need to be supplemented with cytogenetic and DNA-based diagnostic services. Introduction may need to be a gradual process. Over time, the new technologies will support more efficient and cost-effective service delivery. 19. The diversity of priority conditions, social structures, cultural conventions and health-care capabilities means that countries need to be able to consider a range of possible services, assessing costs and relative effectiveness, in order to make a selection and decide the sequence of implementation. However, no organized guidance is yet available on this. The WHO Secretariat has an important potential role to play in identifying successful models, and providing coherent information on community genetics that is accessible to public health policy-makers. POTENTIAL ACTIONS 20. There are several country-level actions that can support the development of services for the prevention and care of birth defects. Prevention requires basic public health approaches to be integrated into health systems including maternal and child health services. Many of the services and interventions proposed are already within the reach of low- and middle-income countries while others can be added as needs and resources determine. 21. Basic components of a national programme for the prevention and care of birth defects include: (a) commitment of policy-makers and provision of adequate managerial support; (b) a core network of appropriate specialist clinical and laboratory services that can be expanded in response to demand; (c) integration of approaches to the prevention and care of birth defects into primary health care, with an emphasis on maternal and child health; (d) education and training for health-care providers, particularly those in primary health care; (e) organization of health-education programmes for the general population and recognized high-risk groups; A63/10 5 (f) establishment of effective mechanisms to foster development of patient–parent support organizations, and collaboration with them in caring for people with birth defects and their families; (g) definition of the ethical, legal, religious and cultural issues relevant to formulating services appropriate for the local population; (h) initiation and monitoring of population-screening programmes such as screening of newborn infants, premarital/pre-pregnancy screening, and screening during pregnancy; (i) establishment of appropriate surveillance systems for birth defects.1 22. The establishment or strengthening of national programmes for the control of birth defects needs technical guidance, and in this regard there are several priority actions for the international community. (a) Resolve currently divergent opinions on the health burden of both environmental and constitutional birth defects, using the revision of ICD-10 to draw on expert review of available data and to consider broadening the groups of conditions beyond those currently included in the classification of congenital anomalies. (b) Promote legislation and public health activities to minimize exposure of the population, and particularly of pregnant women, to potentially teratogenic infections, chemicals and other environmental risk factors. (c) Define effective community services, and support the integration of the prevention and care of birth defects into maternal and child health programmes. Support the provision to health ministries of an organized assessment of requirements and costs, and support them in choosing priorities. (d) Identify successful models that can be applied in low- and middle-income countries. (e) Facilitate and support international networking on birth defect prevention and care programmes, with an emphasis on developing common approaches, and optimizing instruments for information, education, cost analysis and surveillance, among others. Promote informatics approaches in view of their potential to support cost–effectiveness. Congenital Malformations in the Newborn Population: A Population Study and Analysis of the Effect of Sex and Prematurity Alexander Egbe a, *, Santosh Uppu a , Simon Lee a , Annemarie Stroustrup a,b , Deborah Ho a , Shubhika Srivastava a a Mount Sinai Medical Center, New York, NY, USA b Department of Preventative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA Received Dec 17, 2013; received in revised form Feb 18, 2014; accepted Mar 22, 2014 Available online 26 September 2014 Key Words congenital malformation; neonatal outcome; newborn; preterm; sex difference Background: Congenital malformation (CM) is a leading cause of infant mortality. We hypothesized that the current estimates of the prevalence of CM are obsolete because of the increased rate of terminating fetuses with severe CMs and the widespread use of prenatal vitamins. Methods: This population-based cross-sectional study analyzed the effect of sex and prematurity on CM prevalence. All data were derived from birth entriesin the 2008 Nationwide Inpatient Sample (NIS) database. Our objectives were to determine the prevalence of CM diagnoses among all birth hospitalizations in 2008 and to analyze the effect of sex and gestational maturity on CM prevalence. Results: We identified 29,312 patients with CMs from among 1,014,261 live births, which yielded a CM prevalence of 28.9 per 1000