Do Time of Birth, Unit Volume and Staff Seniority Affect Neonatal Outcome in Deliveries at ≥34+0 Weeks of Gestation?

Abstract

Objective We investigated whether time of birth, unit volume, and staff seniority affect neonatal outcome in neonates born at ≥34 +0 weeks of gestation.Design Population-based prospective cohort study.Setting Ten public hospitals in the Austrian province of Styria.Sample A total of 87 065 neonates delivered in the period 2004-2015.Methods Based on short-term outcome data, generalised linear mixed models were used to calculate the risk for adverse and severely adverse neonatal outcomes according to time of birth, unit volume, and staff seniority.Main outcome measures Neonatal composite adverse and severely adverse outcome measures. ResultsThe odds ratio for severely adverse events during the night-time (22:01-07:29 hours) compared with the daytime (07:30-15:00 hours) was 1.35 (95% confidence interval, 95% CI 1.13-1.61). There were no significant differences in neonatal outcome comparing weekdays and weekends, and comparing office hours and shifts. Units with 500-1000 deliveries per year had the lowest risk for adverse events. Adverse and severely adverse neonatal outcomes were least common for midwife-guided deliveries, and became more frequent with the level of experience of the doctors attending the delivery. With increasing pregnancy risks, senior staff attending delivery and delivering in a tertiary centre reduce the odds ratio for adverse events.Conclusions Different times of delivery were associated with increased adverse neonatal outcomes. The management of uncomplicated deliveries by less experienced staff showed no negative impact on perinatal outcome. In contrast, riskier pregnancies delivered by senior staff in a tertiary centre favour a better outcome. Achieving a better balance in the total number of labour ward staff during the day and the night appears to be a greater priority than increasing the continuous presence of senior obstetrical staff on the labour ward during the out-of-hours period.Keywords Delivery, neonatal outcome, staff seniority, time of birth, unit volume.Tweetable abstract Deliveries during night time lead to a greater number of neonates experiencing severely adverse events.

Weekend delivery and maternal–neonatal adverse outcomes in low‐risk pregnancies in the United States: A population‐based analysis of 3‐million live births

“…The major body of existing literature on weekend effect in the field of perinatal medicine is focused on neonatal mortality 4‐9,30‐32 . The result of this study is consistent with the majority of studies conducted in the twenty‐first century 4‐9 in that it shows no increased risk for neonatal mortality among infants who were born during the weekend.…”

“…Among studies that employed the same or similar outcomes, the of this study contradict some previous studies conducted in European countries which found no significant association between weekend delivery and adverse outcomes. 4,10,11,13,32 An important factor that may explain the discrepancy between the current findings and previous research is the differences in the health care system, such as practice guidelines, access to hospitals and insurance coverage. For example, having adequate ANC was significantly associated with delivering during the weekdays (x = 373.21, P < .001) and was protective against having any neonatal adverse outcomes (OR 0.88; 95% CI 0.87-0.89).…”

“…The major body of existing literature on weekend effect in the field of perinatal medicine is focused on neonatal mortality. [4][5][6][7][8][9][30][31][32] The result of this study is consistent with the majority of studies conducted in the twenty-first century [4][5][6][7][8][9] in that it shows no increased risk for neonatal mortality among infants who were born during the weekend. However, with advances in public health and neonatal medicine, neonatal mortality has decreased drastically worldwide.…”

Assessment of temporal variations in adherence to NRP using video recording in the delivery room

“…Reif et al identified that while afternoon and nighttime births were associated with an increase in adverse neonatal outcomes, births occurring in a tertiary or perinatal care center and birth attendance by a senior staff member appeared to have a protective effect in high risk births despite the higher volume of patients cared for in these institutions and the potential for reduced personnel coverage during off hours 19 . This was observed in our data set, as nighttime births had a trend towards significance in having a full resuscitation team (p = 0.08), while daytime births were more likely to have a smaller resuscitation team.…”

“…Furthermore, recent literature suggests potentially worsened outcomes of neonates resuscitated at birth during evening and nighttime hours 16 , 17 , 18 , 19 . Shift length, shifts scheduled outside of typical daytime hours, and physician fatigue can result in increased patient load and capacity strain on perinatal providers during nighttime hours and potentially contribute to medical errors and poor outcomes 20 , 21 , 22 , 23 .…”