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Time at birth and short-term outcomes among extremely preterm infants in Spain: a multicenter cohort study

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Abstract

The first hours after birth entail a window of opportunity to decrease morbidity and mortality among extremely preterm infants. The availability of staff and its tiredness vary depending on the timing and day of the week. We hypothesized that these circumstances may impact neonatal outcomes. We have conducted a multicenter cohort study with data obtained from the Spanish neonatal network database SEN1500, where staff doctors are in the house 24/7. The main study exposure was the time of birth; secondary exposures were cumulative work hours from the medical and nurses’ shifts and day of the week. The primary outcome was survival to hospital discharge. Secondary outcomes included common preterm infants’ in-hospital complications. Univariate and multivariate analysis adjusting for potential confounders was performed. All extremely preterm infants (N = 8798) born between 2011 and 2019 were eligible; 35.7% of them were admitted during the night shift. No differences were found between day and night births regarding survival or morbidity. No differences were found between weekdays and weekends or when considering cumulative worked hours in the shifts. Infants born during the night shift were more likely to be intubated at birth (OR 1.20, CI95% 1.06–1.37), receive surfactant (OR 1.24, CI95% 1.08–1.44), and having anemia requiring transfusion (OR 1.23, CI 95% 1.08–1.42).

Conclusion: the time of birth did not seem to affect mortality and morbidity of extremely preterm infants.

What is Known:

• The first hours after birth in extremely preterm infants are a very valuable opportunity to decrease mortality and morbidity.

• Time and day of birth have long been linked to outcomes in preterm infants, with night shifts and weekends classically having higher rates of mortality and morbidity.

What is New:

• In this study, no differences were found between day and night births regarding survival or major morbidity.

• Infants born during the night shift were more likely to be intubated at birth, receive surfactant and having anemia requiring transfusion.

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Abbreviations

VLBW:

Very-low birth weight

BPD:

Bronchopulmonary dysplasia

VIF:

Variance inflation factor

OR:

Odds ratio

CI:

Confidence interval

SD:

Standard deviation

CRIB:

Clinical risk index for babies

W:

Weeks

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Acknowledgements

We are indebted to all the investigators, coordinators, and members of the Spanish Neonatal Network SEN1500:

