J Korean Med Sci.  2021 Apr;36(13):e86. 10.3346/jkms.2021.36.e86.

Mortality and Morbidities according to Time of Birth in Extremely Low Birth Weight Infants

Affiliations
  • 1Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
  • 2Stem Cell and Regenerative Medicine Institute, Samsung Medical Center, Seoul, Korea
  • 3Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea

Abstract

Background
Although the overall quality of high-risk neonatal care has improved recently, there is still concern about a difference in the quality of care when comparing off-hour births and regular-hour births. Moreover, there are no data in Korea regarding the impact of time of birth on mortality and morbidities in preterm infants.
Methods
A total of 3,220 infants weighing < 1,000 g and born at 23–34 weeks in 2013–2017 were analyzed based on the Korean Neonatal Network data. Mortality and major morbidities were analyzed using logistic regression according to time of birth during off-hours (nighttime, weekend, and holiday) and regular hours. The institutes were sub-grouped into hospital group I and hospital group II based on the neonatal intensive care unit (NICU) care level defined by the mortality rates of < 50% and ≥ 50%, respectively, in infants born at 23–24 weeks' gestation.
Results
The number of births during regular hours and off-hours was similar. In the total population and hospital group I, off-hour births were not associated with increased neonatal mortality and morbidities. However, in hospital group II, increased early mortality was found in the off-hour births when compared to regular-hour births.
Conclusion
Efforts to improve the overall quality of NICU are required to lower the early mortality rate in off-hour births. Also, other sensitive indexes for the evaluation of quality of NICU care should be further studied.

Keyword

Neonatal Mortality; Preterm Infants; Neonatal Intensive Care; Quality of Health Care; After-hours Care

Figure

  • Fig. 1 Number of births by the day of the week during regular hours and off-hours.

  • Fig. 2 Hourly distribution of births between regular hours and off-hours.


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