Neonatal outcomes in babies born out of hours

In the linked study (doi:10.1136/bmj.c3498), Pasupathy and colleagues assess the influence of time of birth on neonatal mortality in singleton term babies and identify an important increase in the risk of neonatal death associated with intrapartum anoxia when delivery occurs outside “normal working hours” of 9 am to 5 pm Monday to Friday.1

The question of whether the quality of provision of obstetric, maternity, and neonatal care varies out of hours has been long standing, and evidence is inconclusive. What is different about the current study is that the data are particularly robust and sufficiently comprehensive to allow the authors to remove or adjust for a range of important confounding factors. Their results show that in Scotland between 1985 and 2004, babies had an increased risk of dying as a result of intrapartum anoxia when delivery occurred outside the normal working week (adjusted odds ratio 1.71, 95% confidence interval 1.26 to 2.32). Although similar data are not available for the rest of the United …