{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T10:53:05Z","timestamp":1787741585646,"version":"build-2784847793"},"reference-count":41,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2023,6,12]],"date-time":"2023-06-12T00:00:00Z","timestamp":1686528000000},"content-version":"unspecified","delay-in-days":11,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000269","name":"Economic and Social Research Council","doi-asserted-by":"publisher","award":["ES\/S010785\/1"],"award-info":[{"award-number":["ES\/S010785\/1"]}],"id":[{"id":"10.13039\/501100000269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002001","name":"Health Services and Delivery Research Programme","doi-asserted-by":"publisher","award":["HSDR 12\/136\/93"],"award-info":[{"award-number":["HSDR 12\/136\/93"]}],"id":[{"id":"10.13039\/501100002001","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>To compare neonatal mortality in English hospitals by time of day and day of the week according to care pathway.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective cohort linking birth registration, birth notification and hospital episode data.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>National Health Service (NHS) hospitals in England.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>6\u2009054\u2009536 liveborn singleton births from 2005 to 2014 in NHS maternity units in England.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Neonatal mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>After adjustment for confounders, there was no significant difference in the odds of neonatal mortality attributed to asphyxia, anoxia or trauma outside of working hours compared with working hours for spontaneous births or instrumental births. Stratification of emergency caesareans by onset of labour showed no difference in mortality by birth timing for emergency caesareans with spontaneous or induced onset of labour. Higher odds of neonatal mortality attributed to asphyxia, anoxia or trauma out of hours for emergency caesareans without labour translated to a small absolute difference in mortality risk.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The apparent \u2018weekend effect\u2019 may result from deaths among the relatively small numbers of babies who were coded as born by emergency caesarean section without labour outside normal working hours. Further research should investigate the potential contribution of care-seeking and community-based factors as well as the adequacy of staffing for managing these relatively unusual emergencies.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2022-067630","type":"journal-article","created":{"date-parts":[[2023,6,14]],"date-time":"2023-06-14T00:15:18Z","timestamp":1686701718000},"page":"e067630","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Neonatal mortality in NHS maternity units by timing and mode of birth: a retrospective linked cohort study"],"prefix":"10.1136","volume":"13","author":[{"given":"Lucy","family":"Carty","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6950-1837","authenticated-orcid":false,"given":"Christopher","family":"Grollman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Plachcinski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Cortina-Borja","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0977-7214","authenticated-orcid":false,"given":"Alison","family":"Macfarlane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,6,13]]},"reference":[{"key":"2023073121211066000_13.6.e067630.1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2016-005793"},{"key":"2023073121211066000_13.6.e067630.2","doi-asserted-by":"crossref","unstructured":"Wise J . The weekend effect-how strong is the evidence? BMJ 2016;353:i2781. doi:10.1136\/bmj.i2781","DOI":"10.1136\/bmj.i2781"},{"key":"2023073121211066000_13.6.e067630.3","unstructured":"Department of Health . The Government\u2019s mandate to NHS England for 2016-17. London, 2015."