5262.0: Wednesday, November 15, 2000 - Board 3

Abstract #7236

Early-neonatal mortality and timing of low risk births in relation to type of birth clinic in the Federal state of Hesse, Germany, 1990-1998

Guenther Heller, Institute of Medical Sociology & Social Medicine, Medical Center of Methodology and Health Research, Philipps-University of Marburg, Bunsenstraße 2, Marburg, D-35033, Germany, +49 6421 286 4089, hellerg@mailer.uni-marburg.de, Bjoern Misselwitz, Institute of Quality Assurance Hesse, and Stephan Schmidt, Department of Obstetrics, Medical Center of Gynecology and Obstetrics, Philipps-University of Marburg.

Introduction: A higher asphyxia related neonatal mortality during nighttime has been previously reported. Our objective was to further investigate this relation with respect to the type of birth clinic.

Participants and Methods: Data from the Hessian perinatal birth register, 1990-1998, were used. Only vaginally born low risk births were included. Outcome measures were death within 7 completed days of life (early-neonatal death) and asphyxia-related death within the same period. Nighttime births were defined as births between 9 p.m. and 6.59 a.m., otherwise daytime births were assumed. According to their procedure capability birth clinics were divided into attending-hospitals (low), general-hospitals (medium), and perinatal-centers (high). Relative risks and 95% confidence intervals were calculated to assess the effect of night- vs. daytime on death rates within each type of clinic.

Results: 362052 births were included. Forty-nine infants died within the first 7 days reflecting the low mortality risk of these pre-selected births. Early-neonatal death was about twice as likely for babies born at night than for babies born during daytime (RR=2.07 CI=1.18-3.64). Higher mortality rates at night were mainly due to general-hospitals (RR=3.28, CI=1.25-8.62). For asphyxia related deaths even more pronounced gradients were observed.

Conclusions: Increased early-neonatal mortality in low risk births at night may be regarded as a consequence of increased fatigue and/or overreliance on less experienced during night times. Especially in general-hospitals better designed shifts, resulting in shorter working hours and/or decreased workload with greater supervision by experienced staff at night should be considered to reduce early-neonatal mortality during this time.

Learning Objectives: The participants will be able to: 1. Recognize that a higher neonatal mortality in low risk births exits at night in developed health care systems. 2. Discuss and evaluate different reasons for this phenomena as well as possible strategies to minimize this problem

Keywords: MCH Epidemiology, Mortality

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

The 128th Annual Meeting of APHA