Can we reduce episodes of haemoglobin desaturation in full‐term babies restrained in car seats?

Tonkin, S; McIntosh, Christine G.; Nixon, Gillian M.; Rowley, Simon; Gunn, Alistair J.

doi:10.1111/j.1651-2227.2007.00584.x

Cited by 9 publications

(9 citation statements)

References 26 publications

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“…Furthermore, infants sleeping in the car seat with the insert had fewer obstructive apneic events, supporting the hypothesis that the insert can help reduce obstruction of the upper airway. 9,10,13 Consistent with previous studies, 3,[6][7][8][9] episodes of transient mild to moderate desaturation were common in otherwise healthy full-term infants restrained in car safety seats. Kornhauser and colleagues, for example, have elegantly shown that term infants have many more desaturations in a car seat than while resting in a crib (mean 17 vs 6 per hour), with significantly lower mean and minimum oxygen saturations.…”

Section: Discussionsupporting

confidence: 77%

“…5,6 Disturbingly, there is compelling evidence that mild desaturations are also common in healthy full-term infants. [6][7][8][9] For example, Merchant et al reported that term infants showed a decline in mean SpO 2 from 97% in the supine position to 94% after 60 minutes in their car safety seats; 8% had SpO 2 values of ,90% for longer than 20 minutes. 8 Similarly, Kornhauser et al found that the time that infants' SpO 2 was ,95% increased from 6.5% while lying in crib to 24% while restrained in a car seat.…”

Section: Discussionmentioning

confidence: 99%

“…13 In term infants, a small nonrandomized pilot study suggested that the insert was associated with a significant reduction in the rate of mild apnea (from a median of 9.2 to 4.4 events/hour). 9 In the current study, we tested in a prospective randomized controlled trial whether a simple foam plastic insert could prevent episodes of reduced oxygenation in healthy young term infants restrained in a car safety seat.…”

Section: Discussionmentioning

confidence: 99%

“…6,7 Furthermore, the great majority of apneic events occurred in active sleep, with few during quiet (or indeterminate) sleep. 9 Thus, the reduction in skeletal muscle tone during active sleep may have allowed greater forward flexion of the head on to the chest, leading to greater narrowing of the upper airway. [21][22][23] Some limitations of the current study should be considered.…”

Section: Figurementioning

confidence: 99%

“…9 Thus, 80 infants was required to have an 80% chance of detecting a two-thirds reduction with the insert. Randomization codes were pregenerated and supplied in numbered, sealed envelopes that were opened on the day of the study.…”

Section: Trial Designmentioning

confidence: 99%

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Randomized Controlled Trial of a Car Safety Seat Insert to Reduce Hypoxia in Term Infants

2013

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WHAT'S KNOWN ON THIS SUBJECT: Brief periods of low oxygen saturation are common in infants while restrained in car safety seats. There is some evidence that an insert that allows the infant head to rest in a neutral position in sleep may reduce hypoxic episodes. WHAT THIS STUDY ADDS:This randomized controlled study shows that the insert reduced numbers of obstructive apneas and the severity of desaturation events but did not significantly reduce the overall rate of moderate desaturations.abstract OBJECTIVE: To test the hypothesis that a foam plastic insert that allows the infant head to rest in a neutral position in sleep may prevent obstruction of the upper airway and thus reduce episodes of reduced oxygenation in term infants in car seats. METHODS:Healthy full-term babies were randomized to be studied during sleep while restrained in an infant car safety seat either with or without the insert, with continuous polysomnographic recordings with sleep video.RESULTS: Seventy-eight infants (39 in each group) had polysomnogram recordings at a mean of 8 days of age. Both groups showed a small fall in mean hemoglobin oxygen saturation (SpO 2 ) over the first hour of sleep. There was no difference between insert and no insert in the rate of moderate desaturations (a fall in SpO 2 $4% lasting for $10 seconds, mean 6 SEM, 17.0 6 1.5 vs 17.2 6 1.5/hour), or mean SpO 2 during sleep. The insert was associated with a significant reduction in the rate of obstructive apnea (0.3 6 0.1 vs 0.9 6 1.5/hour, P , .03), the severity of desaturation events (minimum SpO 2 82% 6 1% vs 74% 6 2%, P , .001), and time with SpO 2 ,85% (0.6% 6 0.3% vs 1.8% 6 1.4%, P = .03). CONCLUSIONS:In full-term newborn infants, a car seat insert that helps the head to lie in a neutral position was associated with reduced severity of desaturation events but not the overall rate of moderate desaturations. Pediatrics 2013;132:326-331

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Figurementioning

confidence: 99%

Section: Trial Designmentioning

confidence: 99%

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Randomized Controlled Trial of a Car Safety Seat Insert to Reduce Hypoxia in Term Infants

2013

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Simultaneous sudden unexpected death in infancy of twins: case report

2010

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Simultaneous sudden infant death syndrome (SIDS) in twins is an extremely rare event. Some believe these are natural deaths, whereas others suggest they are unnatural. We report monozygotic twins dying at 12 weeks of age. Extensive investigation concluded that the cause of death was natural. Our case fulfilled the criteria of simultaneous SIDS in twins. However, thermal stress due to excessive thermal insulation, use of a pillow and placing twins in the same cot all represent a potentially unsafe sleeping environment. We recommend the term "simultaneous sudden unexpected death in infancy of twins" to describe such cases.

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Sudden unexpected infant deaths associated with car seats

Bamber

Pryce

Ashworth

et al. 2014

Forensic Sci Med Pathol

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The purpose of this study was to investigate the frequency, circumstances, demographics, and causes of death of infants dying while seated in car safety seats. A retrospective review of a pediatric autopsy database at a specialist center over a 16-year period was undertaken to identify any infant deaths (aged <1 year), in whom death occurred while seated in a car safety seat. Fourteen car seat-associated deaths were identified from a total of 1,465 coronial infant autopsies (0.96 %). Four involved infants were being appropriately transported in the car seat, all of whom had a medical underlying cause of death (one infection and three congenital heart disease). The majority (10 cases; 70 %) occurred while car seats were being inappropriately used, outside of the car, including as an alternative to a cot or high-chair. Five of these infants died of explained causes, but four deaths remained unexplained after autopsy, and in one no cause of death was available. There were no cases of previously healthy infants dying unexpectedly in a car seat when it was being used appropriately, and in this series there were no cases of traumatic death associated with car seats, either during road traffic accidents, or from falling or being suspended from a car seat. Infant deaths in car seats are rare. These data support the recommendation that car seats be used only for transport and not as alternatives for cots or high-chairs. More research is required to investigate the effect of travel in car seats on infants with underlying conditions. There appears to be no increased risk of unexpected deaths of healthy infants transported appropriately in car seats.

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Can we reduce episodes of haemoglobin desaturation in full‐term babies restrained in car seats?

Abstract: A car seat insert that allows the newborn's head to lie in a neutral position during sleep may reduce the frequency of mild episodes of reduced SpO2 in some full-term newborn babies.

Cited by 9 publications

References 26 publications

Randomized Controlled Trial of a Car Safety Seat Insert to Reduce Hypoxia in Term Infants

Randomized Controlled Trial of a Car Safety Seat Insert to Reduce Hypoxia in Term Infants

Simultaneous sudden unexpected death in infancy of twins: case report

Sudden unexpected infant deaths associated with car seats

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