Timing of birth and infant and early neonatal mortality in Sweden 1973-95: longitudinal birth register study.

OBJECTIVE To assess the impact of time of birth on infant mortality and early neonatal mortality in full term and preterm births. DESIGN Analysis of data from the Swedish birth register, 1973-95. PARTICIPANTS 2 102 324 spontaneous live births of infants without congenital malformation. OUTCOME MEASUREMENTS Absolute and relative risk of infant mortality, early neonatal mortality, and early neonatal mortality related to asphyxia. RESULTS Infant mortality, early neonatal mortality, and early neonatal mortality related to asphyxia were higher in infants who were born during the night (9 pm to 9 am) compared with those born during the day for 1973-9, 1980-9, and 1990-5. The difference was more dramatic for preterm infants. The largest difference was observed during 1990-5, when there was a 30% increase in early neonatal mortality (relative risk 1.31, 95% confidence interval 1.10 to 1.57) and a 70% increase in early neonatal mortality related to asphyxia (1.70, 1.22 to 2.38) in preterm infants born during the night compared with rates for preterm infants born during the day. A detailed analysis over 24 hours revealed two "high risk" periods: between 5 pm and 1 am and around 9 am. CONCLUSIONS Infants born during the night have a greater risk of infant and early neonatal mortality and early neonatal mortality related to asphyxia than those born during the day. There has been no improvement over the past two decades. The problem is more serious for preterm births and was even worse in the 1990s. Shift changes and the hours immediately after such changes are high risk periods for neonatal care.