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Neonatal Mortality in
Weekend vs Weekday Births
Jeffrey B. Gould, MD, MPH;
Cheng Qin, MD, MPH; Amy R. Marks, MPH;
Gilberto Chavez, MD, MPH
JAMA. 2003;289:2958-2962.
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.
Author Affiliations: School of Public
Health, University of California, Berkeley (Drs Gould
and Qin and Ms Marks), and Maternal and Child Health
Branch, California Department of Health Services,
Sacramento (Dr Chavez). Dr Gould is now with the
Division of Neonatal and Developmental Medicine,
Stanford University, Palo Alto, Calif.
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JAMA. 2003;289:2905.
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