Effect of hospital size and on-call arrangements on intrapartum and early neonatal mortality among low-risk newborns in Finland

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http://hdl.handle.net/10138/223904

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Karalis , E , Gissler , M , Tapper , A-M & Ulander , V-M 2016 , ' Effect of hospital size and on-call arrangements on intrapartum and early neonatal mortality among low-risk newborns in Finland ' , European Journal of Obstetrics, and Gynecology ,and Reproductive Biology , vol. 198 , pp. 116-119 . https://doi.org/10.1016/j.ejogrb.2015.10.020

Title: Effect of hospital size and on-call arrangements on intrapartum and early neonatal mortality among low-risk newborns in Finland
Author: Karalis, Elina; Gissler, Mika; Tapper, Anna-Maija; Ulander, Veli-Matti
Other contributor: University of Helsinki, Department of Obstetrics and Gynecology
University of Helsinki, Department of Obstetrics and Gynecology


Date: 2016-03
Language: eng
Number of pages: 4
Belongs to series: European Journal of Obstetrics, and Gynecology ,and Reproductive Biology
ISSN: 0301-2115
DOI: https://doi.org/10.1016/j.ejogrb.2015.10.020
URI: http://hdl.handle.net/10138/223904
Abstract: Objective: To evaluate the influence of delivery unit size and on-call staffing in the performance of low-risk deliveries in Finland. Study design: A population-based study of hospital size and level based on Medical Birth Register data. Population was all hospital births in Finland in 2005-2009. Inclusion criteria were singleton births (birth weight 2500 g or more) without major congenital anomalies or birth defects. Additionally, only intrapartum stillbirths were included. Birthweights and maternal background characteristics were adjusted for by logistic regression. Main outcome measures were intrapartum or early neonatal mortality, neonatal asphyxia and newborns' need for intensive care or transfer to other hospital and longer duration of care. On-call arrangements were asked from each of the hospitals. Results: Intrapartum mortality was higher in units where physicians were at home when on-call (OR 1.25; 95% CI 1.02-1.52). A tendency to a higher mortality was also recorded in non-university hospitals (OR 1.18; 95% CI 0.99-1.40). Early neonatal mortality was twofold in units with less than 1000 births annually (OR 2.11; 95% CI 0.97-4.56) and in units where physicians were at home when on-call (OR 1.85; 95% CI 0.91-3.76). These results did not reach statistical significance. No differences between the units were found regarding Apgar scores or umbilical cord pH. Conclusion: The differences in mortality rates between different level hospitals suggest that adverse outcomes during delivery should be studied in detail in relation to hospital characteristics, such as size or level, and more international studies determining obstetric patient safety indicators are required. (C) 2016 Elsevier Ireland Ltd. All rights reserved.
Subject: Perinatal mortality
Intrapartum mortality
Early neonatal mortality
Neonatal asphyxia
Maternity hospitals
BIRTH-WEIGHT INFANTS
LEVEL HOSPITALS
DELIVERY UNITS
VOLUME
CARE
INDICATORS
REGISTER
QUALITY
EVENTS
SWEDEN
3123 Gynaecology and paediatrics
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