Effect of time and day of birth on the outcome of preterm newborn infants Rhoda Tamakloe,  Marta Barker MSN, Naveed Hussai...
Introduction: <ul><li>Studies have used variations in mortality rates to try to assess whether or not hospital care is com...
Introduction: <ul><li>Studies on mortality rates can be used to determine lapses in the quality of hospital care </li></ul...
Aim: <ul><li>To study the effect of date and time of birth on the mortality and morbidity of preterm newborn infants admit...
Study Design: <ul><li>Study design:  Retrospective  </li></ul><ul><li>Study period:  1993 to 1999  </li></ul><ul><li>Patie...
Temporal Definitions: <ul><li>Weekend </li></ul><ul><ul><ul><li>from 5pm Friday evening to Sunday at Midnight  </li></ul><...
Neonatal Outcomes: <ul><ul><li>Mortality  </li></ul></ul><ul><ul><li>Morbidity   </li></ul></ul><ul><ul><ul><li>Intraventr...
Statistical Method: <ul><ul><li>Univariate analysis: Chi square, T-Test </li></ul></ul><ul><ul><li>Multivariate analysis: ...
Inclusion Criteria: <ul><li>Criteria used for Logistical Regression Analysis </li></ul><ul><ul><li>Gestational Age (GA)  <...
Day of the Week of Birth vs. % Died S&A-Sunday and Saturday  W-Wednesday  M-Monday H-Thursday U-Tuesday  F-Friday
Month of Birth vs. % Died * denotes a significant p-value in univariate and multivariate analyses
Demographic Data   * denotes a significant p-value in univariate and multivariate analyses †  infants born on the weekend ...
Result: Mortality and Morbidity Chart * denotes a significant p-value in univariate analysis †  when adjusted for GA, valu...
Conclusion: <ul><li>Day and time of birth had no significant effect on neonatal mortality </li></ul><ul><li>Day and time o...
Relevance: <ul><li>Using neonatal mortality and morbidity as indicators for quality of care in the NICU,  our results show...
References: <ul><li>Mathers, C.D. Births and Perinatal Deaths in Australia: variations by day of week  JECH , 1983 vol. 37...
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Effect of Time and Day of Birth on the Outcome of Preterm Infants

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A Powerpoint presentation of research completed at the NICU of UCHC - University of Connecticut Health Care Center

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  • Days on vent: CPAP? BEARCUB??? Stats method used????
  • Effect of Time and Day of Birth on the Outcome of Preterm Infants

