A National Survey of Car Seat Tolerance Screening Protocols in Neonatal Intensive Care Units

Davis, Natalie L.; Cheo, S W

doi:10.1016/j.acap.2020.02.004

Cited by 7 publications

(11 citation statements)

References 19 publications

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“…23 In 2 recent surveys of NICUs, the SpO 2 and duration constituting failure ranged widely from ,80% to ,93% and from any drop below the threshold to requiring .60 seconds, respectively. 11,12 Similarly, we found that NBNs also have a wide range of SpO 2 failure cutoffs, with values ranging from ,85% to ,93% and a similar duration range. 25 although it is unclear how applicable these data are to otherwise healthy late-preterm infants in NBNs.…”

Section: Provider Attitudessupporting

confidence: 63%

“…9 Additional guidelines for critical elements of the test, including failure criteria, test timing, and follow-up after a failed CSTS, remain either vague or nonexistent, leading to significant variability across the nation. 11,12 In recent surveys of NICUs in the United States, it was found that the hemoglobin-oxygen saturation (SpO 2 ) constituting failure ranged from ,80% to ,93%, whereas the bradycardia definitions ranged from ,70 to ,120 beats per minute (bpm). 11,12 This wide variation means that an infant could pass a CSTS at one site while failing at another, based not on differences in the infant, but on differences in the failure criteria chosen at each institution.…”

mentioning

confidence: 99%

“…11,12 In recent surveys of NICUs in the United States, it was found that the hemoglobin-oxygen saturation (SpO 2 ) constituting failure ranged from ,80% to ,93%, whereas the bradycardia definitions ranged from ,70 to ,120 beats per minute (bpm). 11,12 This wide variation means that an infant could pass a CSTS at one site while failing at another, based not on differences in the infant, but on differences in the failure criteria chosen at each institution. The lack of guidance on specific performance parameters also makes studying the CSTS difficult because variation in failure criteria makes outcomes less generalizable between institutions.…”

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confidence: 99%

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Variation in Car Seat Tolerance Screen Performance in Newborn Nurseries

2020

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BACKGROUND: Currently, car seat tolerance screens (CSTSs) are recommended for all infants born prematurely in the United States. Although many late-preterm infants are cared for exclusively in newborn nurseries (NBNs), data on implementation of CSTS in nurseries are limited. Our objective for this study was to determine management strategies and potential variation in practice of CSTS in NBNs across the nation. METHODS:We surveyed NBNs across 35 states using the Better Outcomes through Research for Newborns (BORN) network to determine what percentage perform CSTSs, inclusion and failure criteria, performance characteristics, follow-up of failed CSTSs including use of car beds, and provider attitudes toward CSTS.RESULTS: Of the 84 NBNs surveyed, 90.5% performed predischarge CSTSs. The most common failure criteria were saturation ,90%, bradycardia ,80 beats per minute, and apnea .20 seconds. More than 55% noted hypotonia as an additional inclusion criterion for testing, and .34% tested any infant who had ever required supplemental oxygen. After an initial failed CSTS, .93% of NBNs retested in a car seat at a future time point, whereas only ∼1% automatically discharged infants in a car bed. When asked which infants should undergo predischarge CSTS, the most common recommendations by survey respondents included infants with hypotonia (83%), airway malformations (78%), hemodynamically significant congenital heart disease (63%), and prematurity (61%).CONCLUSIONS: There is a large degree of variability in implementation of CSTS in NBNs across the United States. Further guidance on screening practices and failure criteria is needed to inform future practice and policy.WHAT'S KNOWN ON THIS SUBJECT: Data on implementation of car seat tolerance screens (CSTSs) in newborn nurseries (NBNs) are limited. Identifying similarities and differences in CSTS practice across the nation in NBNs will help to inform consensus guidelines and focus future research.WHAT THIS STUDY ADDS: In a cross section of NBNs in the United States, we found a large degree of variability when it came to implementation of CSTS, inclusion criteria, failure criteria, and follow-up after an initial CSTS failure.

