Car Seat Tolerance Screening for Late-Preterm Infants

Magnarelli, Aimee; Solanki, Nina Shah; Davis, Natalie L.

doi:10.1542/peds.2019-1703

Cited by 11 publications

(8 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…7 And in a study evaluating latepreterm infants, researchers found that 21% of those who failed .1 CSTS from the NBN ultimately required NICU admission for significant hypoxia and that twothirds subsequently required supplemental oxygen for safe discharge. 20 It remains unclear whether CSTS failure unnecessarily prolongs inpatient admission or properly identifies infants at risk for unstable cardiorespiratory status before discharge, thereby preventing adverse postdischarge outcomes, which is why more research is needed.…”

Section: Provider Attitudesmentioning

confidence: 99%

Variation in Car Seat Tolerance Screen Performance in Newborn Nurseries

2020

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Section: Provider Attitudesmentioning

confidence: 99%

Variation in Car Seat Tolerance Screen Performance in Newborn Nurseries

2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…(1) information related to car bed screening procedures; (2) constant adult observation of the infant while in the car bed; (3) ensuring that the infant is securely strapped into the car bed and the car bed is properly secured within the automobile; and (4) that a repeat CSTS be performed and passed before transitioning the infant to a traditional car seat. 11 When an infant fails the CSTS and is discharged in a car bed, child passenger safety experts recommend repeating the CSTS based on factors including infant age, resolution of symptoms, and evidence of neurobehavioral maturation.…”

mentioning

confidence: 99%

“…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. 1,[4][5][6][7][8][9][10][11] Physical characteristics of infants at risk for car seatrelated oxygen desaturation events include prematurity, underdeveloped neck muscles, poor head control resulting from the head being relatively large in proportion to body, low birth weight, change in breathing pattern during sleep, heart disease, lung disease, congenital heart disease, and neurological conditions.…”

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

View full text Add to dashboard Cite

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.

show abstract

“…The article by Magnarelli et al 1 in this issue of Pediatrics highlights 3 major issues of importance to clinicians and families caring for infants born late preterm. One is the importance of determining cardiorespiratory stability, especially before being tested for car seat tolerance in preparation for discharge; the second is the importance of appropriate use of car safety seats at the time of hospital discharge; and the third is the value of having a hospital discharge policy in place.…”

mentioning

confidence: 99%

“…5 Use of the hospital policy will expedite having the child's own car safety seat available for the screen, implementation of the CSTS, and providing instruction for caregivers before discharge. Although the Magnarelli et al 1…”

mentioning

confidence: 99%