},{"key":"2023073121211066000_13.6.e067630.4","doi-asserted-by":"crossref","unstructured":"Bion J et al . Increasing specialist intensity at weekends to improve outcomes for patients undergoing emergency hospital admission: the HiSLAC two-phase mixedmethods study, in Health Services and Delivery Research. Southampton (UK): NIHR Journals Library, 2021. doi:10.3310\/hsdr09130","DOI":"10.3310\/hsdr09130"},{"key":"2023073121211066000_13.6.e067630.5","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-016-0260-2"},{"key":"2023073121211066000_13.6.e067630.6","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.2.6153.1670"},{"key":"2023073121211066000_13.6.e067630.7","first-page":"415","article-title":"Day of the week variations in numbers of births and perinatal mortality rates","volume":"4","author":"Macfarlane","year":"1979","journal-title":"Journal of Maternal and Child Health"},{"key":"2023073121211066000_13.6.e067630.8","first-page":"23","article-title":"Births: the Weekly cycle","volume":"13","author":"Macfarlane","year":"1978","journal-title":"Popul Trends"},{"key":"2023073121211066000_13.6.e067630.9","first-page":"5","article-title":"Daily and seasonal variation in live births, stillbirths and infant mortality in England and Wales, 1979-96","volume":"09","author":"Hawe","year":"2001","journal-title":"Health Stat Q"},{"key":"2023073121211066000_13.6.e067630.10","first-page":"337","article-title":"Risks of stillbirth and early neonatal death by day of week","volume":"170","author":"Luo","year":"2004","journal-title":"Can Med Assoc J"},{"key":"2023073121211066000_13.6.e067630.11","doi-asserted-by":"publisher","DOI":"10.1136\/jech.37.1.57"},{"key":"2023073121211066000_13.6.e067630.12","doi-asserted-by":"crossref","unstructured":"Palmer WL , Bottle A , Aylin P . Association between day of delivery and obstetric outcomes: observational study. BMJ 2015;351:h5774. doi:10.1136\/bmj.h5774","DOI":"10.1136\/bmj.h5774"},{"key":"2023073121211066000_13.6.e067630.13","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.316.7132.657"},{"key":"2023073121211066000_13.6.e067630.14","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.317.7157.539"},{"key":"2023073121211066000_13.6.e067630.15","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(02)95408-5"},{"key":"2023073121211066000_13.6.e067630.16","doi-asserted-by":"crossref","first-page":"936","DOI":"10.1093\/oxfordjournals.aje.a116389","article-title":"The circadian rhythm of the perinatal mortality rate in Switzerland","volume":"135","author":"Ruffieux","year":"1992","journal-title":"Am J Epidemiol"},{"key":"2023073121211066000_13.6.e067630.17","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.323.7325.1327"},{"key":"2023073121211066000_13.6.e067630.18","doi-asserted-by":"publisher","DOI":"10.1097\/00001648-200303000-00017"},{"key":"2023073121211066000_13.6.e067630.19","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000168627.33566.3c"},{"key":"2023073121211066000_13.6.e067630.20","doi-asserted-by":"crossref","unstructured":"Pasupathy D , Wood AM , Pell JP , et al . Time of birth and risk of neonatal death at term: retrospective cohort study. BMJ 2010;341:c3498. doi:10.1136\/bmj.c3498","DOI":"10.1136\/bmj.c3498"},{"key":"2023073121211066000_13.6.e067630.21","doi-asserted-by":"publisher","DOI":"10.3310\/hsdr07160"},{"key":"2023073121211066000_13.6.e067630.22","doi-asserted-by":"crossref","unstructured":"Martin P , Cortina-Borja M , Newburn M , et al . Timing of singleton births by onset of labour and mode of birth in NHS maternity units in England, 2005-2014: a study of linked birth registration, birth notification, and hospital episode data. PLOS ONE 2018;13:e0198183. doi:10.1371\/journal.pone.0198183","DOI":"10.1371\/journal.pone.0198183"},{"key":"2023073121211066000_13.6.e067630.23","doi-asserted-by":"crossref","unstructured":"Dattani N , Macfarlane A . Linkage of maternity hospital episode statistics data to birth registration and notification records for births in England 2005-2014: methods. A population-based birth cohort study. BMJ Open 2018;8:e017897. doi:10.1136\/bmjopen-2017-017897","DOI":"10.1136\/bmjopen-2017-017897"},{"key":"2023073121211066000_13.6.e067630.24","doi-asserted-by":"crossref","unstructured":"Harper G . Linkage of maternity hospital episode statistics data to birth registration and notification records for births in England 2005-2014: quality assurance of linkage of routine data for singleton and multiple births. BMJ Open 2018;8:e017898. doi:10.1136\/bmjopen-2017-017898","DOI":"10.1136\/bmjopen-2017-017898"},{"key":"2023073121211066000_13.6.e067630.25","unstructured":"Draper E et al . MBRRACE-UK Perinatal Mortality Surveillance Report, UK Perinatal Deaths for Births from January to December 2020. Leicester: The Infant Mortality and Morbidity Studies, Department of Health Sciences, University of Leicester, 2022."},{"key":"2023073121211066000_13.6.e067630.26","unstructured":"Dattani N , Rowan S . Causes of neonatal deaths and stillbirths: a new hierarchical classification in ICD-10. Health Stat Q 2002:15."