This is à question which occurs in various contexts of course. Postpartum care, but also NICU or even days of hospitalization (1st day in hospital is in effect day 0). One way of sorting that one out is to use postpartum / postnatal hours. Eg baby died at H 60. Still leaves us with improper reporting of babies who die in the 1st hour of life which should be H0. But from an operational viewpoint this is usually immaterial.
A second topic where counting is not always coherent is parity. During pregnancy the lady who has not yet given birth is para 0, and after she is para 1. But countries, or even teams or individuals may disagree on the exact moment: in 3d stage is she para 0 or 1? At the John Radcliffe hospital in Oxford, on labour ward, they used in the 80's the notation para 0>1 which has the benefit of clarity but is orobably incompatable with computerised data collection. in the EUPHRATES trial, for some hospitals, and despite unambiguous instructions on the data collection form, we found variations according to hour of day, probably because the midwives on night shifts had had less complete explications about the trial. We could not do so-called "logical transformation of all parae 0 to parae 1, because it would have required pushing every birth up for a goven midwife, but we could not identify the midwife in charge for filling in the form on a given cqse! In addition, some places count para 0 after a CSection, and people disagree about twins (1 or 2 added parity). There is quite a good paper in the BJOG which discusses this topic, somebody might have the reference easily.
A 3d topic where coherence is lacking is the famous "completed" weeks concept fo GA. for let's say 32 completed does it mean: (a) the seven day span from 32+0 to 32+6 or on the other hand the seven days time span from 32 +6 to 33 + 5, or something else such as just one specific day on which the woman becomes 32 completed.
Amusingly, even in a large project like EUROPERISTAT we have observed lack of consistency and made our definitions as clear as possible, but have not tried to tackle the differences. I believe up to a point FIGO Has tried to give definitions but without checking on results in the countries.
I believe this is a very interesting topic of misclassification bias due to definition differences, requiring more objective research and results from the field in various countries and settings, and potentially coctitutes a partial explanation fo some of the observed differences.
Sophie Alexandrr
Brussels
finally to disagree on theAs far as national mortality statistics are concerned, I think what happens relates simply to lack of recording of time of birth in birth registration systems, except for multiple births. The age at death is derived by subtracting the date of birth from the date of death. So if a baby dies on the day it is born, the age at death is 0 days and if the death occurs the next day, it is 1 day. This happens irrespective of the unrecorded hours since birth.
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>Alison macfarlane
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>From: Coxon, Kirstie [mailto:[log in to unmask]]
>Sent: 14 January 2014 14:26
>To: [log in to unmask]
>Subject: Re: day of birth: postnatal day 1 or 0?
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>Dear Debra and colleagues on jiscmail,
>I am finding this discussion really intriguing ? I have recently returned to clinical practice after 10 years. I remember the day of birth being exactly as Debra says is used to be below (day 1 if birth before midday etc) and I?d carried on doing that ? I asked midwife colleagues if this was still the case and didn?t find any consensus about this, and I hadn?t realised it had formally changed in the interim. I wonder why midwives number days in this way ? it seems a bit odd, and not too helpful for observing newborn adaptations in relation to breastfeeding or jaundice levels. Wouldn?t it be better to think in terms of how many hours old the baby is?
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>Kirstie Coxon (UK)
>
>From: A forum for discussion on midwifery and reproductive health research [mailto:[log in to unmask]] On Behalf Of Debra Kroll
>Sent: 14 January 2014 14:15
>To: [log in to unmask]<mailto:[log in to unmask]>
>Subject: Re: day of birth: postnatal day 1 or 0?
>
>In the UK the day of birth is always Day 0 . It used to be day 1 if birth was before 12midday and day 0 if after 12 midday and before midnight. I believe it changed for 2 reasons the first to do with IT systems and the second was when the timing for the newborn blood spot screening became important . Debra Kroll community midwife clinical lead
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>On Tuesday, 14 January 2014, Paula wrote:
>How does each country define the day of birth? As postnatal day 1 or 0? Or does this, for example, depend on the time of the day the child was born? In The Netherlands, day one is defined as the day of birth. Althought I have heard that this may depend on the time of the day (day 0 when born after 7 pm). So for example, if a child has a (postnatal) age 4, how old is this child? Three (i.e. approximately 72 hours) or four days (i.e. approximately 96 hours) old?
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>Debra Kroll
>Midwife (UCLH)
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