Neonatal Mortality: Is it Safer to be Born on a Weekday?

Abstract

Perinatal Practice| October 01 2003 Neonatal Mortality: Is it Safer to be Born on a Weekday? AAP Grand Rounds (2003) 10 (4): 51–52. https://doi.org/10.1542/gr.10-4-51 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Neonatal Mortality: Is it Safer to be Born on a Weekday?. AAP Grand Rounds October 2003; 10 (4): 51–52. https://doi.org/10.1542/gr.10-4-51 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: birth weight, neonatal mortality, weekend, birth Source: Gould JB, Qin C, Marks AR, et al. Neonatal mortality in weekend vs weekday births. JAMA. 2003;289:2958–2962. There is growing concern regarding adequacy of weekend care in United States hospitals. A recent study reported an increased in-hospital mortality rate among adult patients with serious medical conditions who were admitted over the weekend compared to similar patients who were admitted during the week.1 The objective of this study from the University of California, Berkeley and the California Department of Health was to compare the neonatal mortality rates of infants born during the week versus those born over the weekend. The authors analyzed a linked birth-infant death cohort from California during the period of 1995–1997, which consisted of 1,615,041 live births with birth weights of at least 500 grams. Information available from this linked cohort file included method of delivery, date of birth, date of death, and cause of death. The authors then calculated the average number of births, neonatal mortality rates (NMR) defined as the number of deaths of infants less than 28 days of age per 1,000 live births, the percentage of cesarean deliveries for each day of the week, and an index of occurrence defined as 100 x ratio of the average number of births per day of the week to the average number of births per day. Holiday status was not specifically examined in the analyses. The authors found that over the weekend the average number of births and cesarean deliveries decreased substantially while the proportion of smaller infants and overall NMR increased. The NMR for weekday births was 2.80 and the NMR for weekend births was 3.12 resulting in an unadjusted OR of 1.12 (95% CI, 1.05–1.19; P=.001). The cohort was then further stratified into 4 birth weight groups: very low birth weight (VLBW, 500–1,499 grams), moderately low birth weight (1,500–2,499 grams); normal birth weight (2,500–4,499 grams); and high birth weight (≥4,500 grams). Separate, stepwise logistic models were subsequently performed controlling for birth weight, a measure of neonatal case mix, and lethal congenital anomalies. After adjusting for birth weight, no difference in mortality remained between infants born during the week versus those born over the weekend (OR, 1.01; 95% CI, 0.95–1.08; P=.73). Similarly, when the authors examined the influence of delivery method on observed neonatal mortality, no difference in neonatal mortality was observed after adjustment for birth weight and congenital anomalies. The authors attributed the observed increased mortality in weekend births to a more adverse case mix caused by a change in birth weight distribution. They concluded that there was no evidence of compromised perinatal care in California during the weekend. Although the results of this study are somewhat reassuring, there are a few limitations. Earlier studies demonstrated higher perinatal mortality at night, during the weekend, and on holidays, which were believed to be related to adverse case mix and/or decreased quality of care.2–,8 The decision by the authors to examine the difference in neonatal... You do not currently have access to this content.