Relationships Among Neonatal Mortality, Hospital Volume, Weekday Demand, and Weekend Birth

Background Research findings indicate that hospital volume affects the quality of care, that quality and demand for care on weekends differs from weekdays, and that giving birth on the weekend increases odds of neonatal mortality. Purpose To explore relationships among neonatal mortality, hospital volume, weekday demand for services, and weekend birth and risk of neonatal mortality. Methods For this retrospective, population-based, cohort study design, data were obtained from 32,140 electronic birth certificate records matched with 92 death certificate records from the Texas Department of State Health Services for 2012. Statistical analyses include descriptive procedures, analysis of variance, bivariate correlation, t-test, logistic regression, and chi-square tests of association. Results Higher hospital birth volume and higher concentrations of births during the week were associated with fewer neonatal deaths. Weekend births were associated not only with higher rates of neonatal death but also with lower birth weight and ethnicity of the mother. Conclusions These findings suggest the need for further study of the ways hospital-level organization of services and resources interact with individual risk factors to play a significant role in raising the neonatal mortality risk associated with weekend birth.