Impact of Timing of Birth and Resident Duty-Hour Restrictions on Outcomes for Small Preterm Infants

Bell, Edward F.; Hansen, Nellie I.; Morriss, Frank H.; Stoll, Barbara J.; Ambalavanan, Namasivayam; Gould, Jeffrey B.; Laptook, Abbot R.; Walsh, Michele C.; Carlo, Waldemar A.; Shankaran, Seetha; Das, Abhik; Higgins, Rosemary D.

doi:10.1542/peds.2010-0456

Cited by 39 publications

(42 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…79 These data are similar to those from one other study that found an improvement in mortality in medical patients but not surgical patients. 77 In the study of Medicare hospitals, however, there was no apparent change in outcome in either medical or surgical patients after a reduction in duty hours. 80 Similarly, Silber et al found no difference in length of stay in hospital either in medical or surgical patients admitted to either Medicare or Veterans Affairs hospitals.…”

Section: Studies Showing Predominantly No Difference In Outcomes In Pmentioning

confidence: 95%

Impact of reduction in working hours for doctors in training on postgraduate medical education and patients' outcomes: systematic review

Moonesinghe

Lowery²,

Shahi

et al. 2011

BMJ

194

165

View full text Add to dashboard Cite

Objectives To determine whether a reduction in working hours of doctors in postgraduate medical training has had an effect on objective measures of medical education and clinical outcome. Design Systematic review. Data sources Medline, Embase, ISI Web of Science, Google Scholar, ERIC, and SIGLE were searched without language restriction for articles published between 1990 and December 2010. Reference lists and citations of selected articles. Study selection Studies that assessed the impact of a change in duty hours using any objective measure of outcome related to postgraduate medical training, patient safety, or clinical outcome. Any study design was eligible for inclusion. Results 72 studies were eligible for inclusion: 38 reporting training outcomes, 31 reporting outcomes in patients, and three reporting both. A reduction in working hours from greater than 80 hours a week (in accordance with US recommendations) does not seem to have adversely affected patient safety and has had limited effect on postgraduate training. Reports on the impact of European legislation limiting working hours to less than 56 or 48 a week are of poor quality and have conflicting results, meaning that firm conclusions cannot be made. Conclusions Reducing working hours to less than 80 a week has not adversely affected outcomes in patient or postgraduate training in the US. The impact of reducing hours to less than 56 or 48 a week in the UK has not yet been sufficiently evaluated in high quality studies. Further work is required, particularly in the European Union, using large multicentre evaluations of the impact of duty hours' legislation on objective educational and clinical outcomes.

show abstract

Section: Studies Showing Predominantly No Difference In Outcomes In Pmentioning

confidence: 95%

Impact of reduction in working hours for doctors in training on postgraduate medical education and patients' outcomes: systematic review

Moonesinghe

Lowery²,

Shahi

et al. 2011

BMJ

194

165

View full text Add to dashboard Cite

show abstract

“…4-7,13,14 However, there is substantial between-study heterogeneity. Across these studies, variability existed in the definitions for neonatal morbidity, the classification of delivery time periods (“regular” hours vs. out-of-hours), and the selection of confounders in regression models.…”

Section: Discussionmentioning

confidence: 99%

“…We categorized time of delivery into three time periods: 07:00 to 16:59 (day); 17:00 to 23:59 (evening); and midnight to 06:59 (overnight). These time periods were selected based on prior literature, 4,9 and the authors’ opinions of typical times for changes of physicians’ shifts. Our primary outcome was defined by the presence of at least one of the following severe neonatal morbidities: respiratory distress syndrome, transient tachypnea of the newborn, necrotizing enterocolitis, sepsis, seizures, neonatal intensive care unit (NICU) admission, or a 5-minute APGAR score ≤3.…”

Section: Methodsmentioning

confidence: 99%

“…Several studies reported that neonatal outcomes were not influenced by time of delivery. 4-7 However, the majority of these studies sourced data from single obstetric centers; thus, the generalizability of these findings is uncertain. In contrast, data from population-wide studies indicate that the risk of neonatal death is increased for deliveries in the evening or at night.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Does Time of Delivery Influence the Risk of Neonatal Morbidity?

et al. 2015

View full text Add to dashboard Cite

Objective To examine whether time of delivery influences the risk of neonatal morbidity among women with singleton pregnancies. Study Design Secondary analysis of data from the Maternal Fetal Medicine Units Network Factor V Leiden Mutation study. We categorized time of delivery as day (07:00–16:59), evening (17:00–23:59), and overnight (midnight–06:59). Severe neonatal morbidity was defined by at least one of the following: respiratory distress syndrome, transient tachypnea of the newborn, sepsis, seizures, neonatal intensive care admission, or a 5-minute APGAR ≤3. We calculated frequencies of severe neonatal morbidity by time of delivery. Multivariate analysis was performed to determine whether time of delivery was independently associated with severe neonatal morbidity. Results Among 4,087 women, 1,917 (46.9%) delivered during the day, 1,140 (27.9%) delivered in the evening, and 1,030 (25.2%) delivered overnight. We observed no significant differences in the rates of neonatal morbidity between delivery time periods (day: 12.3%; evening: 12.8%; overnight: 12.6%; p = 0.9). No significant association was observed between time of delivery and neonatal morbidity after adjustment for maternal, obstetric, and peripartum factors. Conclusion Our findings suggest that time of delivery is not associated with severe neonatal morbidity.

show abstract

“…A number of studies have been undertaken to explore the link between neonatal outcomes and increased nursing workload and staffing levels 1–4. However, previous studies have not specifically studied the relationship of staffing to target oxygen levels.…”

Section: Contextmentioning

confidence: 99%

Nurse:patient ratios influence the achievement of oxygen saturation targets in premature infants

Petty

2011

Evid Based Nurs

View full text Add to dashboard Cite

show abstract

Impact of Timing of Birth and Resident Duty-Hour Restrictions on Outcomes for Small Preterm Infants

Abstract: OBJECTIVE-To examine the impact of birth at night, on the weekend, and during July or August -the first months of the academic year -and the impact of resident duty-hour restrictions on mortality and morbidity of VLBW infants.

Cited by 39 publications

References 43 publications

Impact of reduction in working hours for doctors in training on postgraduate medical education and patients' outcomes: systematic review

Impact of reduction in working hours for doctors in training on postgraduate medical education and patients' outcomes: systematic review

Does Time of Delivery Influence the Risk of Neonatal Morbidity?

Nurse:patient ratios influence the achievement of oxygen saturation targets in premature infants

Contact Info

Product

Resources

About