H. GERMANS TRIAS I PUJOL (Gemma Ginovart); H. CLÍNIC DE BARCELONA (Josep Figueras Aloy); H. U. BASURTO (Alberto Pérez Legorburu); H.G. DE CASTELLÓN (Ramon Aguilera Olmos); H.U. DE SAN CECILIO (Eduardo Narbona López); H. DE LEON (Sandra Terroba); H. CARLOS HAYA (Tomás Sanchez-Tamayo); H.I. LA PAZ (Mª Dolores Elorza Fernandez); H. CLÍNICO SAN CARLOS (Araceli Corredera Sánchez); H. CENTRAL DE ASTURIAS (Belén Fernández Colomer); COMPLEXO HOSPITALARIO PONTEVEDRA (Mª Angeles Martinez Fernandez); H. UNIVERSITARIO MARQUES DE VALDECILLA (Mª Isabel de las Cuevas Terán); H. DONOSTIA (Miguel Ángel Cortajarena Altuna); H.U.I. VIRGEN DEL ROCÍO (Carmen Macias Díaz); H.U. DE CANARIAS (Pedro Fuster Jorge); H. MIGUEL SERVET (Segundo Rite Gracia); H.C.U. LOZANO BLESA (Mª Purificación Ventura Faci); H.U. LA FE (Mª Isabel Izquierdo Macián); H. VIRGEN DE LA SALUD (Ana Belén Escobar Izquierdo); H.C.U. DE SANTIAGO (Mª Luz Couce Pico); H.U. SALAMANCA (Elena Pilar Gutierrez González); H.G.U. GREGORIO MARAÑÓN (S. Zeballos Sarrato); H. SAN PEDRO DE LOGROÑO (Mª Yolanda Ruiz del Prado); H.U.M.I. LAS PALMAS (Lourdes Urquía Martí); H. DE CABUEÑES (Rafael Garcia Mozo); H.U. REINA SOFÍA (Mª Pilar Jaraba Caballero); H.U. DE BURGOS (Cristina de Frutos Martínez); SCIAS-H. BARCELONA (Sílvia Martínez-Nadal); H. SAN JOAN DE DEU (Martin Iriondo); H. DE CRUCES (Amaya Rodriguez Serna); H.G.U. DE ALICANTE (María Gonzalez Santacruz); H. VIRGEN DE LAS NIEVES (Maria Fernanda Moreno Galdo); CORPORACIO PARC TAULÍ (Joan Badia Barnusell); H.U. RIO HORTEGA (Mª Mar Montejo Vicente); H. TXAGORRITXU (Aintzane Euba); H. JUAN XXIII (Mar Albújar); H. DE GETAFE (Irene Cuadrado Perez); INSTITUT DEXEUS; COMPLEJO HOSPITALARIO ALBACETE (Andres Martinez Gutierrez); H. DE LA SANTA CREU I SANT PAU (Gemma Ginovart Galiana); H. SAN PEDRO DE ALCÁNTARA CÁCERES (Mª Jesús López Cuesta); H. SEVERO OCHOA (Mª José Santos Muñoz); ESTRUCTURA ORGANIZADA DE XESTIÓN INTEGRADA DE VIGO. HOSPITAL ALVARO CUNQUEIRO (María Suárez Albo); H. VIRGEN DE LA CONCHA—COMPLEJO ASISTENCIAL DE ZAMORA (Víctor Manuel Marugán Isabel); H. DE JEREZ (María Victoria Ramos Ramos); H. MONTEPRINCIPE (Gerardo Romera Modamio); H. DE ELCHE (Carolina Vizcaíno); H. JUAN RAMÓN JIMÉNEZ (David Mora Navarro); H. VALME DE SEVILLA (Laura Acosta Gordillo); H.U. ARNAU DE VILANOVA DE LLEIDA (Eduard Soler Mir); H. VIRGEN DE LA MACARENA DE SEVILLA (Mercedes Granero Asensio); H.C.U. DE VALENCIA (Dr. Javier Estañ Capell); H.G.U. DE CIUDAD REAL (Miguel Angel García Cabezas); H. DE LA ZARZUELA (D. López Gómez); H. U. DE GIRONA DR. JOSEP TRUETA (Alberto Trujillo Fagundo); H. DE GRANOLLERS (Israel Anquela Sanz); H. PUERTA DEL MAR (Antonio Segado Arenas); H. 12 DE OCTUBRE (Carmen Rosa Pallás Alonso); H.U. NUESTRA SEÑORA DE CANDELARIA (Sabina Romero); H. PUERTA DE HIERRO (Carmen González Armengod); H.U. SANTA LUCIA DE CARTAGENA (Jose María Lloreda García); H. FUENLABRADA (Laura Domingo Comeche); H.G. DE CATALUÑA (Laura Castells Vilella); H. VIRGEN DEL CAMINO DE PAMPLONA (Concepción Goñi Orayen); H.U. QUIRÓN; CLÍNICA CORACHÁN (Mª Dolores Muro Sebastian); COMPLEXO HOSPITALARIO UNIVERSITARIO DE A CORUÑA (Alejandro Avila-Alvarez); HOSPITAL HM PUERTA DEL SUR (Mara Fernandez Diaz); HOSPITAL QUIRÓN SAGRADO CORAZÓN (Elena García Victori); HOSPITAL UNIVERSITARIO FUNDACIÓN JIMENEZ DÍAZ (Tamara Carrizosa Molina).

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Authors and Affiliations

  1. Division of Neonatology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

    Gonzalo Solis-Garcia

  2. Department of Paediatrics, Neonatal Unit, Complexo Hospitalario Universitario A Coruña, Institute for Biomedical Research A Coruña, Coruña, Spain

    Alejandro Avila-Alvarez

  3. Division of Neonatology, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain

    Fermín García-Muñoz Rodrigo

  4. Division of Neonatology, Hospital Universitari I Politècnic La Fe, Health Research Institute La Fe, Valencia, Spain

    Máximo Vento

  5. Neonatology Department, Malaga Regional Hospital, Malaga Biomedical Research Institute-IBIMA, Malaga, Spain

    Tomás Sánchez Tamayo

  6. Division of Neonatology, Hospital Universitario La Paz, Madrid, Spain

    Carlos Zozaya

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  1. Gonzalo Solis-Garcia
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  2. Alejandro Avila-Alvarez
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  3. Fermín García-Muñoz Rodrigo
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  4. Máximo Vento
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  5. Tomás Sánchez Tamayo
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  6. Carlos Zozaya
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Contributions

C.Z. developed the original research idea. C.Z., G.S.G., A.A.A., F.M.G.M.R., M.V., and T.M.T. designed the protocol and requested the data. G.S.G. and C.Z. analyzed the data. G.S.G. wrote the initial draft of the manuscript, which was critically revised by C.Z., A.A.A., F.M.G.M.R., M.V., and T.M.T.

Corresponding author

Correspondence to Gonzalo Solis-Garcia.

Ethics declarations

Ethics approval and consent to participate/publishing

Local Ethics Research Committees of all participant centers approved the data collection protocol when joining the network. Permission for data analysis was obtained from the executive committee of the Spanish Neonatal Network SEN1500.

Conflict of interest

The authors declare no competing interests.

Additional information

Communicated by Daniele De Luca

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Solis-Garcia, G., Avila-Alvarez, A., García-Muñoz Rodrigo, F. et al. Time at birth and short-term outcomes among extremely preterm infants in Spain: a multicenter cohort study. Eur J Pediatr 181, 2067–2074 (2022). https://doi.org/10.1007/s00431-022-04404-z

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