{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,19]],"date-time":"2025-10-19T00:37:55Z","timestamp":1760834275653,"version":"build-2065373602"},"reference-count":23,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T00:00:00Z","timestamp":1738195200000},"content-version":"unspecified","delay-in-days":29,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Foundation for Pediatric Research in Finland [Lastentautien tutkimuss\u00e4\u00e4ti\u00f6].","award":["220123"],"award-info":[{"award-number":["220123"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,12,11]]},"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To evaluate the effect of delivery hospital busyness on the postnatal condition and the perinatal mortality among small preterm infants born at \u226432+0 gestational weeks.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>The daily delivery volume distribution is defined as lowest 10% (\u2018quiet\u2019) and highest 10% (\u2018busy\u2019) delivery-volume days, and days between (80%) as optimal delivery-volume days. We analysed differences in the incidence of selected adverse outcomes between quiet and busy days compared with optimal delivery-volume days by logistic regression followed by crude (ORs) and adjusted ORs (aORs) with 99% CIs.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>A population-based cohort study based on prospectively collected real-world data from five university hospitals and 21 non-tertiary-level delivery hospitals in Finland, 2006\u20122016.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>4323 small preterm infants.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Primary outcome measures<\/jats:title>\n                  <jats:p>Umbilical cord pH \u22647.05, Apgar score 0\u20133 points at the age of 1\u2009min, Apgar score 0\u20133 points at age 5\u2009min, birth asphyxia (International Classification of Diseases-10 code), resuscitation with intubation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Secondary outcome measures<\/jats:title>\n                  <jats:p>Perinatal mortality comprising stillbirths and early neonatal deaths (&lt;7 days).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Busy days (busy vs optimal) showed no correlation with the primary birth-related outcomes. However, in the university hospitals, quiet days were associated with 80% lower odds of asphyxia (aOR 0.20, 99%\u2009CI 0.08 to 0.48) and 47% lower odds of resuscitation (aOR 0.53, 99%\u2009CI 0.39 to 0.72) compared with their incidence on optimal days.<\/jats:p>\n                  <jats:p>In university hospitals, the odds of early neonatal mortality among small preterm infants on busy days were twofold (aOR 2.08, 99% CI 1.26 to 3.45) than on optimal days. In the non-tertiary hospitals, however, this difference was statistically non-significant (aOR 0.68, 99% CI 0.19 to 2.45).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>In the tertiary university delivery hospitals, busyness was associated with a twofold increase in early neonatal mortality among small preterm infants, whereas infants\u2019 condition at birth on busy days was comparable to their condition on optimal days. Neonatal capacity in tertiary units during busy days may be critical under stress.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-086868","type":"journal-article","created":{"date-parts":[[2025,1,31]],"date-time":"2025-01-31T01:26:02Z","timestamp":1738286762000},"page":"e086868","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Effect of delivery hospital busyness on early mortality in small preterm infants: a Finnish population-based cohort study in 2006\u20132016"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7798-8123","authenticated-orcid":false,"given":"Riitta","family":"Vilkko","sequence":"first","affiliation":[{"name":"Faculty of Medicin, University of Helsinki, Helsinki, Finland"},{"name":"Metropolia University of Applied Sciences, Helsinki, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seppo","family":"Heinonen","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynaecology, HUS Helsinki University Hospital, Helsinki, Finland"},{"name":"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":"Laurea University of Applied Sciences, Vantaa, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mika","family":"Gissler","sequence":"additional","affiliation":[{"name":"Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Finland"},{"name":"Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sture","family":"Andersson","sequence":"additional","affiliation":[{"name":"University of Helsinki Children's Hospital, Helsinki, Finland"},{"name":"Pediatric Research Center, University of Helsinki, Helsinki, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Markus","family":"Leskinen","sequence":"additional","affiliation":[{"name":"Pediatric Research Center, University of Helsinki, Helsinki, Finland"},{"name":"New Children's Hospital, HUS Helsinki University Hospital, Helsinki, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,1,30]]},"reference":[{"key":"2025101812560192000_15.1.e086868.1","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.bpobgyn.2020.09.003","article-title":"Preterm birth prevention","volume":"69","author":"da Fonseca","year":"2020","journal-title":"Best Pract Res Clin Obstet Gynaecol"},{"key":"2025101812560192000_15.1.e086868.2","unstructured":"WHO . Preterm birth. n.d. Available: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/preterm-birth"},{"key":"2025101812560192000_15.1.e086868.3","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(14)60496-7"},{"key":"2025101812560192000_15.1.e086868.4","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2393-9-S1-S6","article-title":"Reducing