Gould Jeffrey B, Qin Cheng, Marks Amy R, Chavez Gilberto
School of Public Health, University of California, Berkeley, USA.
JAMA. 2003 Jun 11;289(22):2958-62. doi: 10.1001/jama.289.22.2958.
Increases in neonatal mortality for infants born on the weekend were last noted several decades ago. Although the current health care environment has raised concern about the adequacy of weekend care, there have been no contemporary evaluations of daily patterns of births, obstetric intervention, and case mix-adjusted neonatal mortality.
To compare the neonatal mortality of infants born on weekdays and weekends.
DESIGN, SETTING, AND PARTICIPANTS: Case series of 1 615 041 live births (weight >or=500 g) in California between 1995-1997 to determine patterns of births, cesarean deliveries, and neonatal deaths. Analyses were stratified by birth weight and delivery method. To assess the role of weekend differences in case mix, observed and birth weight-adjusted odds ratios (ORs) for increased weekend mortality were estimated using logistic regression.
Birth weight-adjusted neonatal mortality.
There was a 17.5% decrease in births on weekends, accompanied by a decrease in the proportion of cesarean deliveries from 22% on weekdays to 16% on weekends. Weekend decreases in births were least pronounced in smaller infants, resulting in a weekend concentration of high-mortality, very low-birth-weight (<1500 g) births. Observed neonatal mortality increased from 2.80 per 1000 weekday births to 3.12 per 1000 weekend births (OR, 1.12; 95% confidence interval [CI], 1.05-1.19; P =.001) for all births, and from 4.94 to 6.85 (OR, 1.39; 95% CI, 1.25-1.55; P<.001) for cesarean deliveries. After adjusting for birth weight, the increased odds of death for infants born on the weekend were no longer significant.
The provision of optimal care regardless of the day of week is an important goal for perinatal medicine. Comparing the neonatal mortality of infants born on weekdays and weekends provides a straightforward assessment of this goal. After controlling for birth weight, we found no evidence that the quality of perinatal care in California was compromised during the weekend.
新生儿死亡率在周末出生的婴儿中上升的情况上次被注意到是在几十年前。尽管当前的医疗保健环境引发了对周末护理充足性的担忧，但尚未有对每日出生模式、产科干预以及病例组合调整后的新生儿死亡率的当代评估。
比较工作日和周末出生婴儿的新生儿死亡率。
设计、地点和参与者：1995 - 1997年加利福尼亚州1615041例活产（体重≥500克）的病例系列，以确定出生模式、剖宫产以及新生儿死亡情况。分析按出生体重和分娩方式分层。为评估周末病例组合差异的作用，使用逻辑回归估计观察到的和出生体重调整后的周末死亡率增加的比值比（OR）。
出生体重调整后的新生儿死亡率。
周末出生人数减少了17.5%，同时剖宫产比例从工作日的22%降至周末的16%。较小婴儿的周末出生人数减少最不明显，导致高死亡率、极低出生体重（<1500克）的出生在周末集中。所有出生婴儿中，观察到的新生儿死亡率从每1000例工作日出生的2.80例增至每1000例周末出生的3.12例（OR，1.12；95%置信区间[CI]，1.05 - 1.19；P =.001），剖宫产的死亡率从4.94例增至6.85例（OR，1.39；95% CI，1.25 - 1.55；P<.001）。在调整出生体重后，周末出生婴儿死亡几率增加不再显著。
无论星期几都提供最佳护理是围产期医学的一个重要目标。比较工作日和周末出生婴儿的新生儿死亡率可直接评估这一目标。在控制出生体重后，我们没有发现证据表明加利福尼亚州的围产期护理质量在周末受到损害。
