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Association of timing of birth with mortality among preterm infants born in Canada

Journal of Perinatology volume 41, pages 2597–2606 (2021)Cite this article

Subjects

Abstract

Objective

To assess the association between time of birth and mortality among preterm infants.

Study design

Population-based study of infants born 22–36 weeks gestation (GA) in Canada from 2010 to 2015 (n = 173 789). Multivariable logistic regression models assessed associations between timing of birth and mortality.

Result

Among infants 22–27 weeks GA, evening birth was associated with higher mortality than daytime birth (adjusted odds ratio [AOR] 1.14, 95% CI 1.01–1.29). Among infants 28–32 weeks GA and 33–36 weeks GA, night birth was associated with lower mortality than daytime birth (AOR 0.75, 95% CI 0.59–0.95; AOR 0.78, 95% CI 0.62–0.99, respectively). Sensitivity analysis excluding infants with major congenital anomaly revealed that associations between hour of birth and mortality among infants born 28–32 and 33–36 weeks GA decreased or were not statistically significant.

Conclusion

Higher mortality among extremely preterm infants during off-peak hours may suggest variations in available resources based on time of day.

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Fig. 1: Study flow chart.

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Acknowledgements

The authors thank all site investigators and data abstractors of the Canadian Neonatal Network (CNN) and the Canadian Preterm Birth Network (CPTBN). A list of Network member investigators and their affiliations is provided below. We thank Heather McDonald Kinkaid, PhD, for editorial support in preparing this manuscript. Dr. Kinkaid is a scientific writer employed with the Maternal-infant Care Research Centre (MiCare) at Mount Sinai Hospital in Toronto, Ontario, Canada; and receives a salary for her work. We thank other MiCare staff for organizational support.

Canadian Neonatal Network (CNN) and the Canadian Preterm Birth Network

Haim Abenhaim8, Jehier Afifi9, Ruben Alvaro10, James Andrews11, Anthony Armson9, Francois Audibert12, Khalid Aziz13, Marilyn Ballantyne14, Jon Barrett15, Marc Beltempo16, Anick Berard17, Valerie Bertelle18¸ Lucie Blais17, Alan Bocking19, Jaya Bodani20, Jason Burrows21, Kimberly Butt4, Roderick Canning22, George Carson20, Nils Chaillet23, Sue Chandra13, Paige Church24, Zenon Cieslak25, Kevin Coughlin26, Joan Crane27, Dianne Creighton28, Orlando Da Silva29¸ Thierry Daboval30, Leanne Dahlgren31, Sibasis Daspal32, Cecilia de Cabo33, Akhil Deshpandey27, Kimberly Dow34, Christine Drolet35, Michael Dunn24, Salhab el Helou36, Darine El-Chaar30, Walid El-Naggar9, Carlos Fajardo28, Jonathan Foster37, Robert Gagnon16, Rob Gratton29, Victor Han38, Adele Harrison39, Shabih Hasan40, Michael Helewa10, Matthew Hicks41, KS Joseph42, Andrzej Kajetanowicz43, Zarin Kalapesi20, May Khairy44, Thierry Lacaze-Masmonteil45, Kyong-Soon Lee46, Brigitte Lemyre47, Abhay Lodha48, Deepak Louis49, Thuy Mai Luu50, Linh Ly46, Annette Majnemer44, Hala Makary51, Isabelle Marc23, Edith Masse18, Sarah D McDonald52, Doug McMillan10, Nir Melamed24, Amy Metcalfe53, Diane Moddemann33, Luis Monterrosa11, Michelle Morais36, Amit Mukerji36, William Mundle54, Lynn Murphy22, Kellie Murphy19, Anne-Monique Nuyt12, Chuks Nwaesei54, Karel O’Brien19, Martin Offringa46, Cecil Ojah11, Annie Ouellet18, Jean-Charles Pasquier55, Petros Pechlivanoglou46, Ermelinda Pelausa8, Bruno Piedboeuf23, Elodie Portales-Casamar56, Shahirose Premji40, Pramod Puligandla44, Eleanor Pullenayegum46, Amber Reichert57, Kate Robson37, Carol Schneider58, Mary Seshia58, Prakesh S Shah19, Vibhuti Shah19, Rebecca Sherlock21, Sandesh Shivananda42, Nalini Singhal28, Erik Skarsgard59, Amanda Skoll60, Graeme Smith34, Anne Synnes42, Katherine Thériault35, Joseph Ting60, Suzanne Tough40, Jennifer Toye13, Jagdeep Ubhi25, Michael Vincer9, Wendy Whittle19, Hilary Whyte46, Doug Wilson48, Stephen Wood48, Philip Ye19, Wendy Yee48, Jill Zwicker42

