BACKGROUND AND PURPOSE:

• Reif et al. (BJOG, 2017) assessed whether time of birth, unit volume, and staff seniority affected neonatal outcome among infants born ≥34w0d weeks

METHODS:

• Population-based prospective cohort study
• Participants: Singleton and multiple pregnancies ≥34w0d weeks
  • This gestational age cut-off used because it is the threshold found in multiple practice guidelines
• Exposures: Time of birth | Unit volume | Staff seniority
• Full staff size during 07:30 and 15:00 hours
  • Remaining hours were divided into an afternoon period (15:01–22:00 hours) and a night period (22:01–07:29 hours)
• Staffing levels
  • Midwife only
  • Midwife plus intern or GP attending the delivery
  • Midwife plus ObGyn resident attending the delivery
  • Midwife plus consultant attending the delivery
• Primary outcomes: Composite of ‘severely adverse outcomes’ measures
  • Blood pH of ≤7.00 | 5-minute Apgar score of ≤3 | Cardiac massage or CPR | Intrapartum or death within 7 days after birth
• Secondary outcomes: Composite of ‘adverse outcomes’
  • Cord blood pH of ≤7.05 | 5-minute Apgar score ≤6 | NICU within 24 hours of birth | Respiratory support

RESULTS:

• 87,065 neonates were included in the study
• There were no significant differences in outcomes between weekdays and weekends
• The risk for severely adverse events during the night-time (22:01–07:29 hours) compared with the daytime (07:30–15:00 hours) was significantly increased
  • Odds ratio (OR) 1.35 (95% CI 1.13–1.61)
• Adverse and severely adverse neonatal outcomes were least common for midwife‐guided deliveries and increased with seniority of the staff
  • When correcting for severity of clinical situation, senior staff attending delivery and delivering in a tertiary center reduce the odds ratio for adverse events

CONCLUSION:

• Pregnancies at night were most at risk for neonatal adverse outcome and may benefit from more balanced staffing
• In high-risk pregnancies, more experienced staff favored a better outcome
• Low-risk patients did not experience adverse outcomes when managed by more junior staff

Learn More – Primary Sources:

Do time of birth, unit volume, and staff seniority affect neonatal outcome in deliveries at ≥34+0 weeks of gestation?

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