Karalis Elina, Gissler Mika, Tapper Anna-Maija, Ulander Veli-Matti
a Department of Obstetrics and Gynecology , University of Helsinki, Helsinki University Hospital , Helsinki , Finland.
b THL, National Institute for Health and Welfare , Helsinki , Finland.
J Matern Fetal Neonatal Med. 2019 May;32(10):1696-1702. doi: 10.1080/14767058.2017.1416081. Epub 2017 Dec 20.
To evaluate the impact of time of birth on adverse neonatal outcome in singleton term hospital births.
Medical Birth Register Data in Finland from 2005 to 2009. Study population was all hospital births (n = 263,901), excluding multiple pregnancies, preterm births <37 weeks, major congenital anomalies or birth defects, and antepartum stillbirths. Main outcome measures were either 1-minute Apgar score 0-3, 5-minute Apgar score 0-6, or umbilical artery pH <7.00, and intrapartum and early neonatal mortality. We calculated risk ratios (ARRs) adjusted for maternal age and parity, and 95% confidence intervals (CIs) to indicate the probability of adverse neonatal outcome outside of office hours in normal vaginal delivery, in vaginal breech delivery, in instrumental vaginal delivery, and in elective and nonelective cesarean sections. We analyzed different size-categories of maternity hospitals and different on-call arrangements.
Instrumental vaginal delivery had increased risk for mortality (ARR 3.31, 95%CI; 1.01-10.82) outside office hours. Regardless of hospital volume and on-call arrangement, the risk for low Apgar score or low umbilical artery pH was higher outside office hours (ARR 1.23, 95%CI; 1.15-1.30). Intrapartum and early neonatal mortality increased only in large, nonuniversity hospitals outside office hours (ARR 1.51, 95%CI; 1.07-2.14).
Compared to office hours, babies born outside office hours are in higher risk for adverse outcome. Demonstration of more detailed circadian effects on adverse neonatal outcomes in different subgroups requires larger data.
评估单胎足月医院分娩的出生时间对新生儿不良结局的影响。
芬兰2005年至2009年的医学出生登记数据。研究人群为所有医院分娩（n = 263,901），排除多胎妊娠、孕周<37周的早产、严重先天性畸形或出生缺陷以及产前死产。主要结局指标为1分钟阿氏评分0 - 3、5分钟阿氏评分0 - 6或脐动脉pH<7.00，以及产时和早期新生儿死亡率。我们计算了经产妇年龄和胎次调整的风险比（ARR）以及95%置信区间（CI），以表明正常阴道分娩、臀位阴道分娩、器械助产阴道分娩以及择期和非择期剖宫产在非工作时间出现新生儿不良结局的概率。我们分析了不同规模的妇产医院以及不同的值班安排。
器械助产阴道分娩在非工作时间的死亡风险增加（ARR 3.31，95%CI；1.01 - 10.82）。无论医院规模和值班安排如何，非工作时间低阿氏评分或低脐动脉pH的风险更高（ARR 1.23，95%CI；1.15 - 1.30）。仅在非大学附属医院的大型医院中，非工作时间的产时和早期新生儿死亡率有所增加（ARR 1.51，95%CI；1.07 - 2.14）。
与工作时间相比，非工作时间出生的婴儿出现不良结局的风险更高。要证明不同亚组中昼夜节律对新生儿不良结局的更详细影响，需要更大规模的数据。
