Congenital malformations in Israel.

The interest in congenital malformations increases when the infant mortality rate declines. When the preventable cases decline and form only a small part of the total infant mortality, attention is directed towards the remaining hard-core of infant mortality. At this stage, congenital malformations (CM), which are still to a certain degree a terra incognita, gain in importance and are rated at high priority. Infant mortality in Israel declined from 51 7 per 1,000 live births in 1949 to 23-7 in 1964. During these 16 years, the mortality in the second half of infancy (infants aged 6-11 months) diminished to about one-fifth of the 1949 figure; the mortality at the ages 1-5 months declined to less than one-third; even the late neonatal mortality (1-3 weeks) decreased to less than half; but in the first week of life the decrease amounted to only 16 4 per cent. This is the period in which intra-uterine developments influence the mortality rather more than environmental circumstances. Most causes of death showed a more or less regular tendency to decline. But the share ofCM in the total infant mortality increased from 9 8 per cent. in 1950 to 21L3 per cent. in 1963 and 20 0 per cent. in 1964. Further improvement in the infant mortality will depend on understanding the biological processes underlying congenital malformations. CM ranked tenth among causes of death in Israel during 1950-63, when their average rate per 100,000 Jewish population was 163. In 1963 there were 285 cases of death among Jews ascribed to CM; only 216 were under one year of age. There were 26 deaths caused by CM per million of population aged 15 and over. The impact of CM is not limited, therefore, to mortality only. In 1962, cases of CM constituted a rate of 159 per 10,000 hospitalizations, excluding deliveries and mental hospitals, and of 195 hospitalization days per 10,000 total days. The average stay of these cases was almost a fortnight, and the annual total of hospitalization days approaches the 50,000 mark, not including certain categories of CM.