An editorial interpolation in an interview with Mayor Andrew Young published in today's Washington Post Magazine, which was printed in advance, inaccurately states the circumstances of the imprisonment in South Africa of African National Congress leader Nelson Mandela. Mandela was sentenced to life in prison in August 1964. He was held in the maximum security prison on Robben Island in Table Bay until April 1, 1982, when he was transferred to a prison on the mainland in Pollsmoor, South Africa. In yesterday's Metro section, an article on infant mortality incorrectly stated that Greater Southeast Community Hospital, D.C. General Hospital and Georgetown University Hospital all treat seriously ill newborns transported from other District hospitals. Of the three facilities, only Georgetown has such a program. Also, Dr. Paul Domson's comments on the need for mothers-to-be to lose weight referred only to very overweight women. An article yesterday about a police investigation of counterfeit $1 and $5 bills in Prince George's and Charles counties incorrectly spelled the name of James Rembold, one of the men arrested.
Cradling her tiny daughter in her arms, Michele, 16, sat in the intensive care nursery of Greater Southeast Community Hospital yesterday and spoke about her panic last month when she suddenly went into labor and delivered her baby 2 1/2 months prematurely.
"I was frightened the first day -- she was hooked up to all those machines," the Northeast high school junior recalled about the June 18 birth.
The infant, whose premature birth and complications were linked to the mother's urinary infection and inadequate prenatal care, weighed just three pounds, according to hospital doctors. She had a mild lung disease associated with premature births, and she still must be watched for respiratory irregularity. But she will live and is expected to go home with her mother in two weeks.
Babies such as Michele's, who arrive in this world too soon and too sickly, are a source of great concern among District health care professionals. Amid reports this week that the city's infant mortality rate is again rising -- up 16.5 percent last year over the year before -- there is a new urgency about finding out why so many D.C. babies die and what can be done to prevent it.
Teen-age mothers account for only a part, and some say a small part, of the problem. In the District, according to several hospital officials, pregnancies are more apt to be complicated by alcoholism, drug addiction or hypertension.
What the baby deaths have in common, however, is that the infants who die are usually born to mothers who do not take good care of themselves during pregnancy and who, as a consequence, give birth prematurely and have babies that are well below standards for acceptable birth weight.
Of the 202 infant deaths that occurred in the District in 1984, for example, 96 occurred during the first day. That was a sharp increase from 1983 infant mortality figures, which showed that 75 out of 173 baby deaths occurred during the first day.
"It is a known fact that the District of Columbia's low-birth-weight rate is high, so it's no surprise that its infant mortality rate is high," said Joan Maxwell, president of Better Babies Inc., which is conducting prenatal care research in Northeast Washington.
An absence of, or late start with, prenatal care appears to be the primary cause of infant deaths. Poor women cannot always afford to follow their doctor's advice, and city programs designed to buy food in such cases may not be reaching all the women who need them.
The District and five states are serving fewer women under these programs this year than last year, according to recent figures, which are expected to be made public next week by the National Governors Association and the National Conference of State Legislatures.
A newsletter published by both organizations reports that the District served 629 fewer people in its Women, Infants and Children feeding program from May 1984 to May 1985. The actual number of WIC clients dropped from 11,336 to 10,707, and the most current figures available from the District government yesterday showed that 239 fewer pregnant or nursing mothers participated in the program between March of last year and March of this year.
"We work hard to put them on the program," said Doreleena Sammons, who handles caseload management for WIC in the District, "but many women are not picking up their checks."
She said WIC staff members have begun calling women to urge them to collect the money, which averages about $30 a month for purchase of dairy products and other nutritional items.
Technological advances in prenatal and after-birth care have enabled hospital staffs to perform miracles compared to even 10 years ago. But doctors are the first to admit there are limits to what they can do in the operating room, especially if babies are severely underweight.
"Over a third of the infants born here last year weighed less than one pound, one ounce, and we just couldn't do anything about those babies," said Dr. Dorothy Hsiao, director of the nursery at Greater Southeast Community Hospital.
Hospital doctors at Greater Southeast, D.C. General and Georgetown University, which treat many seriously ill newborns transported from other city hospitals, say they are doing a good job of caring for premature infants. And many of these health experts praise the attention and care city officials have given to the problem.
But, they add, the socioeconomic factors -- poverty, poor nutrition, poor prenatal education and stress -- are overwhelming the health care system and keeping the infant death rate here notoriously high.
"It's living in D.C. that's the problem, it's not delivering [in] D.C.," said Dr. Paul Domson, head of pediatrics at Greater Southeast. "If we could get the 25-year-old mother to take better care of herself, if we could get the mothers off heroin and alcohol and get the mothers to lose weight, that would take care of close to 90 percent of the problem."
At D.C. General Hospital, according to Dr. Stanley Sinkford, chairman of pediatrics, about half of the 52 babies there now were born at high risk but are expected to live. Fifteen were born to drug-addicted mothers, eight birth mothers had syphilis and four were born to mothers with tuberculosis, he said.
While expressing alarm over the new upswing in infant mortality here, city and hospital officials note that the statistical increase represents a relatively small number of additional deaths -- 29 more than in 1983 -- and does not mean that infant care is in significantly worse shape.
"You have to be careful about the numbers." said Dr. Andrew McBride, the District's commissioner of public health. "The few more people [dying] are very important, but before we draw systemic conclusions around one year of statistics, we have to have more study."
McBride, who suspects that the existing gap between white and non-white infant mortality rates is widening here and nationwide, said medical records as well as birth data and death certificates will be looked at, "and there will be steps taken."
At this point, no one can say just what steps will be taken.
There were no infant deaths among mothers under 30 who lived in affluent Ward 3 in Northwest Washington, according to the 1984 figures, though some doctors expressed skepticism about hospital record-keeping in this area. And after a significant decrease in wards 7 and 8, east of the Anacostia River, the infant mortality rates rose there last year. Predominantly Northeast Ward 5 continues to have the highest infant mortality rate in the city.
"We don't know where [in the wards] it's coming from, and we're trying to get a better picture by census tracts," said Dr. Harry Lynch, acting chief of the District's bureau of maternal and child health.
Lynch, who has worked in the District's health clinics since 1965 and occasionally fills in at several city facilities, including those in Ward 5, said health officials need to improve their tracking of patients to the clinics, from the clinics to the hospitals and from the hospitals back to the clinics.
There's an obvious problem, he said, with women who for whatever reason don't hear about or seek out prenatal and infant care services. But there's a problem with women who do visit the clinics.
"The patients I've seen are exposed to health education, but whether they're practicing it is another matter," Lynch said. "We ask them if they're eating properly -- sometimes they tell us what they want us to hear."
While city health officials talk of gathering more information about infant mortality rates, however, many hospital officials expressed a growing frustration with further studies. It's obvious, they say, that many poor women in the District are not getting, are not seeking or do not have access to proper prenatal care.
The city, they say, needs to try new and additional ways to get the message about good health care to expectant mothers.
Pediatricians differ on what aspect of prenatal care to emphasize most. One doctor said she would put the money in a no-smoking campaign, considered the single biggest preventable cause of low birth weight. Another said he would stress getting doctor care earlier. Another worries that teen-age mothers do not know how to eat properly and that illegal aliens in the District are afraid to seek prenatal care.
"Women must learn about personal health habits and how it can affect their babies," said Maxwell of the Better Babies project.
It is possible, she said, "for you to take three drinks a day and smoke a lot and still have a great big fat baby -- but it increases the odds against it."