Assessing the Influence of Shift Timing on Mortality Rates in <32-Week Preterm Infants

Quality of continuous patient care is crucial in neonatal intensive care units (NICUs). Staff numbers and intervention timings may vary with working hours, potentially affecting clinical outcomes. However, the effect of on- and off-duty hours on neonatal mortality remains unclear. This study examined the clinical data of deceased premature infants during these hours and assessed mortality frequency over time.

A retrospective cohort analysis was performed at a single institution, focusing on deceased infants born at ≤ 32 weeks' gestation (WG). The study classified patients based on their time of death using two methods: on-duty versus off-duty periods and three consecutive eight-hour shifts across the day.

Overall, 256 deceased premature infants (on-duty group: 66 (25.8%); off-duty group: 190 (74.2%)) were enrolled. The off-duty period lasted approximately three times longer than the on-duty period, with a corresponding three-fold increase in the mortality rate. During off-duty hours, the number of medical doctors was 4.5 times fewer than that during on-duty hours. Nevertheless, mortality rates per unit time were comparable between the groups. Additionally, the clinical characteristics and morbidities of patients across the groups exhibited similar profiles.

Despite a 4.5-fold decrease in physicians working during off-duty hours in our NICU, the mortality and morbidity rates for infants born at or before 32 WG remained unchanged.