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Infants born at night or early morning are at increased risk of early death

WESTPORT, CT (Reuters Health) – Infants born at night or early morning, particularly around the time of hospital shift changes, have a greater mortality risk compared with infants born during the day, researchers report in the December 8th issue of the British Medical Journal.

Drs. J. Karlberg and Z. C. Luo from the University of Hong Kong, Peoples Republic of China analyzed data from the Swedish birth register between 1973 and 1995. During that period, there were 2,102,324 spontaneous live births without congential malformations.

"Infant mortality, early neonate mortality, and early neonatal mortality related to asphyxia were higher in infants born during the night (9 pm to 9 am) compared with those born during the day. This difference was most pronounced in preterm infants, the researchers note.

Drs. Karlberg and Luo noted the largest difference between day and night births between 1990 and 1995. During those years, compared with infants born during the day, infants born at night had a 30% increase in early neonatal mortality (relative risk 1.31). Preterm infants born during this period had a 70% increase in early neonatal mortality related to asphyxia (relative risk 1.70).

A detailed 24-hour analysis revealed two "high risk" periods: between 9 pm and 1 am and "around 9 am," Drs. Karlberg and Luo report. "This pattern indicates that shift changes and the periods immediately after are high risk periods for neonatal care," they write.

Although the reasons for these findings remain unclear, Drs. Karlberg and Luo speculate that excess workloads, inadequate or inexperienced staff at night or out-of-date shift management systems might explain this pattern.

"Furthermore, there was no improvement in the quality of neonatal healthcare in the night compare with the day over the decades we studied."

BMJ 2001;323:1327-1330.

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