Funding

This study was supported by a grant from the Canadian Institutes of Health Research (CIHR) funding the Canadian Preterm Birth Network (PBN 150642). Organizational support for the Canadian Neonatal Network and the Canadian Preterm Birth Network was provided by the Maternal-infant Care Research Centre (MiCare) at Mount Sinai Hospital in Toronto, Ontario, Canada. MiCare is supported by a CIHR Team Grant (CTP 87518), the Ontario Ministry of Health and Long-Term Care, and the participating hospitals. Prakesh Shah holds a CIHR Applied Research Chair in Reproductive and Child Health Services and Policy Research (APR-126340). Marc Beltempo holds an Early Career Investigator Grant from the CIHR Institute of Human Development, Child and Youth Health (IHDCYH). The funding agencies had no role in the design or conduct of the study; the collection, management, analysis, or interpretation of the data; the preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada

    Angelo Rizzolo & Marc Beltempo

  2. Departments of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, ON, Canada

    Prakesh S. Shah

  3. Department of Pediatrics, University of Sherbrooke, Sherbrooke, QC, Canada

    Valerie Bertelle

  4. Department of Pediatrics, Dr. Everett Chalmers Hospital, Fredericton, NB, Canada

    Hala Makary & Kimberly Butt

  5. Maternal-infant Care Research Centre, Mount Sinai Hospital, Toronto, ON, Canada

    Xiang Y. YE

  6. Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, QC, Canada

    Haim A. Abenhaim

  7. Department of Pediatrics, Université Laval, Quebec, QC, Canada

    Bruno Piedboeuf

  8. Jewish General Hospital, Montréal, QC, Canada

    Haim Abenhaim & Ermelinda Pelausa

  9. IWK Health Centre, Halifax, NS, Canada

    Jehier Afifi, Anthony Armson, Walid El-Naggar & Michael Vincer

  10. St. Boniface General Hospital, Winnipeg, MB, Canada

    Ruben Alvaro, Michael Helewa & Doug McMillan

  11. Saint John Regional Hospital, Saint John, NB, Canada

    James Andrews, Luis Monterrosa & Cecil Ojah

  12. Hôpital Sainte-Justine, Montréal, QC, Canada

    Francois Audibert & Anne-Monique Nuyt

  13. Royal Alexandra Hospital, Edmonton, AB, Canada

    Khalid Aziz, Sue Chandra & Jennifer Toye

  14. Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada

    Marilyn Ballantyne

  15. Sunnybrook Health Sciences Center, Sunnybrook Research Institute, Toronto, ON, Canada

    Jon Barrett

  16. McGill University Health Centre, Montréal, QC, Canada

    Marc Beltempo & Robert Gagnon

  17. Université de Montréal, Montréal, QC, Canada

    Anick Berard & Lucie Blais

  18. Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada

    Valerie Bertelle, Edith Masse & Annie Ouellet

  19. Mount Sinai Hospital, Toronto, ON, Canada

    Alan Bocking, Kellie Murphy, Karel O’Brien, Prakesh S. Shah, Vibhuti Shah, Wendy Whittle & Philip Ye

  20. Regina General Hospital, Regina, SK, Canada

    Jaya Bodani, George Carson & Zarin Kalapesi

  21. Surrey Memorial Hospital, Surrey, BC, Canada

    Jason Burrows & Rebecca Sherlock

  22. Moncton Hospital, Moncton, NB, Canada

    Roderick Canning & Lynn Murphy

  23. Université Laval, Québec City, QC, Canada

    Nils Chaillet, Isabelle Marc & Bruno Piedboeuf

  24. Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Paige Church, Michael Dunn & Nir Melamed

