Early neonatal mortality and timing of low risk births

doi:10.1136/bmj.322.7283.433

BMJ 2001;322:433 ( 17 February )

Letters

Early neonatal mortality and timing of low risk births

Several factors predisposing to increased mortality at night were not excluded

Data suggest that difficulties in fetal monitoring are magnified at night

Authors' reply

Several factors predisposing to increased mortality at night were not excluded

The first 150 words of the full text of this article appear below.

EDITOR $---$ Heller et al's unstated premise that the incidence of perinatal death due to intrapartum asphyxia in low risk pregnanciesmay serve as a sensitive measure of the quality of peripartumcare delivered is appealing. ¹ ² But their proposition thatthe observed higher nocturnal perinatal mortality in their selectedpopulation arose because of substandard care was notjustified.

Firstly, the authors did not do a comprehensive interrogation of index case records. The Confidential Enquiry into Stillbirthsand Deaths in Infancy adopts the gold standard method of a multidisciplinaryscrutiny of records to ensure accurate diagnosis and quantifysubstandardcare.

Secondly, imprecise selection criteria meant that the sample population was heterogeneous in terms of pregnancy risk and methodof delivery. Further bias arose because Heller et al's early neonataldeath rate (0.15/1000 births selected) represented only a smallfraction of the unstated overall early neonatal death rate (3.1/1000live births found . . . [Full text of this article]

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