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Section: Provider Attitudessupporting

confidence: 63%

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confidence: 99%

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confidence: 99%

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Variation in Car Seat Tolerance Screen Performance in Newborn Nurseries

2020

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“…However, whether CSTS prevents morbidity associated with car seat use among infants at-risk is unknown (Pilley & McGuire, 2006 ). Recently, a national survey of well-baby nurseries found wide variation in CSTS and in providers’ thoughts about the utility of CSTS (Davis & Cheo, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

Adherence to Car Seat Tolerance Screening Differs by Indication and Patient Characteristics

McLaurin‐Jiang

Weinberger

Ritter

et al. 2021

Matern Child Health J

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Objectives To assess whether adherence to institutional car seat tolerance screening (CSTS) guidelines differed for infants born preterm (PTM), term low birth weight (T-LBW), or both preterm and low birth weight (P-LBW), and to examine the association between CSTS adherence and patient characteristics. Study Design Within two large academic and community hospitals, we retrospectively reviewed all infants meeting institutional criteria (< 37 weeks’ gestation and/or < 2.27 kg) for CSTS from 2014 to 2018. Multivariable logistic regression evaluated the association of patient characteristics with institutional CSTS guideline adherence. Results 4374 eligible infants were born PTM (50.9%), T-LBW (6.5%), or P-LBW (42.6%). Adherence rates were 92.7% in the neonatal intensive care unit (NICU) and 95.2% in the well-baby nursery with initial CSTS failure rates of 6.1% and 9.9%, respectively. Adherence was lowest among T-LBW (80.7%) compared to PTM (95.1%) or P-LBW (92.2%) infants in the NICU (p < 0.001) and well-baby nursery (81.6%, 96.7% and 97.1%, respectively, p < 0.001). In bivariate analyses, gestational age, birth weight, insurance, race, hospital type, discharge year, and preferred language were associated with adherence. In fully-adjusted models, adherence was positively associated with lower gestational age, higher birth weight, non-Medicaid insurance, and later discharge year (NICU) and lower gestational age and later discharge year (well-baby nursery). Conclusions Adherence was lower for T-LBW than PTM or P-LBW infants, despite similar CSTS failure rates. Disparities in adherence among Medicaid-insured patients in the NICU warrant further study. Future studies are needed to clarify the benefit of CSTS and increase adherence in high-risk populations. Supplementary Information The online version contains supplementary material available at 10.1007/s10995-021-03220-5.

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“…Screening of infants for car seatrelated oxygen desaturation events is referred to as the car seat tolerance screen (CSTS), or alternatively the infant car seat challenge. 1 In the United States, an estimated 19,096 preterm infants (5%) fail the CSTS annually, as well as many full-term infants with complex respiratory and cardiac issues. 2,3 Infants who fail the CSTS are recommended for car bed travel, ambulance travel, or in some instances, hospitalization may be prolonged until they pass the CSTS.…”

mentioning

confidence: 99%

Parental Experiences of Infant Car Bed Use After Failure of Car Seat Tolerance Screen

O'Connor¹,

McGrath²,

DeGrazia³

2021

Advances in Neonatal Care

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Background: Failure of the car seat tolerance screen (CSTS) during hospitalization often leads to a recommendation for automobile travel within a car bed at discharge. Purpose: To describe the parental experience utilizing a car bed for infant automobile transportation. Methods: A descriptive, qualitative study design was undertaken with a purposive sample of parents recruited for a single interview in the pulmonary clinic at the time of the follow-up CSTS, approximately 1 month after hospital discharge. Interviews, guided by a semistructured interview tool, provided a holistic understanding of the parental experience utilizing car bed travel. Findings/Results: Data from 15 parental interviews revealed an overarching emotional journey consisting of 5 themes:(1) an adjustment period; (2) decision-making related to the car bed purchase; (3) encounters with varied provider education and knowledge; (4) safety and security of the car bed during transit; and (5) space and mobility restrictions imposed by the car bed. Implications for Practice: While recommendations exist for infant travel in a car seat, supportive recommendations for parents with an infant who needs to travel in a car bed do not exist. Based on study findings, providing parents supportive guidelines, education, and recommendations for their infant requiring travel in a car bed may be a strategy to ease the stress experienced in this situation. Implications for Research: Findings indicated a need to develop policies and standards, as well as comprehensive education, for providers and parents related to car bed travel. Further research is needed to identify strategies to best support parents and infants.

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A National Survey of Car Seat Tolerance Screening Protocols in Neonatal Intensive Care Units

Cited by 7 publications

References 19 publications

Variation in Car Seat Tolerance Screen Performance in Newborn Nurseries

Variation in Car Seat Tolerance Screen Performance in Newborn Nurseries

Adherence to Car Seat Tolerance Screening Differs by Indication and Patient Characteristics

Parental Experiences of Infant Car Bed Use After Failure of Car Seat Tolerance Screen

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