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To the Editor: Dr Gould and colleagues¹ concluded that the higher neonatal mortality rates on weekends might be decreased by shifting high-risk deliveries from weekends to weekdays. We have 3 concerns about this conclusion. First, if this strategy were to improve the prognosis of such births, this would also result in an apparently higher mortality rate for weekend births.

Second, although the authors' analyses account for birth weight categories as well as lethal congenital malformations, we are uncertain whether this approach fully adjusts for these biases. A simple way to minimize such bias would be to restrict the analyses to those births in which the time of birth was unaffected by obstetrical intervention (eg, spontaneous vaginal births or emergency cesarean deliveries). Similar strategies have been reported in analyses of weekend vs weekday mortality among adult patients.²

Third, if an increased mortality in weekend births is attributable to a decreased provision . . . [Full Text of this Article]

Günther Heller, MD
Research Institute of the Local Healthcare Funds (WIdO)
Bonn, Germany

Rainer Schnell, PhD
University of Konstanz
Konstanz, Germany

Björn Misselwitz, MPH
Institute of Quality Assurance Hesse
Eschborn, Germany

Stephan Schmidt, PhD
University of Marburg
Marburg, Germany

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