stillbirths: interventions during labour","volume":"9 Suppl 1","author":"Darmstadt","year":"2009","journal-title":"BMC Pregnancy Childbirth"},{"key":"2025101812560192000_15.1.e086868.5","first-page":"409","article-title":"No cry at birth: global estimates of intrapartum stillbirths and intrapartum-related neonatal deaths","volume":"83","author":"Lawn","year":"2005","journal-title":"Bull World Health Organ"},{"key":"2025101812560192000_15.1.e086868.6","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/j.ogrm.2022.08.002","article-title":"The management of preterm labour","volume":"32","author":"Spencer","year":"2022","journal-title":"Obstet Gynaecol Reprod Med"},{"key":"2025101812560192000_15.1.e086868.7","doi-asserted-by":"crossref","first-page":"S123","DOI":"10.1016\/j.ijgo.2009.07.021","article-title":"Reducing intrapartum-related deaths and disability: can the health system deliver?","volume":"107 Suppl 1","author":"Lawn","year":"2009","journal-title":"Int J Gynaecol Obstet"},{"key":"2025101812560192000_15.1.e086868.8","first-page":"102155","article-title":"New World Health Organization recommendations for care of preterm or low birth weight infants: health policy","volume":"63","author":"Darmstadt","year":"2023","journal-title":"eClinMed"},{"key":"2025101812560192000_15.1.e086868.9","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(18)30451-0"},{"key":"2025101812560192000_15.1.e086868.10","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0060663","article-title":"Quality indicators for continuous monitoring to improve maternal and infant health in maternity departments: a modified Delphi survey of an international multidisciplinary panel","volume":"8","author":"Boulkedid","year":"2013","journal-title":"PLoS One"},{"key":"2025101812560192000_15.1.e086868.11","doi-asserted-by":"crossref","first-page":"1328","DOI":"10.1111\/1471-0528.17502","article-title":"Busy day effect on adverse obstetric outcomes using a nationwide ecosystem approach: Cross-sectional register study of 601\u2009247 hospital deliveries","volume":"130","author":"Vilkko","year":"2023","journal-title":"BJOG"},{"key":"2025101812560192000_15.1.e086868.12","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-022-04798-6","article-title":"Busy day effect on the use of obstetrical interventions and epidural analgesia during labour: a cross-sectional register study of 601 247 deliveries","volume":"22","author":"Vilkko","year":"2022","journal-title":"BMC Pregnancy Childbirth"},{"key":"2025101812560192000_15.1.e086868.13","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/j.ejogrb.2021.09.007","article-title":"Daily patient flow unevenness in different sized delivery hospitals - An 11-year register study of 610 227 deliveries","volume":"266","author":"Vilkko","year":"2021","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"2025101812560192000_15.1.e086868.14","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-021-03552-8","article-title":"Busy day effect on intrapartum adverse maternal outcomes - a population-based study of 601 247 singleton deliveries","volume":"21","author":"Vilkko","year":"2021","journal-title":"BMC Pregnancy Childbirth"},{"key":"2025101812560192000_15.1.e086868.15","unstructured":"Perinatal statistics - parturients, delivers and newborns 2023. Available: https:\/\/thl.fi\/en\/statistics-and-data\/statistics-by-topic\/sexual-and-reproductive-health\/parturients-deliveries-and-births\/perinatal-statistics-parturients-delivers-and-newborns [Accessed 13 Feb 2024]."},{"key":"2025101812560192000_15.1.e086868.16","unstructured":"Health care act. Available: https:\/\/www.finlex.fi\/en\/laki\/kaannokset\/2010\/en20101326 [Accessed 13 Feb 2024]."},{"key":"2025101812560192000_15.1.e086868.17","unstructured":"Primary health care act. Available: https:\/\/www.finlex.fi\/en\/laki\/kaannokset\/1972\/19720066 [Accessed 13 Feb 2024]."},{"key":"2025101812560192000_15.1.e086868.18","unstructured":"Act on specialized health care. Available: https:\/\/www.finlex.fi\/en\/laki\/kaannokset\/1989\/19891062 [Accessed 13 Feb 2024]."},{"key":"2025101812560192000_15.1.e086868.19","doi-asserted-by":"publisher","DOI":"10.1080\/14639230110119234"},{"key":"2025101812560192000_15.1.e086868.20","doi-asserted-by":"publisher","DOI":"10.1023\/A:1007379029182"},{"key":"2025101812560192000_15.1.e086868.21","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3182a2dd93"},{"key":"2025101812560192000_15.1.e086868.22","doi-asserted-by":"crossref","DOI":"10.1136\/bmjqs-2016-005257","article-title":"A \u201cbusy day\u201d effect on perinatal complications of delivery on weekends: a retrospective cohort study","volume":"26","author":"Snowden","year":"2017","journal-title":"BMJ Qual Saf"},{"key":"2025101812560192000_15.1.e086868.23","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2006-1964"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2024-086868","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T19:56:09Z","timestamp":1760817369000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2024-086868"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":23,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1,30]]},"published-print":{"date-parts":[[2025,1]]}},"alternative-id":["10.1136\/bmjopen-2024-086868"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2024-086868","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"type":"print","value":"2044-6055"},{"type":"electronic","value":"2044-6055"}],"subject":[],"published":{"date-parts":[[2025,1]]}}}