**1. Introduction**

Congenital anomalies (CA) are the leading cause of infant mortality in the USA (**Figure 1**) [1]. The five most common birth malformations recorded in the USA are club foot (1 in 593 births), Down syndrome (1 in 707 births), pulmonic stenosis/atresia (1 in 1052 births), cleft palate (1 in 1687 births), and limb defects (1 in1943 birth). Congenital heart disorders, neural tube defects, and Down syndrome are the three commonest causes of mortality due to CA in that order

One in every 33 children born in the USA suffers from a birth anomaly, and 1 in 5 deaths among infants is due to morbidities related to them [2]. Globally about 7.9 million children are born with a major birth malformation every year, and CA is the fourth leading cause of neonatal death worldwide [3]. The annual cost of hospitalization due to congenital malformations is reported to be \$22.9 billion in the USA [4]. The cost of care of infants suffering from CA is relatively higher than any

**Figure 1.** *Infant mortality per 100,000 live births in the United States.*

other childhood morbidity. While 3.0% of all hospitalizations are attributed to birth anomalies, the diagnosis accounts for 5.2% of total hospital costs. The cost of care is highest in the children who are <1 year of age and accounts for 35.0% of the total hospitalization costs among the pediatric population. The congenital cardiac defects register the highest CA-associated hospitalization costs across all age groups at 26.6%, while only 14.0% of CA–associated hospitalizations are attributed to this system.
