Objective: In obstetrics, the care of patients in labor or with emergencies takes place day and night. Birth-related injury is among the worst of obstetric outcomes. This study sought to examine the relationship between time of birth and fetal injury resulting in death.
Study design: The Birth-Related Neurologic Injury Compensation Association (NICA) is a Florida organization that pays for the care of infants >2500 g with birth-related brain or spinal cord injury resulting in permanent impairment. We conducted a case-control study using all deaths from the NICA database from 1989 to 2002. Data were collected on the antepartum, intrapartum, and postpartum care of the mother and fetus/child. Time of birth was identified for all cases and compared with a randomly selected control group of 1000 births in 1996 from Florida.
Results: Eighty deaths were identified in the NICA database of 447 total cases. Of the 80 cases, 36/80 (45%) were born from 11 pm to 8 am. Of the 999 controls (1 certificate sealed for adoption) 281 (28.1%) were born from 11 pm to 8 am. This yields an odds ratio of 2.09 (95% CI 1.29-3.40) for the association of nighttime birth with fetal injury resulting in death.
Conclusion: Fetuses sustaining injuries resulting in death were more than twice as likely as controls to have been born from 11 pm to 8 am. Further studies are needed to determine the factors that affect this association and what changes might need to be made to optimize care regardless of time of day or night.