Ginna Cabra-Bautista, Andres F Pérez, Gissel V Ruiz, Daniel Camilo Aguirre-Acevedo, Ivan D Florez, Jose A Calvache
{"title":"出生时间对早期新生儿死亡率和发病率的影响：回顾性队列研究。","authors":"Ginna Cabra-Bautista, Andres F Pérez, Gissel V Ruiz, Daniel Camilo Aguirre-Acevedo, Ivan D Florez, Jose A Calvache","doi":"10.1136/bmjpo-2024-003236","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>A key target of the 2030 Sustainable Development Goals is to eliminate preventable deaths in newborns and children under 5. This study aimed to estimate the effect of time of birth on early neonatal mortality (ENM) and low Apgar scores at 5 min (LA5) in newborns.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using vital statistics data on live births, maternal morbidity, congenital defects and perinatal mortality in Cauca-Colombia (2017-2021) excluding out-of-hospital, multiple and major defect cases. A directed acyclic graph was constructed to define the confounder adjustment set. Multivariable logistic, linear and propensity score models evaluated the effect of birth timing on neonatal outcomes, estimating crude and adjusted incidence rate ratios (IRRa).</p><p><strong>Results: </strong>We assessed 65 182 live births, finding similar baseline characteristics for daytime and night-time births. ENM was 0.2% (95% CI 0.19% to 0.26%) at 7 days of follow-up, absolute mortality difference 0.1% (95% CI -0.01% to 0.12%). Night-time births increased the incidence of ENM in the primary analysis IRRa 1.27 (95% CI 0.90 to 1.82), in the secondary IRRa 1.45 (95% CI 0.94 to 2.20), and in the primary and secondary sensitivity analysis, respectively, IRRa 1.48 (95% CI 1.06 to 2.07) and 1.70 (95% CI 1.16 to 2.59). LA5 was present in 0.7% (95% CI 0.60% to 0.72%) of birth, with absolute LA5 difference 0.1% (95% CI -0.02% to 0.22%). Night-time births increased the incidence of LA5 in the primary analysis IRRa 1.31 (95% CI 1.00 to 1.49), in the secondary IRRa 1.44 (95% CI 1.13 to 1.83), and in the primary and secondary sensitivity analysis, respectively, IRRa 1.31 (95% CI 1.08 to 1.59) and IRRa 1.54 (95% CI 1.23 to 1.92).</p><p><strong>Conclusions: </strong>Birth at night-time is associated with worse neonatal outcomes, ENM and low Apgar scores in Colombia's diverse population, highlighting the need for optimised prenatal care, revised work schedules and improved referral systems in maternal health.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0000,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11887291/pdf/","citationCount":"0","resultStr":"{\"title\":\"Influence of time of birth in early neonatal mortality and morbidity: retrospective cohort study.\",\"authors\":\"Ginna Cabra-Bautista, Andres F Pérez, Gissel V Ruiz, Daniel Camilo Aguirre-Acevedo, Ivan D Florez, Jose A Calvache\",\"doi\":\"10.1136/bmjpo-2024-003236\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>A key target of the 2030 Sustainable Development Goals is to eliminate preventable deaths in newborns and children under 5. This study aimed to estimate the effect of time of birth on early neonatal mortality (ENM) and low Apgar scores at 5 min (LA5) in newborns.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using vital statistics data on live births, maternal morbidity, congenital defects and perinatal mortality in Cauca-Colombia (2017-2021) excluding out-of-hospital, multiple and major defect cases. A directed acyclic graph was constructed to define the confounder adjustment set. Multivariable logistic, linear and propensity score models evaluated the effect of birth timing on neonatal outcomes, estimating crude and adjusted incidence rate ratios (IRRa).