Context Increases in neonatal mortality for infants born on the weekend were
last noted several decades ago. Although the current health care environment
has raised concern about the adequacy of weekend care, there have been no
contemporary evaluations of daily patterns of births, obstetric intervention,
and case mix–adjusted neonatal mortality.
Objective To compare the neonatal mortality of infants born on weekdays and weekends.
Design, Setting, and Participants Case series of 1 615 041 live births (weight ≥500 g) in
California between 1995-1997 to determine patterns of births, cesarean deliveries,
and neonatal deaths. Analyses were stratified by birth weight and delivery
method. To assess the role of weekend differences in case mix, observed and
birth weight–adjusted odds ratios (ORs) for increased weekend mortality
were estimated using logistic regression.
Main Outcome Measure Birth weight–adjusted neonatal mortality.
Results There was a 17.5% decrease in births on weekends, accompanied by a decrease
in the proportion of cesarean deliveries from 22% on weekdays to 16% on weekends.
Weekend decreases in births were least pronounced in smaller infants, resulting
in a weekend concentration of high-mortality, very low-birth-weight (<1500
g) births. Observed neonatal mortality increased from 2.80 per 1000 weekday
births to 3.12 per 1000 weekend births (OR, 1.12; 95% confidence interval
[CI], 1.05-1.19; P = .001) for all births, and from
4.94 to 6.85 (OR, 1.39; 95% CI, 1.25-1.55; P<.001)
for cesarean deliveries. After adjusting for birth weight, the increased odds
of death for infants born on the weekend were no longer significant.
Conclusions The provision of optimal care regardless of the day of week is an important
goal for perinatal medicine. Comparing the neonatal mortality of infants born
on weekdays and weekends provides a straightforward assessment of this goal.
After controlling for birth weight, we found no evidence that the quality
of perinatal care in California was compromised during the weekend.