The final version of a high-level report on infant death in District hospitals concludes that some babies died because hospital personnel and doctors did not move aggressively enough to save them.
The report prepared for Mayor Marion Barry's Blue Ribbon Commission on Infant Mortality, will be used by the commission to recommend how the District could reduce its rate of infant mortality, which is one of the highest in the nation.
The final report, based on infant deaths in 1977 and 1978, echoes a preliminary study of such deaths in 1977. When the earlier report was made public, hospital officials attacked its findings, saying the information was inaccurate and incomplete.
But the final version found the same wide differences in infant death rates among District hospitals -- reflecting great differences in the treatment given high-risk infants.
The hospital varied on whether they resuscitated infants in the delivery room, performed blood and other tests on high-risk babies, or monitored the infants closely in the nursery, among other things.
The report acknowledge that Washington's high rate of premature births -- three times the national average if prematurity is measured by low birth weight -- is a major factor in the high death rate. It also cites high blood pressure during the mother's pregnancy, infections just before and during delivery and inadequate prenatal care as significant factors.
But it says the District's high rate of teen-aged pregancies has little to do with the high infant mortality rate. And it concluded there is not enough information to determine whether malnutrition during pregnancy contributed to the number of small, high-risk babies.
"Perhaps 10 percent of the infant deaths could have been prevented" if intensive care had been uniform and immediate in all the hospitals, according to the report. Of the 340 babies who died during the two years, the committee identified 228 as "potentially salvageable," eliminating those who were too small or too severely malformed to live. They judged that the 228 infants had some chance of surviving if given the best of care.
But in many instances, the babies did not receive blood pressure, blood oxygen, urinalysis or other tests usually considered standard during resuscitation of a high-risk newborn. More than 25 percent of those described as blue at birth were not given oxygen. And about the same percentage were not given oxygen mechanically if they failed to breathe on their own.
The training of those responsible for resuscitating the infants varied greatly among the hospitals, with some relying on an obstetrician or an obstetrics resident instead of a pediatrician or a specialist in "newborns."
The infant mortality rate in Washington in 1978 was 28.6 deaths per 1,000 births, compared with a national rate of 13.6 deaths per 1,000 births, according to the National Center for Health Statistics.
The infant death rates for 1977-78 at the nine District hospitals in the study varied widely. At Columbia Hospital for Women, Georgetown University Hospital and George Washington University Hospital, the overall rate was 11 or 12 deaths per 1,000 births, or better than the national average. At D.C. General Hospital, mortality was highest -- 29 deaths per 1,000 births. Washington Hospital Center had 15 deaths per 1,000, Howard University Hospital, 18 deaths per 1,000, and Greater Southeast Community Hospital 25 deaths per 1,000. Both Sibley and Providence hospitals had very low death rates -- 2 and 6 deaths per 1,000 births, respectively -- but those hospitals also had very few low-birth-weight infants, compared with the others.
Spokesmen for D.C. General Hospital and Greater Southeast Community Hospital said the high death rates there were partly due to the greater number of babies born at those hospitals weighing 500 grams or less -- that is, too small to be saved with current technology.
Other hospital sopkesmen criticized the study's data collection methods, but several said its conclusions were generally valid.
Dr. Frederick Green, chairman of the Blue Ribbon Commission, which will send its recommendations to the mayor May 25, said the report provides "a handle" on hospital care so that the city can do something about it. But, he added, "This is just half a loaf. We still have to be sure of better access to care" during pregnancy.