{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T19:38:39Z","timestamp":1754163519178,"version":"3.41.2"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T00:00:00Z","timestamp":1753920000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To calculate the impact of birth defects (BDs) diagnosed during the perinatal period on the mortality of children under 5 years of age.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective cohort analysis. From the monitoring system, we collected all hospital delivery, BD monitoring, and death information for children under 5 years in Hunan Province from 2017\u20132022. These data were linked by ID number. Mortality rates and Cox proportional hazards models were used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for the impact of BDs on mortality in children under 5 years of age.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 3,807,340 live-born children, 29,879 (0.8%) had at least one type of BDs during the perinatal period, with a total of 12,215,033 person-years of follow-up. The mortality rate of the BDs group was 14.5% (95% CI: 13.7\u201315.3) per 1,000 person-years, which was 11.6 times (HR\u2009=\u200911.6, 95% CI: 10.5\u201312.8) greater than that of the nondefect group. The mortality rate per 1,000 person-years of girls with BDs was higher than that of boys (15.4% vs. 13.5%). For the BDs group, congenital anomalies (CAs) were the most common cause of death (57.2%). Compared with children without BDs, those with BDs had elevated mortality risks for CAs (HR, 58.1; 95% CI, 42.7\u201379.0), digestive (HR\u2009=\u200916.5, 95% CI: 6.1\u201345.0) and respiratory system malformations (HR, 11.9; 95% CI, 7.9\u201317.8), and cancer (HR\u2009=\u200911.1 95% CI: 4.7\u201326.2).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study revealed that BDs were strongly associated with mortality under 5 years of age, especially in the first 28 days, for muscular, chromosomal, genetic, and nervous system abnormalities.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fped.2025.1485176","type":"journal-article","created":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T05:38:20Z","timestamp":1753940300000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of birth defects during the perinatal period with child mortality under 5 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