Time of birth and the risk of neonatal death
Time of birth and the risk of neonatal death
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DOI：
10.1097/01.aog.0000168627.33566.3c
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发表时间：
2005-08-01
影响因子：
7.2
通讯作者：
Chavez, G
中科院分区：
文献类型：
--
作者：
Gould, JB;Qin, C;Chavez, G
目的：为了评估美国夜间出生婴儿的死亡率是否增加，我们比较了白天出生的低风险和高风险婴儿的病例组合调整的新生儿死亡率（上午7点至下午6点），深夜（晚上7点到凌晨12点）和深夜方法：对1992-1999年加州出生的3,363,157名体重超过500 g且出生时无致命先天性畸形的婴儿的出生-死亡证明数据进行分析。Logistic回归分析，调整出生体重，性别，产前护理的启动，母亲高血压，子痫，糖尿病，胎盘剥离/前置，被用来估计新生儿死亡率和出生时间之间的关系。白天出生的新生儿死亡率为1.88，夜间出生的新生儿死亡率增加到2.37，深夜出生的新生儿死亡率增加到2.31。在调整病例组合后，夜间分娩增加了12%，夜间分娩增加了16%，新生儿死亡的几率增加了9.6%。死亡率增加夜间分娩小于1,500 g或大于1,500 g，单胎或多胎，阴道分娩或剖宫产。增加的风险被确定在医院，提供中间，社区和区域新生儿重症监护，但不是在医院提供初级care.Conclusion：确定的因果因素和减少增加的负担，在夜间出生的婴儿死亡率应该是围产期医学的一个主要优先事项。
Objective: To assess whether mortality is increased in the United States in infants born at night, we compared case-mix adjusted neonatal mortality for low- and high-risk infants born during the daytime (7 AM to 6 PM), early night (7 PM to 12 AM), and late night (1 AM to 6 AM).Methods: California linked birth-death certificate data on 3,363,157 infants, weighing more than 500 g and born without lethal congenital anomalies in 1992-1999, were analyzed. Logistic regression, adjusting for birth weight, gender, prenatal care initiation, maternal hypertension, eclampsia, diabetes, and placental abruption/previa, was used to estimate the relationship between neonatal mortality and time of birth.Results: The overall neonatal mortality was 2.08 deaths per 1,000 live births. Neonatal mortality was 1.88 for daytime births, increasing to 2.37 for early night and 2.31 for late night births. After adjusting for case mix, early night births had a 12% increase and late night births a 16% increase in the odds of neonatal death an excess that accounts for 9.6% of all neonatal cleat's. Mortality was increased for night births that were less than 1,500 g or more than 1,500 g, singletons or multiples, and those delivered vaginally or by cesarean. The increased risk was identified in hospitals that provide intermediate, community, and regional neonatal intensive care, but not in hospitals that provide primary care.Conclusion: Identifying the causal factors and reducing the increased burden of mortality for infants born at night should be a major priority for perinatal medicine.