Abstract
ObjectiveThis study estimated the effects of weekend and off-hour childbirth and the size of perinatal medical care center on the incidence of cerebral palsy.MethodsThe cases were all children with severe cerebral palsy born in Japan from 2009 to 2012 whose data were stored at the Japan Obstetric Compensation System for Cerebral Palsy database, a nationally representative database. The inclusion criteria were the following: neonates born between January 2009 and December 2012 who had a birth weight of at least 2000 g and gestational age of at least 33 weeks and who had severe disability resulting from cerebral palsy independent of congenital causes or factors during the neonatal period or thereafter. Study participants were restricted to singletons and controls without report of death, scheduled cesarean section, or ambulance transportation. The controls were newborns, randomly selected by year and type of delivery (normal spontaneous delivery without cesarean section and emergency cesarean section) using a 1:10 case to control ratio sampled from the nationwide Japan Society of Obstetrics and Gynecology database.ResultsA total of 90 cerebral palsy cases and 900 controls having normal spontaneous delivery without cesarean section were selected, as were 92 cerebral palsy cases and 920 controls with emergent cesarean section. A significantly higher risk for cerebral palsy was found among cases that underwent emergent cesarean section on weekends (odds ratio [OR] 1.72, 95% confidence interval [CI] 1.06–2.81) and during the night shift (OR 2.29, 95% CI 1.30–4.02). No significant risk was found among normal spontaneous deliveries on weekends (OR 1.63, 95% CI 0.97–2.73) or during the quasi-night shift (OR 1.26, 95% CI 0.70–2.27). Regional perinatal care centers showed significantly higher risk for cerebral palsy in both emergent cesarean section (OR 2.35, 95% CI 1.47–3.77) and normal spontaneous delivery (OR 2.92, 95% CI 1.76–4.84).ConclusionLabor on weekends, during the night shift, and at regional perinatal medical care centers was associated with significantly elevated risk for cerebral palsy in emergency cesarean section.
Highlights
Over the past two decades, a growing body of evidence has demonstrated an association between work outside of the Monday through Friday schedule and increased morbidity and mortality in hospital settings [1]
Study design and participants This was a retrospective case-control study that used data extracted from nationwide Japanese databases, namely, the Japan Obstetric Compensation System for Cerebral Palsy (JOCSC) and the Japan Society of Obstetrics and Gynecology (JSOG)
The JOCSC is a government-supervised compensation system intended to provide prompt, no-fault compensation for children diagnosed with severe cerebral palsy (CP) caused by trauma during labor and delivery and for their families, as well as to provide information that could help in prevention, the early resolution of disputes, and improving the quality of obstetric health care
Summary
Over the past two decades, a growing body of evidence has demonstrated an association between work outside of the Monday through Friday schedule and increased morbidity and mortality in hospital settings [1]. In obstetrical and perinatal outcomes, several studies have indicated the unfavorable influence of weekend and night delivery on neonatal death [9,10,11,12,13,14], birth-related injury,[14, 15] asphyxia, [16] intraventricular hemorrhage, [11] neonatal encephalopathy [17], maternal complication [18], and perinatal complication [12, 14, 18, 19]. A report from Sweden found an increased risk of asphyxia in infants born at night [16]. This indicates a possible negative weekend and off-hour effect on obstetrical care. Definitive conclusions have not been reached in this area due to narrowly focused research settings and the range of disease and symptom outcomes assessed [11, 18, 21, 25,26,27,28]
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