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  • Title: [Why are babies born at night at increased risk of early neonatal mortality?].
    Author: Heller G, Schnell R, Misselwitz B, Schmidt S.
    Journal: Z Geburtshilfe Neonatol; 2003; 207(4):137-42. PubMed ID: 14528416.
    Abstract:
    BACKGROUND: Increased perinatal and neonatal mortality rates have been previously reported in night-time births compared with births during the day. This effect has been attributed to decreased quality of medical care during the night. However, alternative explanations exist such as decreased birth-weight of night births. The objective of this study was to further investigate this relationship. MATERIALS AND METHODS: Data from 590,332 low risk births (singleton births, > or = 2500 g birth-weight, no major congenital anomaly) were obtained from the perinatal birth register of Hesse, Germany, 1990-2000. Outcome was defined as either death during labour or within 7 days of life. Night-time births were defined as births between 9.00 p.m. and 6.59 a.m., otherwise day-time births were assumed. Subgroup analyses and logistic regression analyses were performed to assess whether the excess mortality of night-births might be explained by other factors. RESULTS: Mortality rates were increased in night-time births (RR = 1.26; 95% CI = 0.94-1.70). This relationship was more pronounced in spontaneous births (RR = 1.58; 95% CI = 0.96-2.61) and emergency cesarean sections (RR = 1.76; 95% CI = 1.10-2.82). Significance persisted after adjusting for numerous potential confounders. CONCLUSION: Our results confirm an increased mortality risk for night-time births which could not be explained by other accessible risk factors. This suggests that the increased risk at night might be attributable to a reduced availability to provide appropriate medical care in delivery units at night. DISCUSSION: As mainly the presence of staff is decreased during the night, introduction of better designed shifts can be expected to reduce neonatal mortality.
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