</p><p><strong>Results: </strong>We assessed 65 182 live births, finding similar baseline characteristics for daytime and night-time births. ENM was 0.2% (95% CI 0.19% to 0.26%) at 7 days of follow-up, absolute mortality difference 0.1% (95% CI -0.01% to 0.12%). Night-time births increased the incidence of ENM in the primary analysis IRRa 1.27 (95% CI 0.90 to 1.82), in the secondary IRRa 1.45 (95% CI 0.94 to 2.20), and in the primary and secondary sensitivity analysis, respectively, IRRa 1.48 (95% CI 1.06 to 2.07) and 1.70 (95% CI 1.16 to 2.59). LA5 was present in 0.7% (95% CI 0.60% to 0.72%) of birth, with absolute LA5 difference 0.1% (95% CI -0.02% to 0.22%). 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引用次数: 0
摘要
背景：《2030年可持续发展目标》的一项关键目标是消除新生儿和5岁以下儿童可预防的死亡。本研究旨在评估出生时间对新生儿早期新生儿死亡率（ENM）和5分钟低Apgar评分（LA5）的影响。方法：采用2017-2021年考卡-哥伦比亚地区活产、孕产妇发病率、先天性缺陷和围产期死亡率生命统计资料进行回顾性队列研究，排除院外、多发和重大缺陷病例。构造了一个有向无环图来定义混杂调整集。多变量logistic、线性和倾向评分模型评估了出生时间对新生儿结局的影响，估计了粗发病率比和调整发病率比（IRRa）。结果：我们评估了65182例活产，发现白天和夜间分娩的基线特征相似。随访7天ENM为0.2% (95% CI 0.19% ~ 0.26%)，绝对死亡率差0.1% （95% CI -0.01% ~ 0.12%）。在初级分析IRRa 1.27 (95% CI 0.90至1.82)，次级分析IRRa 1.45 (95% CI 0.94至2.20)，在初级和次级敏感性分析中，IRRa分别为1.48 （95% CI 1.06至2.07）和1.70 (95% CI 1.16至2.59)，夜间分娩增加ENM的发生率。出生者中有0.7% （95% CI 0.60% ~ 0.72%）存在LA5， LA5的绝对差异为0.1% （95% CI -0.02% ~ 0.22%）。在初级分析IRRa 1.31 (95% CI 1.00 - 1.49)，次级分析IRRa 1.44 （95% CI 1.13 - 1.83）中，夜间分娩增加LA5的发生率，在初级和次级敏感性分析中，IRRa 1.31 （95% CI 1.08 - 1.59）和IRRa 1.54 （95% CI 1.23 - 1.92）。结论：在哥伦比亚不同的人口中，夜间分娩与新生儿结局、ENM和低Apgar评分较差有关，突出了优化产前护理、修订工作时间表和改进孕产妇保健转诊系统的必要性。
Influence of time of birth in early neonatal mortality and morbidity: retrospective cohort study.
Background: A key target of the 2030 Sustainable Development Goals is to eliminate preventable deaths in newborns and children under 5. This study aimed to estimate the effect of time of birth on early neonatal mortality (ENM) and low Apgar scores at 5 min (LA5) in newborns.
Methods: A retrospective cohort study was conducted using vital statistics data on live births, maternal morbidity, congenital defects and perinatal mortality in Cauca-Colombia (2017-2021) excluding out-of-hospital, multiple and major defect cases. A directed acyclic graph was constructed to define the confounder adjustment set. Multivariable logistic, linear and propensity score models evaluated the effect of birth timing on neonatal outcomes, estimating crude and adjusted incidence rate ratios (IRRa).
Results: We assessed 65 182 live births, finding similar baseline characteristics for daytime and night-time births. ENM was 0.2% (95% CI 0.19% to 0.26%) at 7 days of follow-up, absolute mortality difference 0.1% (95% CI -0.01% to 0.12%). Night-time births increased the incidence of ENM in the primary analysis IRRa 1.27 (95% CI 0.90 to 1.82), in the secondary IRRa 1.45 (95% CI 0.94 to 2.20), and in the primary and secondary sensitivity analysis, respectively, IRRa 1.48 (95% CI 1.06 to 2.07) and 1.70 (95% CI 1.16 to 2.59). LA5 was present in 0.7% (95% CI 0.60% to 0.72%) of birth, with absolute LA5 difference 0.1% (95% CI -0.02% to 0.22%). Night-time births increased the incidence of LA5 in the primary analysis IRRa 1.31 (95% CI 1.00 to 1.49), in the secondary IRRa 1.44 (95% CI 1.13 to 1.83), and in the primary and secondary sensitivity analysis, respectively, IRRa 1.31 (95% CI 1.08 to 1.59) and IRRa 1.54 (95% CI 1.23 to 1.92).
Conclusions: Birth at night-time is associated with worse neonatal outcomes, ENM and low Apgar scores in Colombia's diverse population, highlighting the need for optimised prenatal care, revised work schedules and improved referral systems in maternal health.
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