Contribution of Birth Defects to Infant Mortality -- United States, 1986
As infant mortality in the United States has declined during the 20th century, the proportion of infant deaths attributed to birth defects has increased steadily  (Figure 1). Birth defects also contribute substantially to years of potential life lost before age 65 .
To evaluate the contribution of birth defects to infant mortality in the United States, mortality data for 1986 from CDC's National Center for Health Statistics were analyzed. Birth defects were defined as conditions coded within Congenital Anomalies (740.0--759.9) of the International Classification of Diseases, Ninth Revision (ICD-9). Excluded from this group were 460 babies with lung hypoplasia (748.5), patent ductus arteriosus (747.0), or hydrocephalus (742.3) secondary to intraventricular hemorrhage (772.1) who also had ICD-9 codes 764 or 765 (disorders relating to low birthweight and short gestation).
Of 38,957 reported infant deaths in 1986, 8005 (20.5%) had birth defects listed as the underlying cause of death; birth defects were the leading cause of infant mortality (Figure 2). Birth defects were listed as a contributing cause of death for an additional 1088 infants. Thus, in 1986 birth defects were an underlying or contributing cause of death for 9093 (23.3%) infants.
Cardiovascular defects, the most frequent type of birth defect, were present in 3057 (38.2%) of the 8005 babies. Central nervous system defects (including anencephalus and similar anomalies, spina bifida, and other congenital anomalies of the central nervous system and eye) were the second largest group, occurring in 1991 (14.9%). Birth defects of the respiratory system comprised the third largest group (870 [10.9%]). Editorial Note: The rapid decline of infant mortality rates in the 1970s has been attributed largely to the advent of medical technology in the care of premature and other critically ill newborns. In the 1980s, this decline has slowed considerably--partly because of a lack of progress in primary prevention of conditions which lead to infant death. As a consequence, the 1990 health objective of nine infant deaths per 1000 live births is unlikely to be met . Additionally, to meet the year 2000 objectives, health agencies will have to make substantial efforts to prevent the leading causes of infant mortality.
Birth defects, prematurity, and sudden infant death syndrome account for 52% of all infant deaths. Epidemiologic and basic research are integral to the development of prevention programs for infant mortality. The federal government and 22 states maintain surveillance systems for birth defects. These systems can assist in assessing the effectiveness of intervention programs in preventing defects whose etiology is known (e.g., fetal alcohol syndrome) and in serving as a basis for the epidemiologic research needed to understand the causes of birth defects. [Figure 1 to 2 Omitted]
References Warkany J. Congenital malformations. Chicago: Year Book Medical Publishers, 1971:41. CDC. Premature mortality due to congenital anomalies--United States. MMWR 1988;37:505--6. Public Health Service. The 1990 health objectives for the nation: a midcourse review. Washington, DC: US Department of Health and Human Services, Public Health Service, 1986.
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