternoon. Within minutes they were placed in an infant intensive care unit in University of Minnesota hospitals and were receiving treatment for severe multiple-birth defects. It was the end of a 100-mile air dash-involving both a plane and the copterthat took only 40 minutes to bring the boy and girl babies from Shell Lake, Wis. "We're hoping it helped," said Dr. Arnold Leonard, who noted that it would have taken much longer to bring them by ambulance, and every minute counted. The twins were born about p.m. Wednesday in Spooner, Wis., near Shell Lake. Their parents are Mr. and Mrs. Joseph Poffel. Both babies have respiratory problems and cleft palates. The boy, who Leonard said has been "extremely ill," is a blue baby, probably due to a heart defect. The babies weigh about 6 pounds each, but both rode together in a single special incubator on the flight. Leonard recently was named head of a pediatric surgery unit at the hospital. He instituted a flight service program to rush infants to the hospital when necessary. The doctor said he hopes that the use of planes and copters will be "one way to decrease the child mortality rate," by saving time in getting newborns with birth defects and other serious illnesses to the infant intensive care ward that he helped set up. In eight recent cases, planes have flown youngsters into a Twin Cities area airport to meet ambulances. Time, however, was additionally important in the case of the Poffel twins. About noon yesterday a small charter plane took off from the Anoka airport with a medical student and a surgical resident aboard. With them was a 6-pound incubator, designed by Leonard especially for use aboard aircraft. The plane landed in Wisconsin about 12:30 p.m., picked up the twins, then landed about 1 p.m. back at the Anoka airport. There the three-seat bubble-nose copter was waiting. The twins, in the incu bator, were placed in the middle seat. Pilot Bruce Schiltz of Lake Line Helicop ters was on the left and medical student Fred Hathaway on the right. At 1:08 p.m. the copter landed at the university, atop the parking ramp behind the Coffman Union building. An ambulance was waiting for the block ride to the hospital. A short time later, Dr. William Norwood, the surgical resident who was on the plane trip, returned to the hospital after a drive from the Anoka airport. [From Welfare in Review, vol. 5, No. 7, August-September 1967, pp. 1-12] INFANT MORTALITY AND POVERTY AREAS (By Eleanor P. Hunt1) This report summarizes the latest information available experience in infant mortality at different ages in infancy and in the perinatal period.2 Differing mortality levels among a variety of geographic jurisdictions or areas are examined for evidence they provide on the size of the national problem of preventable infant deaths, their distribution and association with different levels of living. Assessment is not confined to large areas such as States and counties, but for the first time significant variations in infant survival are viewed as they relate to poverty and other neighborhoods in larger cities. Recent studies of the Bureau of the Census have identified in comparable fashion the small areas within these cities having the highest concentrations of families living in poverty. The national infant mortality rate in 1965 was 24.7 per 1,000 live births, almost identical to the 1964 level of 24.8. (table 1) This stable level principally reflected unchanged but relatively low risks for white infants. For nonwhite infants, there was a noteworthy 4.2-percent reduction in mortality in the neonatal period (under 28 days old). Among older (1-11 months) nonwhite infants, however, mortality was higher, although the 1964 rate was already about 170 percent 1 Division of Research, Children's Bureau, Welfare Administration. 2 Deaths counted in the perinatal period are the deaths of stillborn infants and of liveborn infants before 28 days of age. greater than for the white group (14.6 per 1,000 in 1964 in contrast to 5.4 per 1,000 among white infants). NOTE. For references, see end of article. Data on births and deaths were provided by the National Center for Health Statistics. Public Health Service, except data for poverty and other neighborhoods in Chicago and Washington, D.C., which were supplied by health departments in those cities. TABLE 1.-INFANT MORTALITY, UNITED STATES, 1965 The reduction in the neonatal rate for nonwhite infants narrowed the gap between neonatal rates for white and nonwhite, from a 64-percent excess of nonwhite over white in 1964 to 58 percent in 1965. For the period of infancy as a whole (under 1 year), the excess was reduced from 90 percent in 1964 to 87 percent in 1965. The perinatal mortality rate covering fetal deaths and deaths of live newborn in the neonatal period is a useful measure of fatal risks just before, during and soon after birth. A still more inclusive view of fatalities in the birth period and in the first year of life is gained from the joint perinatalpostneonatal rate. This rate is the number of perinatal deaths (fetal and neonatal) plus postneonatal deaths (deaths of infants 1-11 months old) per 1,000 total births, live and still. Significant reductions of about 1 percent occurred in perinatal as well as joint perinatal-postneonatal mortality rates in 1965 (table 2). Rates for nonwhite infants were from 2 to 4 percent lower than in 1964. Since there was little change in these rates for white infants in 1965, the excess of the rates for nonwhite infants over those for white infants was diminished. A marked reduction in the fetal death rate in 1965 was recorded for both white and nonwhite groups, and the excess of the fetal death rate for nonwhite infants as compared with white infants decreased from 98 percent to 94 percent. TABLE 2.-FETAL AND INFANT MORTALITY RATES, UNITED STATES, 1965 STATE DIFFERENTIALS State infant mortality rates continued to vary widely, from the low rate of 18.3 per 1,000 live births in Utah to 40.6 in Mississippi. Rates tended to be higher than the national average in States with relatively low per capita income and below average in high and middle per capita income States. (7) In 1965, the postneonatal mortality rate for the 17 States with the lowest per capita income (1963–65) was 40 percent above the national average (table 3). One out of five births in the United States in 1965 was in families living in States of the low per capita income group. TABLE 3.-INFANT MORTALITY, UNITED STATES, 1965, AND PER CAPITA INCOME A recent study of county infant mortality rates in the 5-year period 1956–60 has provided estimates of the extent of excess infant mortality in these relatively small jurisdictions. Study findings are serving as geographic guidelines in planning services for the reduction of needless infant deaths. (4) The concept of excess deaths is based on the selection of a hypothetical and relatively low-infant mortality level to serve as a ceiling with which to compare the level actually prevailing. Accordingly, the level selected was the mortality rate in the 10th percentile position or upper limit of the first decile in the array of U.S. county rates 1956-60. The rate at this level was 18.3 infant deaths per 1,000 live births. The excess number of infant deaths for any county was the difference between the actual number of deaths occurring in those years and the number that would have occurred if the 10th percentile rate had prevailed. The infant mortality rate for each county during the 5-year period is shown in figure 1. The number of excess deaths estimated for each county in the same period appears in figure 2. While the rates in figure 1 show the variations in fatal risk among counties, the estimated excess in figure 2 reflects, in addition to the risk, the size of the newborn population exposed to it. In this period, 320 U.S. counties comprised the first decile and had 18.3 or fewer infant deaths per 1,000 live births. Had this low rate prevailed generally in the other U.S. counties, an additional 169,784 infants, or an estimated 34,000 annually, would have survived their first year. |