  25. Royal Columbian Hospital, New Westminster, BC, Canada

    Zenon Cieslak & Jagdeep Ubhi

  26. London, ON, Canada

    Kevin Coughlin

  27. Janeway Children’s Health and Rehabilitation Centre, St. John’s, NL, Canada

    Joan Crane & Akhil Deshpandey

  28. Alberta Children’s Hospital, Calgary, AB, Canada

    Dianne Creighton, Carlos Fajardo & Nalini Singhal

  29. London Health Sciences Centre, London, ON, Canada

    Orlando Da Silva & Rob Gratton

  30. Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada

    Thierry Daboval & Darine El-Chaar

  31. Children’s & Women’s Health Centre of BC, Vancouver, BC, Canada

    Leanne Dahlgren

  32. Royal University Hospital, Saskatoon, SK, Canada

    Sibasis Daspal

  33. University of Manitoba, Winnepeg, MB, Canada

    Cecilia de Cabo & Diane Moddemann

  34. Kingston General Hospital, Kingston, ON, Canada

    Kimberly Dow & Graeme Smith

  35. Centre Hospitalier Universitaire de Québec, Sainte Foy, QC, Canada

    Christine Drolet & Katherine Thériault

  36. Hamilton Health Sciences Centre, Hamilton, ON, Canada

    Salhab el Helou, Michelle Morais & Amit Mukerji

  37. Canadian Premature Babies Foundation, Toronto, ON, Canada

    Jonathan Foster & Kate Robson

  38. University of Western Ontario, London, ON, Canada

    Victor Han

  39. University of Calgary, Calgary, AB, Canada

    Adele Harrison, Shabih Hasan, Shahirose Premji & Suzanne Tough

  40. University of Alberta, Edmonton, AB, Canada

    Matthew Hicks

  41. University of British Columbia, Vancouver, BC, Canada

    K. S. Joseph, Sandesh Shivananda, Anne Synnes & Jill Zwicker

  42. Cape Breton Regional Hospital, Sydney, NS, Canada

    Andrzej Kajetanowicz

  43. McGill University, Montréal, QC, Canada

    May Khairy, Annette Majnemer & Pramod Puligandla

  44. Alberta Health Services and the Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

    Thierry Lacaze-Masmonteil

  45. Hospital for Sick Children, Toronto, ON, Canada

    Kyong-Soon Lee, Linh Ly, Martin Offringa, Petros Pechlivanoglou, Eleanor Pullenayegum & Hilary Whyte

  46. Children’s Hospital of Eastern Ontario and Ottawa General Hospital, Ottawa, ON, Canada

    Brigitte Lemyre

  47. Foothills Medical Centre, Calgary, AB, Canada

    Abhay Lodha, Doug Wilson, Stephen Wood & Wendy Yee

  48. University of Manitoba, Winnipeg, MB, Canada

    Deepak Louis

  49. University of Montréal, Montréal, QC, Canada

    Thuy Mai Luu

  50. Victoria General Hospital, Victoria, BC, Canada

    Hala Makary

  51. McMaster University, Hamilton, ON, Canada

    Sarah D. McDonald

  52. Foothills Medical Centre, University of Calgary, Calgary, AB, Canada

    Amy Metcalfe

  53. Windsor Regional Hospital, Windsor, ON, Canada

    William Mundle & Chuks Nwaesei

  54. Université de Sherbrooke, Sherbrooke, QC, Canada

    Jean-Charles Pasquier

  55. BC Children’s Hospital, Vancouver, ON, Canada

    Elodie Portales-Casamar

  56. Glenrose Rehabilitation Hospital, Edmonton, AB, Canada

    Amber Reichert

  57. Winnipeg Health Sciences Centre, Winnipeg, MB, Canada

    Carol Schneider & Mary Seshia

  58. Children’s Hospital, Vancouver, BC, Canada

    Erik Skarsgard

  59. Women’s Hospital and Health Center, Vancouver, BC, Canada

    Amanda Skoll & Joseph Ting

Authors
  1. Angelo Rizzolo
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  2. Prakesh S. Shah
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  3. Valerie Bertelle
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  4. Hala Makary
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  5. Xiang Y. YE
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  6. Haim A. Abenhaim
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  7. Bruno Piedboeuf
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  8. Marc Beltempo
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Consortia

on behalf of the Canadian Neonatal Network (CNN) and Canadian Preterm Birth Network (CPTBN) Investigators

