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Infant mortality is slowly declining in Western New York but remains a fixture in some city neighborhoods, where newborn death rates reflect deep-rooted health problems, experts at a conference here said Tuesday.

The latest statistics show Buffalo, overall, making improvements in the last decade, a positive trend in line with decreasing infant mortality rates nationwide.

However, the rate in the city -- 13.4 deaths per 1,000 live births -- is nearly twice the national average and in some neighborhoods is more than three times the U.S. average.

In Niagara Falls, rates are equally high and on the rise.

"We are one of the wealthiest countries in the world, but still have infant mortality rates that rival some developing countries. It's shameful," Dr. Olivia Smith-Blackwell, chief executive officer of Sheehan Memorial Hospital, said at the conference sponsored by the Buffalo Prenatal-Perinatal Task Force.

Some elements of infant mortality remain a mystery, such as the striking disparity between African-Americans and whites even among college-educated women.

But poverty is the driving force, experts said, as is ignorance, drug abuse, cigarette smoking, poor nutrition, inadequate prenatal care, teen-age pregnancy and lack of health insurance.

"There are many factors wrapped into this problem," said Dr. Vivien Carrion, a pediatrician at Children's Hospital who directs the regional perinatal outreach program.

Among other remedies, she called for reducing the number of low-weight newborns and improving education of moms-to-be to avoid such problems as sudden infant death syndrome.

Whatever the cause, speakers at the conference said infant mortality, like the canary in a coal mine, serves as a good measure of the health status of a community.

"People in health care are caught up with talking about market share and creating big health systems," said Dr. Smith-Blackwell, who also serves as president of the task force. "We should be asking ourselves if we're making an impact on the real bottom line by improving health for everyone in this community."

The gathering at the University at Buffalo follows the recent release of a national ranking of kid-friendly cities that, using infant mortality as one indicator, assigned Buffalo a "D" grade.

Conference participants acknowledged that Buffalo and Niagara Falls could improve their infant mortality rates, but they warned that comparisons of cities and countries should be looked at closely because of differing definitions of infant death.

Many states and countries define infant mortality as infants who die in the first year of life. But others use a more liberal definition, an acknowledgment of the improved abilities of doctors to save the tiniest babies, by counting preemies who show a fleeting heartbeat and breath.

Pregnant moms also have better access to medical technology in some cities than in others.

Indeed, George Kobas said current statistics give the impression infant mortality rates are higher in Buffalo than in New York City. However, if miscarriages after 20 weeks of pregnancy are counted, a different picture emerges.

"New York City has a much higher late miscarriage rate than Buffalo, which suggests that women here have better access to the doctors and technology that can save these tiny lives," said Kobas, the data management coordinator.

The U.S. infant mortality rate hit an all-time low in 1997 of 7.1 deaths per 1,000 live births, representing 27,691 infant deaths, according to the most recent annual report from the American Academy of Pediatrics.

The top four causes of infant mortality in the U.S. -- multiple congenital deformities, low birth weight, sudden infant death syndrome and respiratory distress syndrome -- account for half of the deaths.

The U.S. has improved, yet still compares poorly to other nations, ranking 23rd in the world.

By comparison, the infant mortality rate in the Cold Spring neighborhood of Buffalo was 21.8 in 1997, the highest in the city. Other neighborhoods with high rates are concentrated on the city's East Side and Lower West Side.

The rate in Niagara Falls stands at 12.4 deaths per 1,000 live births, an increase from 9.5 deaths in the period 1989-91.

Kobas and others suggested the reason for the increase may be statistical -- the result of residents who left for jobs elsewhere, leaving the city's population poorer.

Among some of the other findings noted at the conference:

Although physicians have made advances in saving babies with congenital deformities, the cost of caring for these children is huge. A 1995 study estimated the lifetime expense of one cerebral palsy case at $503,000.

The hospital cost after delivery of a premature infant in Buffalo is also large -- nearly $80,000 over 50 days for a baby born at 28 weeks gestation.

Nearly one-third of the women whose pregnancies end in death in this region lack health insurance.

Half of the women here whose babies die receive prenatal care, compared to the 75 percent of all area women who get such care. The national average is 84 percent.

One often overlooked aspect of infant mortality is a field of medicine devoted to consoling patients whose babies die.

Obstetricians are trained to prevent death, but they are not very good at talking about it with patients when death occurs, said Dr. James R. Woods Jr., a Rochester physician and noted author on how to handle a pregnancy loss.

Ultrasound, the technology that offers a view of the fetus, has radically changed the practice of medicine, he said.

Abnormalities and their treatment used to be identified at birth and were the pediatrician's responsibility. With ultrasound, problems can be anticipated before birth when the obstetrician is in charge of a patient's care.

Woods said the trouble is obstetricians tend to retreat from patients after an infant dies, saying they don't have time, using hard-to-understand medical jargon or putting off even a brief talk.

"I cannot accept that a doctor is too busy to spend 10 minutes with a patient when they are most devastated. That's all the time you need to say, 'I'm sorry your baby died,' " he said.

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