Working-hour phenomenon in obstetrics is an attainable target to improve neonatal outcomes

• Published in: American journal of obstetrics and gynecology 2019-09, Vol.221 (3), p.257.e1-257.e9
• Main Authors: Windsperger, Karin, Kiss, Herbert, Oberaigner, Wilhelm, Leitner, Hermann, Muin, Dana A., Husslein, Peter W., Farr, Alex
• Format: Article
• Language: English
• Subjects: adverse neonatal outcome; After-Hours Care - standards; Apgar Score; circadian rhythm; Delivery, Obstetric - standards; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases - etiology; Infant, Newborn, Diseases - prevention & control; Intensive Care Units, Neonatal; Logistic Models; neonatal acidemia; neonatal intensive care unit; neonatal morbidity; neonatal mortality; obstetrics; Outcome Assessment, Health Care; parturition; Patient Admission - statistics & numerical data; Pregnancy; pregnancy outcome; Quality Assurance, Health Care; Quality Improvement; Retrospective Studies; Risk Factors; working-hour phenomenon
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2019.04.034

Giving birth in a health care facility does not guarantee high-quality care or favorable outcomes. The working-hour phenomenon describes adverse outcomes of institutional births outside regular working hours. The objectives of the study were to evaluate whether the time of birth is associated with adverse neonatal outcomes and to identify the riskiest time periods for obstetrical care. This nationwide retrospective cohort study analyzed data from 2008 to 2016 from all 82 obstetric departments in Austria. Births at ≥ 23+0 gestational weeks with ≥500 g birthweight were included. Independent variables were categorized by the time of day vs night as core time (morning, day) and off hours (evening, nighttime periods 1–4). The composite primary outcome was adverse neonatal outcome, defined as arterial umbilical cord blood pH