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Birth Time and Early Outcomes in Very Preterm Infants in China: A Cohort Study
27 Pages Posted: 23 Apr 2024
More...Abstract
Background: To investigate the association between the timing of birth and the outcomes of very preterm infants (VPIs) in China.
Methods: A multicenter retrospective cohort study included preterm infants with gestational ages (GA) less than 32 weeks was conducted based on database of the Chinese Neonatal Network (CHNN) collected between January 1, 2019 to December 31, 2021. The exposure is the time of birth, which included daytime, evening and night on both weekdays and non-weekdays. The primary outcome was in-hospital mortality rate. Secondary outcomes included delivery room outcomes and morbidities.
Findings: 17,670 VPIs were included in the study. We identified an increased mortality during the daytime-evening shift, as well as the night shift on weekdays, maily impacting Infants of 240-276 weeks GA. On weekday birth subgroup, there were persistent associations between evening births and 5-minute Apgar scores ≤7 (aOR 1.22, 95% CI 1.07 to 1.39) or sIVH (aOR 1.30, 95% CI 1.08 to 1.57); and the association between nighttime births and hypothermia (aOR 1.13, 95% CI 1.02 to 1.24). Among infants of 280-296 weeks GA, night shift was associated with intensive resuscitation (aOR 1.23, 95% CI 1.02 to 1.48), as well as evening shift with 5-minute Apgar scores ≤7 (aOR 1.38, 95% CI 1.11 to 1.71). In cases of infants at 300-316 weeks GA, the risk of sIVH significantly increased during the evening shift (aOR 1.78, 95% CI 1.27 to 2.48).
Interpretation: There were increases in mortalities for infants born during daytime handover period and nighttime, impacting infants at 240-276 weeks GA. Heightened risk of asphyxia, hypothermia, or sIVH happened in infants of 280-316 weeks GA born during off-peak hours.
Funding: Canadian Institutes of Health Research (CTP87518).
Declaration of Interest: No financial or non-financial benefits have been received or will be received from any party related directly or indirectly to the subject of this article.
Ethical Approval: The study was approved by the ethics review board of Children’s Hospital of Fudan University (2018-296) and was endorsed by all participating centers. Waiver of consent was granted at all sites owing to the use of deidentified patient data.
Keywords: Very preterm infants, Time of birth, Infant mortality, Preterm outcomes
Suggested Citation: Suggested Citation