  • Haim Abenhaim
  • , Jehier Afifi
  • , Ruben Alvaro
  • , James Andrews
  • , Anthony Armson
  • , Francois Audibert
  • , Khalid Aziz
  • , Marilyn Ballantyne
  • , Jon Barrett
  • , Marc Beltempo
  • , Anick Berard
  • , Valerie Bertelle
  • , Lucie Blais
  • , Alan Bocking
  • , Jaya Bodani
  • , Jason Burrows
  • , Kimberly Butt
  • , Roderick Canning
  • , George Carson
  • , Nils Chaillet
  • , Sue Chandra
  • , Paige Church
  • , Zenon Cieslak
  • , Kevin Coughlin
  • , Joan Crane
  • , Dianne Creighton
  • , Orlando Da Silva
  • , Thierry Daboval
  • , Leanne Dahlgren
  • , Sibasis Daspal
  • , Cecilia de Cabo
  • , Akhil Deshpandey
  • , Kimberly Dow
  • , Christine Drolet
  • , Michael Dunn
  • , Salhab el Helou
  • , Darine El-Chaar
  • , Walid El-Naggar
  • , Carlos Fajardo
  • , Jonathan Foster
  • , Robert Gagnon
  • , Rob Gratton
  • , Victor Han
  • , Adele Harrison
  • , Shabih Hasan
  • , Michael Helewa
  • , Matthew Hicks
  • , K. S. Joseph
  • , Andrzej Kajetanowicz
  • , Zarin Kalapesi
  • , May Khairy
  • , Thierry Lacaze-Masmonteil
  • , Kyong-Soon Lee
  • , Brigitte Lemyre
  • , Abhay Lodha
  • , Deepak Louis
  • , Thuy Mai Luu
  • , Linh Ly
  • , Annette Majnemer
  • , Hala Makary
  • , Isabelle Marc
  • , Edith Masse
  • , Sarah D. McDonald
  • , Doug McMillan
  • , Nir Melamed
  • , Amy Metcalfe
  • , Diane Moddemann
  • , Luis Monterrosa
  • , Michelle Morais
  • , Amit Mukerji
  • , William Mundle
  • , Lynn Murphy
  • , Kellie Murphy
  • , Anne-Monique Nuyt
  • , Chuks Nwaesei
  • , Karel O’Brien
  • , Martin Offringa
  • , Cecil Ojah
  • , Annie Ouellet
  • , Jean-Charles Pasquier
  • , Petros Pechlivanoglou
  • , Ermelinda Pelausa
  • , Bruno Piedboeuf
  • , Elodie Portales-Casamar
  • , Shahirose Premji
  • , Pramod Puligandla
  • , Eleanor Pullenayegum
  • , Amber Reichert
  • , Kate Robson
  • , Carol Schneider
  • , Mary Seshia
  • , Prakesh S. Shah
  • , Vibhuti Shah
  • , Rebecca Sherlock
  • , Sandesh Shivananda
  • , Nalini Singhal
  • , Erik Skarsgard
  • , Amanda Skoll
  • , Graeme Smith
  • , Anne Synnes
  • , Katherine Thériault
  • , Joseph Ting
  • , Suzanne Tough
  • , Jennifer Toye
  • , Jagdeep Ubhi
  • , Michael Vincer
  • , Wendy Whittle
  • , Hilary Whyte
  • , Doug Wilson
  • , Stephen Wood
  • , Philip Ye
  • , Wendy Yee
  •  & Jill Zwicker

Contributions

AR and MB were responsible for designing and writing the protocol, interpreting results, and redacting this manuscript. XYY was responsible for statistical analysis and generating the tables. PSS, VB, HM, XYY, HAA, and BP were responsible for reviewing the manuscript.

Corresponding author

Correspondence to Marc Beltempo.

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Conflict of interest

The authors declare no competing interest.

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Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Members of the Canadian Neonatal Network (CNN) and Canadian Preterm Birth Network (CPTBN) are listed below Acknowledgements.

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Rizzolo, A., Shah, P.S., Bertelle, V. et al. Association of timing of birth with mortality among preterm infants born in Canada. J Perinatol 41, 2597–2606 (2021). https://doi.org/10.1038/s41372-021-01092-9

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