Mayor Marion Barry plans to launch an attack on the city's high infant mortality rate that will focus on improving the care newborn infants receive rather than tackling the problems of teenage pregnancy and maternal nutrition.
In taking that tack, Barry is trying to make a dent as quickly as possible in the city's rate of infant deaths -- one of the highest rates in the nation.
Barry's plan is outlined in a draft of a speech he is scheduled to deliver Feb. 14 -- 14 months after he declared that infant mortality is the city's worst health problem and pledged his administration would reduce it.
In choosing this course, Barry has rejected the traditional approach of city health officials, who have blamed the high rate on teen-age pregnancy and poor nutrition, and have urged that those long-term problems be addressed.
Barry instead has cast his lot with his Blue Ribbon Commission on Infant Mortality, which told him that the quickest way to reduce infant deaths was to improve the quality of hospital care received by newborns and their mothers.
Among the steps outlined by Barry in the speech, a copy of which was obtained by The Washington Post are:
The establishment by March of next year of a transport system to get sick newborns and pregnant women likely to deliver sick babies to the hospitals best equipped to treat them.
A team of experts, to be set up by this July, to teach hospital personnel how to resuscitate newborn babies and stabilize their condition.
The completion by this June of a study of whether obstetricians, pediatricians, anesthesiologists and nursing personnel in hospital delivery rooms and nurseries should be required to know cardiopulmonary resuscitation skills for infants before being licensed.
City licensing officials -- rather than the hospitals themselves -- should assess how hospitals use their personnel in delivery suites and nurseries.
The replacement of the Blue Ribbon Commission with a permanent Maternal and Child Health Advisory Board (although it is unclear what its functions would be) and an upgrading of the role of the chief of Maternal and Child Health in the Department of Human Resources.
While many of Barry's proposals can be implemented at little or no cost, it is unclear whether the city, in its current budgetary crisis, will be able to implement ideas such as the transport system.
Sources said Barry has been told by his health advisor, Dr. Arthur Hoyt, that the city may be able to get the necessary funds from the U.S. Department of Health, Education and Welfare or private sources.
Barry also calls for an annual indepth analysis of the city's infant morality data and the adoption by the City Council of data collection regulations based on a model national vital statistics registration act.
He also calls for DHR to complete a study by June of the cost and feasibility of establishing computer links between all hospitals and clinics in the city to transmit the medical records of pregnant women and infants.
Until such a system is established, Barry wants to create a prenatal "health passbook" system. Under the proposal, every pregnant woman would be given a small record book in which her clinic or doctor visits would be recorded, along with all her test results.
Ideally, women would carry the booklets with them during pregnancy and present them upon admission to a hospital, giving the hospital a record of their care and problems.
In the speech, Barry says he knows that some persons have been upset that the emphasis is being placed on improving the hospital care for sick babies, rather than on long-term efforts to improve the conditions -- social and physical -- that produce the sick babies.
He endorses efforts to reduce the number of teen-age pregnancies and to improve the nutrition of pregnant mothers, and says that these problems "must be addressed concurrently" with the plan he is outlining.
Barry also will announce that the Georgetown University School of Medicine has received a contract to work with the federally funded Improved Pregnancy Outcome Project to study why so many infants born in the city weigh less than 5.5 pounds. Those infants accounted for more than 90 percent of the infant deaths in 1978.
Sources said Barry decided to support the recommendations of the Blue Ribbon Commission, and abandon DHR's solutions, partly because of the genuine shock he experienced on reading an in-depth study of infant deaths here in 1977.
That report, recently completed and released by the National Capitol Medical Foundation, showed that many of the babies who died in 1977 did not receive even the most minimal kinds of life support.
The study looked at 106 infants who it said might have been saved -- based on their birth weights and condition -- and found that many of them were not given such a basic aid as oxygen for breathing.
Sources said a study of 1978 data will show similar patterns of care given infants who died that year.