},{"key":"2023073121211066000_13.6.e067630.27","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(80)92717-8"},{"key":"2023073121211066000_13.6.e067630.28","doi-asserted-by":"publisher","DOI":"10.1177\/0049124103262065"},{"key":"2023073121211066000_13.6.e067630.29","unstructured":"National Institute for Health Research . Births and their outcome: analysing the daily, Weekly and yearly cyles and their implications for the NHS: study documentation. 2017. Available: https:\/\/www.journalslibrary.nihr.ac.uk\/programmes\/hsdr\/1213693"},{"key":"2023073121211066000_13.6.e067630.30","doi-asserted-by":"crossref","first-page":"1366","DOI":"10.23889\/ijpds.v5i3.1366","article-title":"Involving service users in the birth timing project, a data linkage study analysing the timing of births and their outcomes","volume":"5","author":"Newburn","year":"2020","journal-title":"International Journal of Population Data Science"},{"key":"2023073121211066000_13.6.e067630.31","doi-asserted-by":"crossref","unstructured":"Knight HE , Gurol-Urganci I , Mahmood TA , et al . Evaluating maternity care using national administrative health datasets: how are statistics affected by the quality of data on method of delivery? BMC Health Serv Res 2013;13:200. doi:10.1186\/1472-6963-13-200","DOI":"10.1186\/1472-6963-13-200"},{"key":"2023073121211066000_13.6.e067630.32","unstructured":"Euro-peristat project with SCPE and eurocat, euro-peristat project: European perinatal health report. core indicators of the health and care of pregnant women and babies in Europe in 2015; 2018."},{"key":"2023073121211066000_13.6.e067630.33","unstructured":"McIlwaine G et al . Caesarean section in Scotland 1994\/5: a national audit. 1996."},{"key":"2023073121211066000_13.6.e067630.34","doi-asserted-by":"publisher","DOI":"10.1136\/qshc.2008.028639"},{"key":"2023073121211066000_13.6.e067630.35","unstructured":"Freudenthal B . Editorial double-standards for DR foster-a major fail for BMJ. BMJ Rapid Response 2015. Available: http:\/\/www.bmj.com\/content\/351\/bmj.h5774\/rr-8"},{"key":"2023073121211066000_13.6.e067630.36","doi-asserted-by":"crossref","unstructured":"Palmer WL , Bottle A , Aylin P . Association between day of delivery and obstetric outcomes: observational study. BMJ 2015;351:h5774. doi:10.1136\/bmj.h5774 Available: http:\/\/www.bmj.com\/content\/351\/bmj.h5774\/rr-7","DOI":"10.1136\/bmj.h5774"},{"key":"2023073121211066000_13.6.e067630.37","doi-asserted-by":"crossref","unstructured":"Palmer WL , Bottle A , Aylin P . Association between day of delivery and obstetric outcomes: observational study. BMJ 2015;351:h5774. doi:10.1136\/bmj.h5774 Available: http:\/\/www.bmj.com\/content\/351\/bmj.h5774\/rr-13","DOI":"10.1136\/bmj.h5774"},{"key":"2023073121211066000_13.6.e067630.38","unstructured":"Draper ES et al . MBRRACE-UK Perinatal Mortality Surveillance Report, UK Perinatal Deaths for Births from January to December 2020, in The Infant Mortality and Morbidity Studies. Leicester: Department of Health Sciences, University of Leicester, 2022."},{"key":"2023073121211066000_13.6.e067630.39","unstructured":"Draper E , Kurinczuk J , Kenyon S . In: MBBRACE-UK Perinatal Confidential Enquiry: Term, singleton, intrapartum stillbirth and intrapartum-related neonatal death, MBBRACE-UK. 2017."},{"key":"2023073121211066000_13.6.e067630.40","doi-asserted-by":"crossref","unstructured":"Chen Y-F , Armoiry X , Higenbottam C , et al . Magnitude and modifiers of the weekend effect in hospital admissions: a systematic review and meta-analysis. BMJ Open 2019;9:e025764. doi:10.1136\/bmjopen-2018-025764","DOI":"10.1136\/bmjopen-2018-025764"},{"key":"2023073121211066000_13.6.e067630.41","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1111\/ajo.13493","article-title":"Neonatal near miss: a review of current definitions and the need for standardisation","volume":"62","author":"Medeiros","year":"2022","journal-title":"Aust N Z J Obstet Gynaecol"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2022-067630","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,1]],"date-time":"2023-08-01T04:35:22Z","timestamp":1690864522000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2022-067630"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6]]},"references-count":41,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2023,6,13]]},"published-print":{"date-parts":[[2023,6]]}},"alternative-id":["10.1136\/bmjopen-2022-067630"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2022-067630","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6]]}}}