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Exploding the myth: assessing the weekend effect on neonatal outcome

Presented at the Neonatal Society 2016 Summer Meeting.

Guram S, Long I, Venkatesh V, Kelsall W

Neonatal Intensive Care Unit, Addenbrookes Hospital, Hills Road, Cambridge CB2 0QQ

Background: A weekend effect causing increased mortality across many areas of the NHS is being debated. This may be attributed to lower levels of medical staffing, reduced access to investigations and admission of sicker patients. A recent study by Palmer (1) suggested a possible weekend effect on perinatal mortality. Neonatal care is a fully staffed, consultant led, seven day, twenty-four hour service which should not demonstrate a weekend effect.

Methods: This retrospective observational study investigated the outcome of babies admitted to a neonatal unit in the East of England Neonatal Network between 01.01.11 and 31.12.15. There were 17 units in the region of which 2 were excluded due to shared care with a neighbouring network. 13 of the 17 units were included in the study. Data was extracted from the SEND record, specifically looking at neonatal deaths.

Results: There were 41,023 babies admitted to a neonatal unit in the East of England Neonatal Network over the 5-year period with 347 deaths. Of the infants who died the median gestational age was 28 weeks (range 22-41 weeks). The median birth weight was 1180g (range 400-4880g). The median age of death was 2 days (range 30 minutes-163 days). Of the infants that subsequently died, most were born on a Tuesday (17%) with 13% born on a Saturday and 12% on a Sunday. In terms of the day of admission, the highest percentage of deaths occurred on a Tuesday (16%) with 13% on Saturday and 12% on a Sunday. The day of death itself showed a slight increase at the weekend with 16% on a Saturday and Sunday, 15% on a Tuesday and Wednesday, and the lowest on a Monday with 11%.

Conclusion: This study shows that there is no weekend effect resulting in increased neonatal mortality. Neither weekend birth nor admission to the neonatal unit at the weekend appears to result in increased mortality. Neonatal death is multifactorial and we must be careful in attributing causation without adjusting for confounding factors.

Corresponding author: s.guram@nhs.net

References
1. Palmer WL, Bottle A, Aylin P. Association between day of delivery and obstetric outcomes: observational study. BMJ2015;351:h5774.

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