Risks higher for babies born out of working hours

A study of more than 500 infant deaths found that babies born outside the hours of 9am to 5pm, Monday to Friday, were more at risk – an extra one or two deaths per 10,000 live births.

The babies were significantly more likely to die from a lack of oxygen than those born during usual working hours, experts said.

They believe one possible reason for the extra risk is a lack of immediate access to senior staff at weekends and during the evenings.

It comes after research published last month found patients were more likely to die if they were admitted to hospital at weekends.

A major report in June also said the NHS was "too reliant" on trainees outside of normal working hours and called on consultants to work more flexibly.

For the latest study, cases from Scotland were analysed but experts said there was no reason to believe the picture was not the same across the UK.

Professor of obstetrics and gynaecology Gordon Smith and colleagues from the University of Cambridge analysed 539 neo-natal deaths among more than a million births in Scotland between between 1985 and 2004.

The deaths occurred at birth or in the first four weeks of life and were not related to congenital abnormalities.

All the births analysed were at or around full-term and were single births only, excluding twins or triplets.

The overall risk of death was 4.2 per 10,000 live births during the working week, rising to 5.6 per 10,000 at all other times.

Around half of the 539 deaths recorded were due to a lack of oxygen. The experts said the higher rate of death out of hours was due to "a significant excess risk" – 70 per cent higher - of the baby dying due to lack of oxygen.

Even when planned Caesarean sections were excluded (which have a very low risk of death from lack of oxygen), there was still a 45 per cent increased risk of death due to lack of oxygen when the baby was born out of hours.

The increased risk to the baby of being born out of hours accounted for around one in four of all deaths from lack of oxygen.

All the results held true even when factors likely to influence the results - such as a mother's age and social class - were taken into account.

Writing online in the British Medical Journal (BMJ), the experts said there could be several reasons for the findings.

"For example, it could be explained by variation in staffing at different times of day, such as the total number of staff or the profile of staff, in particular the immediate availability of senior clinicians.

"It could also be related to access to clinical facilities, such as obstetric operating theatres," they said.

They said tiredness among staff was unlikely to be to blame because the women themselves were at no higher risk of dying out of hours.

They concluded: "Improving the level of clinical care for women delivered out of normal working hours might reduce overall rates of perinatal death."

The Royal College of Obstetricians and Gynaecologists (RCOG) said previous data from the National Patient Safety Agency showed the most severe incidents relating to babies occur between 8pm and 4am.