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The days between (80%) were defined as optimal delivery volume days. The differences in the incidence of selected adverse neonatal outcome measures were analysed between busy versus optimal days and quiet versus optimal days at the hospital category and for the entire obstetric ecosystem level.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>A total of 601\u2009247 singleton hospital deliveries between 2006 and 2016, occurred in non\u2010tertiary (C1\u2013C4, stratified by size) and tertiary level (C5) delivery hospitals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Analyses were performed by the methods of the regression analyses with crude and adjusted odds ratios including 99% CI.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Birth asphyxia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>At the ecosystem level, adjusted odds ratio for birth asphyxia was 0.81 (99% CI 0.76\u20130.87) on busy versus optimal days. Breakdown to hospital categories show that adjusted odds ratios for asphyxia on busy versus optimal days in non\u2010tertiary hospitals (C3, C4) were 0.25 (99% CI 0.16\u20130.41) and 0.17 (99% CI 0.13\u20130.22), respectively, and in tertiary hospitals was 1.20 (99% CI 1.10\u20131.32).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Busy day effect as a stress test caused no extra cases of neonatal adverse outcomes at the ecosystem level. However, in non\u2010tertiary hospitals busy days were associated with a lower and in tertiary hospitals a higher incidence of neonatal adverse outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.17502","type":"journal-article","created":{"date-parts":[[2023,4,20]],"date-time":"2023-04-20T17:08:36Z","timestamp":1682010516000},"page":"1328-1336","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Busy day effect on adverse obstetric outcomes using a nationwide ecosystem approach: Cross\u2010sectional register study of 601\u2009247 hospital deliveries"],"prefix":"10.1111","volume":"130","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7798-8123","authenticated-orcid":false,"given":"Riitta","family":"Vilkko","sequence":"first","affiliation":[{"name":"Faculty of Medicine University of Helsinki  Helsinki Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2899-5885","authenticated-orcid":false,"given":"Sari","family":"R\u00e4is\u00e4nen","sequence":"additional","affiliation":[{"name":"School of Health Tampere University of Applied Sciences  Tampere Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mika","family":"Gissler","sequence":"additional","affiliation":[{"name":"Knowledge Brokers THL Finnish Institute for Health and Welfare  Helsinki Finland"},{"name":"Region Stockholm, Academic Primary Health Care Centre  Stockholm Sweden"},{"name":"Department of Molecular Medicine and Surgery Karolinska Institutet  Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vedran","family":"Stefanovic","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Fetomaternal Medical Centre Helsinki University Hospital and University of Helsinki  Helsinki Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7664-0587","authenticated-orcid":false,"given":"Ilkka","family":"Kalliala","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology University Hospital and University of Helsinki  Helsinki Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seppo","family":"Heinonen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology University Hospital and University of Helsinki  Helsinki Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,4,20]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1994.03510340051033"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3181ea4d4f"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2014.03.017"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen\u20102019\u2010036203"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884\u2010019\u20102173\u20102"},{"key":"e_1_2_12_7_1","unstructured":"Euro\u2010Peristat project with SCPE and Eurocat.European Perinatal Health Report The Health and Care of Pregnant Women and Babies in Europe in 2010.2013. 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