Infant Deaths Throughout the <scp>COVID</scp> ‐19 Pandemic in the U.S

We read with interest the article by Lyu et al. [1], who conducted a search of the U.S. Vital Statistics Natality Files and found no significant evidence of a link between the coronavirus disease 2019 (COVID-19) pandemic and low birth weight and preterm births in the U.S. [1]. To gain further insight into the course of births during the COVID-19 pandemic, we conducted an electronic search of the Centers for Disease Control and Prevention (CDC) National Vital Statistics System to obtain data on infant deaths recorded from 2018 through 2023 [2]. Specifically, the database provides counts and death rates of infants less than 1 year of age occurring in the U.S., for all residents. The information from the death certificates is directly linked to the corresponding birth certificates. Results were downloaded as infant death rate ×1000 births. The mean mortality rate was calculated for the first 2 years of the COVID-19 pandemic (2020–2021) and compared to that of the two pre-pandemic (i.e., 2018–2019) and the two “endemic” (i.e., 2022–2023) years. Statistical differences were calculated using one-way analysis of variance (ANOVA) and Tukey HSD (Honestly Significant Difference) post hoc test based on the total number of deaths, the mean death rate and its standard deviation (SD), with Statistics Kingdom. The information used for this analysis was taken from an anonymized and publicly available dataset, so that this study did not require ethics committee approval. The mean infant death rate ×1000 in the 2 years before the pandemic was 5.63 ± 0.4, decreased to 5.43 ± 0.01 in the first two pandemic years, and increased again to 5.61 ± 0.1 in the endemic period (Figure 1). The difference between the pre-pandemic years was statistically significant compared to the pandemic years (p = 0.029), resulting in a cumulative reduction in the infant mortality rate of −0.195 (95% confidence interval (CI), −0.037 to −0.353; p < 0.001; −3.5%), but not with the two endemic years 2022–2023 (p = 0.863) (Figure 1). The results of our analysis suggest that the COVID-19 pandemic is unlikely to have had a significant negative impact on the U.S. infant death rate, as infant mortality may have even declined by approximately 3.5% during the first 2 years of the pandemic. This finding is plausibly explained by several pandemic-related public health measures, such as social distancing, mask-wearing and lockdowns, which likely reduced the transmission of common respiratory infections that disproportionately affect infants, including influenza and respiratory syncytial virus (RSV). Additionally, increased parental supervision during this period may have contributed to improved infant care and safety [3]. The authors declare no conflicts of interest. The data that support the findings of this study are openly available in the National Center for Health Statistics at http://wonder.cdc.gov/lbd-current-expanded.html.