February 10, 2012
Night, Weekend Delivery OK For Babies With Birth Defects
Weekday delivery is no better than night or weekend delivery for infants with birth defects, according to a new study presented today at The Pregnancy Meeting, the Society for Maternal-Fetal Medicine´s annual conference. The finding is good news for all parties — moms, babies and healthcare teams — and suggests that this high-risk population of women should deliver when their bodies are ready to deliver, regardless of the day or time.
The study, conducted by researchers at the University of Rochester Medical Center, found that infants with birth defects that were delivered at night or over the weekend fared just as well as those delivered on a weekday — they stayed at the hospital for the same amount of time, were admitted to the neonatal intensive care unit at the same rate, and were given antibiotics or got help breathing just as often.
While several studies have looked at the relationship between delivery time and outcomes for healthy infants, there are no current studies on infants with birth defects. These physical abnormalities can occur in any major organ or part of the body and can profoundly influence an infant´s overall health and wellbeing, but little is known about delivery time and results for infants with these problems.
“When we know that a baby will need further testing or surgical repair during the newborn period due to an identified abnormality, we typically try to arrange the delivery on a weekday,” said Eva K. Pressman, M.D., professor and director of the high-risk pregnancy program at the Medical Center. “But the bottom line is that the timing of delivery isn´t terribly important; if a woman goes into labor in the middle of the night or over the weekend her baby will do just as well.”
Senior study author Loralei L. Thornburg, M.D., assistant professor of Maternal-Fetal Medicine in the Department of Obstetrics and Gynecology at the Medical Center, says the data suggest that there is no reason to induce labor or perform a cesarean section in this group solely for the sake of delivering during the day, which is widely perceived as being safer for mom and baby.
“If there is no medical reason for inducing labor it is best to let the baby come on its own time, because we know elective induction is associated with negative outcomes for mom, including increased rates of cesarean delivery, greater blood loss and an extended length of stay in the hospital, and is without significant benefits for the baby,” noted Thornburg.
Her team analyzed data from 220 infants with known, non-lethal birth defects that were born between 2000 and 2010. The most common abnormalities were related to the heart, such as holes between the chambers of the heart, and to the gastrointestinal system, like openings in the abdominal wall which allow the intestines to hang out. Less common problems were central nervous system, facial and musculoskeletal defects. Such irregularities are often detected by ultrasound prior to birth.
Time of delivery was divided into weekday — 7 a.m. to 6 p.m., Monday through Friday — and night/weekend — 6 p.m. to 7 a.m., Monday through Friday, or over the weekend. All infants were delivered at the University of Rochester Medical Center, which has a highly specialized neonatal intensive care unit with surgical and medical teams capable of caring for the smallest and sickest newborn babies — the only one of its kind in the Finger Lakes Region.
For infants who required surgery after birth, the time it took to get into surgery was shorter for the day than for the night/weekend babies, but they spent the same amount of time in the hospital and there was no difference in outcomes. For just infants with gastrointestinal or cardiac defects, the time to surgery was about the same for the day and the night/weekend babies.
Weekday delivery did decrease the amount of time infants with gastrointestinal abnormalities stayed at the hospital, but did not influence overall infant outcome. Infants with cardiac abnormalities that were delivered on a weekday stayed at the hospital as long as those delivered at night or over the weekend. Overall, the rate of infant death was the same for weekday and night/weekend babies.
According to the Centers for Disease Control and Prevention, about one in every 33 babies is born with a birth defect.
Thornburg acknowledges that there are several limitations to the study, including its small size, retrospective nature, and the fact that it was carried out at a single institution and therefore may not be reflective of other centers across the country.
In addition to Thornburg and Pressman, Dzhamala Gilmandyar, M.D., lead study author, Brittany Paivanas, M.D., Amy Hoeft MacDonald, M.D., Oluwateniola Brown, Tina Jensen, and J. Christopher Glantz, M.D., M.P.H., all from the University of Rochester Medical Center, contributed to the research.
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