    1. 1. Effect of time and day of birth on the outcome of preterm newborn infants Rhoda Tamakloe, Marta Barker MSN, Naveed Hussain MD Farmington, CT
    2. 2. Introduction: <ul><li>Studies have used variations in mortality rates to try to assess whether or not hospital care is compromised during the weekend </li></ul><ul><ul><li>An Australian study of births from 1976-9 reported stillbirth and neonatal death rates as 17% and 29% higher on weekends – (study now obsolete due to increase in obstetric interventions (e.g. cesarean deliveries)) </li></ul></ul><ul><ul><li>A Canadian study from 1988-1997 found that weekend-admitted adults with serious medical conditions had significantly higher mortality rates </li></ul></ul><ul><ul><li>A study of all infants born in California between 1995-7, reported no significant difference in mortality rates between infants born on the weekend and those born during the week </li></ul></ul>
    3. 3. Introduction: <ul><li>Studies on mortality rates can be used to determine lapses in the quality of hospital care </li></ul><ul><li>Researchers speculate that 2 possible factors could contribute to increased mortality in weekend births </li></ul><ul><ul><li>1. Decreased quality in care resulting from sub-optimal staffing and/or </li></ul></ul><ul><ul><li>2. A more adverse weekend case mix </li></ul></ul>
    4. 4. Aim: <ul><li>To study the effect of date and time of birth on the mortality and morbidity of preterm newborn infants admitted to the neonatal intensive care unit </li></ul>
    5. 5. Study Design: <ul><li>Study design: Retrospective </li></ul><ul><li>Study period: 1993 to 1999 </li></ul><ul><li>Patients: 2795 newborn infants born at 24 to 34 weeks of gestational age </li></ul><ul><li>Site: NICU at University Of Connecticut Health Center, Farmington, CT </li></ul><ul><li>Exclusion: any infants with insufficient data </li></ul>
    6. 6. Temporal Definitions: <ul><li>Weekend </li></ul><ul><ul><ul><li>from 5pm Friday evening to Sunday at Midnight </li></ul></ul></ul><ul><li>Off hours </li></ul><ul><ul><ul><li>between 5:30pm to 7:30am </li></ul></ul></ul><ul><ul><ul><li>this time period represents the night shift </li></ul></ul></ul><ul><li>On hours </li></ul><ul><ul><ul><li>between 7:30am to 5:30pm </li></ul></ul></ul><ul><ul><ul><li>this time period represents the day shift </li></ul></ul></ul>
    7. 7. Neonatal Outcomes: <ul><ul><li>Mortality </li></ul></ul><ul><ul><li>Morbidity </li></ul></ul><ul><ul><ul><li>Intraventricular hemorrhage (IVH) </li></ul></ul></ul><ul><ul><ul><ul><li>bleeding into the normal fluid spaces (ventricles) within the brain, rated in 4 grades </li></ul></ul></ul></ul><ul><ul><ul><li>Retinopathy (ROP) </li></ul></ul></ul><ul><ul><ul><ul><li>disorder of retinal blood vessel development in the premature infant </li></ul></ul></ul></ul><ul><ul><ul><ul><li>the severe form is characterized by retinal vascular proliferation, scarring, retinal detachment, and blindness, occurs in 5 stages </li></ul></ul></ul></ul><ul><ul><ul><li>Rate of Growth </li></ul></ul></ul><ul><ul><ul><ul><li>(Discharge weight - birth weight)/length of stay </li></ul></ul></ul></ul><ul><ul><ul><ul><li>poor rate of growth is <10 grams per day </li></ul></ul></ul></ul>
    8. 8. Statistical Method: <ul><ul><li>Univariate analysis: Chi square, T-Test </li></ul></ul><ul><ul><li>Multivariate analysis: Logistic regression analysis </li></ul></ul><ul><ul><li>P < 0.05 was considered significant </li></ul></ul>
    9. 9. Inclusion Criteria: <ul><li>Criteria used for Logistical Regression Analysis </li></ul><ul><ul><li>Gestational Age (GA) </li></ul></ul><ul><ul><li>Race: </li></ul></ul><ul><ul><ul><li>W-White, B-Black, H-Hispanic, O-Other </li></ul></ul></ul><ul><ul><li>Sex </li></ul></ul><ul><ul><li>Month of Birth </li></ul></ul>
    10. 10. Day of the Week of Birth vs. % Died S&A-Sunday and Saturday W-Wednesday M-Monday H-Thursday U-Tuesday F-Friday
    11. 11. Month of Birth vs. % Died * denotes a significant p-value in univariate and multivariate analyses
    12. 12. Demographic Data * denotes a significant p-value in univariate and multivariate analyses † infants born on the weekend had lower gestational age and birth weight GA*† mean+sd BW*† mean+sd Sex (%F) White % Black % Hispanic % Other % weekend 31.36 ±3.84 1764.87 ±783.01 45.75 76.96 10.79 9.45 2.79 weekday 31.95 ±3.98 1850.52 ±836.99 46.67 74.97 9.82 12.08 3.12
    13. 13. Result: Mortality and Morbidity Chart * denotes a significant p-value in univariate analysis † when adjusted for GA, value no longer significant % died IVH (%with) ROP (% with) Rate of Growth (% poor) Weekend Weekday 5.36 5.52 7.05 7.50 11.5 * † 8.94 18.90 16.90 Wknd+off On hours 5.58 5.32 7.71 7.11 10.6 8.63 18.22 16.44 off hours on hours 5.30 5.27 7.70 7.37 10.11 9.56 18.02 17.05
    14. 14. Conclusion: <ul><li>Day and time of birth had no significant effect on neonatal mortality </li></ul><ul><li>Day and time of birth had no significant effect on neonatal morbidity as measured by: </li></ul><ul><ul><li>IVH </li></ul></ul><ul><ul><li>ROP </li></ul></ul><ul><ul><li>Rate of Growth </li></ul></ul>
    15. 15. Relevance: <ul><li>Using neonatal mortality and morbidity as indicators for quality of care in the NICU, our results show that neonatal outcomes are not compromised by the date and/or time of admission </li></ul><ul><li>Despite lower gestational age and birth weight in infants born over the weekend, the mortality and morbidity remained unchanged </li></ul><ul><li>The finding of higher neonatal mortality in September requires further study </li></ul>
    16. 16. References: <ul><li>Mathers, C.D. Births and Perinatal Deaths in Australia: variations by day of week JECH , 1983 vol. 37, 57 – 62. </li></ul><ul><li>Bell, C.M. and Redelmeier, D.A. Mortality among Patients Admitted to Hosptials on Weekends as Compared with Weekedays N. Engl. J. Med ., August 30, 2001; 345(9): 663-668. </li></ul><ul><li>Gould, J.B., Qin, C., Marks, A.R., and Chavez, G. Neonatal Mortality in Weekend vs. Weekday Births JAMA , June 11, 2003; 289(22):2958 – 2962. </li></ul><ul><li>Curtin, S.C., Kozak, L.J. Decline in US Cesarean delivery rate seems to stall Birth,. 1998; 25:259 – 262. </li></ul><ul><li>Paul, R.H., Miller, D.A., Cesarean birth: how to reduce the rate. Am. J. Obstet. Gynecol. 1995; 172: 1903 – 1911. </li></ul><ul><li>http://www.1uphealth.com/health/retinopathy_of_prematurity_info.html </li></ul><ul><li>http://www.pediatrics.wisc.edu/childrenshosp/parents_of_preemies/ivh.html </li></ul>

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