{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T05:40:17Z","timestamp":1774330817831,"version":"3.50.1"},"reference-count":47,"publisher":"Wiley","issue":"20","license":[{"start":{"date-parts":[[2022,9,29]],"date-time":"2022-09-29T00:00:00Z","timestamp":1664409600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Birth Defects Research"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>We aimed to analyze recent infant and neonatal mortality from congenital heart defects (CHD) in Costa Rica, a middle\u2010income country where CHD mortality was above expectations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A descriptive analysis of infant and neonatal mortality rates from CHD (IMR\u2010CHD and NMR\u2010CHD) during 2000\u20132019 was performed, according to province, sex, specific CHD, and sub\u2010period, using data from the National Institute of Statistics and Censuses. We used joinpoint regression to identify any calendar\u2010year where a significant change in trend occurred; the average annual percent change (AAPC) was determined. Using Poisson regression, marginal means and mortality ratios (MR) for IMR\u2010CHD and NMR\u2010CHD by sub\u2010period (2000\u20132006\u2013referent\u2010, 2007\u20132013, 2014\u20132019) were estimated and compared using Wald's chi\u2010square tests (\u03b1\u00a0\u2264\u2009.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During 2000\u20132019, CHD accounted for 12% of overall infant mortality. IMR\u2010CHD and NMR\u2010CHD decreased linearly over the study period (AAPC\u00a0=\u00a0\u22123.4; <jats:italic>p<\/jats:italic>\u00a0&lt;\u2009.01). IMR\u2010CHD decreased by 41%, from 13.6 per 10,000 in 2000\u20132006 (13.4% of infant mortality) to 8.1 per 10,000 in 2014\u20132019 (10% of infant mortality) (MR\u00a0=\u00a00.59; 95% confidence intervals [CI]\u00a0=\u00a00.52\u20130.68). NMR\u2010CHD decreased by 38%, from 7.9 per 10,000 in 2000\u20132006 (11.1% of neonatal mortality) to 4.9 per 10,000 in 2014\u20132019 (7.9% of infant mortality) (MR\u00a0=\u00a00.59; 95% CI\u00a0=\u00a00.52\u20130.68). Male presented significantly higher NMR\u2010CHD. The main causes of mortality (2014\u20132019) were total anomalous pulmonary venous connections, hypoplastic left heart syndrome, and double inlet ventricle.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>IMR\u2010CHD, NMR\u2010CHD, and their proportional contribution to mortality by all causes and by birth defects decreased significantly, demonstrating that all improvements implemented in the last decades have yielded favorable results.<\/jats:p><\/jats:sec>","DOI":"10.1002\/bdr2.2093","type":"journal-article","created":{"date-parts":[[2022,9,30]],"date-time":"2022-09-30T06:29:24Z","timestamp":1664519364000},"page":"1364-1375","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Reduction of infant mortality from congenital heart defects in a middle\u2010income country: Costa Rican experience"],"prefix":"10.1002","volume":"114","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7121-1388","authenticated-orcid":false,"given":"Adriana","family":"Benavides\u2010Lara","sequence":"first","affiliation":[{"name":"Costa Rican Birth Defects Register Center (CREC) Costa Rican Institute of Research and Education in Nutrition and Health (INCIENSA)  Cartago Costa Rica"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mar\u00eda de la Paz","family":"Barboza\u2010Arg\u00fcello","sequence":"additional","affiliation":[{"name":"Costa Rican Birth Defects Register Center (CREC) Costa Rican Institute of Research and Education in Nutrition and Health (INCIENSA)  Cartago Costa Rica"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olga","family":"Arguedas\u2010Arguedas","sequence":"additional","affiliation":[{"name":"Hospital Nacional de Ni\u00f1os \u201cDr. Carlos S\u00e1enz Herrera\u201d, Caja Costarricense del Seguro Social  San Jos\u00e9 Costa Rica"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jorge Enrique","family":"Faerron\u2010Angel","sequence":"additional","affiliation":[{"name":"Hospital Nacional de Ni\u00f1os \u201cDr. Carlos S\u00e1enz Herrera\u201d, Caja Costarricense del Seguro Social  San Jos\u00e9 Costa Rica"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eduardo M.","family":"da Cruz","sequence":"additional","affiliation":[{"name":"Children's Hospital Colorado  Aurora Colorado USA"},{"name":"University of Colorado Denver School of Medicine  Aurora Colorado USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,9,29]]},"reference":[{"key":"e_1_2_9_2_1","first-page":"5","article-title":"Estudio retrospectivo del diagn\u00f3stico de cardiopat\u00edas cong\u00e9nitas en el per\u00edodo prenatal en el Hospital Nacional de Ni\u00f1os, junio 2001\u2014mayo 2002","volume":"5","author":"Ac\u00f3n F.","year":"2003","journal-title":"Revista Costarricense de Cardiolog\u00eda"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-028139"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.51481\/amc.v63i2.1185"},{"key":"e_1_2_9_5_1","first-page":"304","article-title":"Mortalidad infantil por defectos cong\u00e9nitos en Costa Rica, 1981\u20132010","volume":"34","author":"Barboza\u2010Arguello M. d. l. 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