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Retrospective cohort study
Risk of neonatal death is increased by birth outside the normal working week for singleton infants with cephalic presentation born at term
  1. Edward F Bell
  1. Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA
  1. Correspondence to Edward F Bell
    Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA; edward-bell{at}

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It has long been suspected that the risk of adverse obstetrical outcomes is higher with births at night and on the weekend, when medical staff are usually less plentiful and, on average, less experienced. Published reports examining the impact of hour and day of birth on neonatal mortality have had inconsistent findings, with some showing higher mortality after night and weekend births and others showing no difference. The reasons for these inconsistent findings are not clear but may include variation in staffing and available services in the hospitals studied; approaches to analysis, including patients excluded; and the use of insufficient or inappropriate study populations.


This was a population-based retrospective cohort study of term, live born singleton infants with cephalic presentation born in Scotland between 1985 and 2004. The authors used linked records from the Scottish morbidity record, a database of characteristics and outcomes of patients in …

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  • Competing interests None.