Sudden unexpected infant deaths associated with car seats

Bamber, AR; Pryce, Jeremy; Ashworth, Michael; Sebire, Neil J.

doi:10.1007/s12024-013-9524-5

Cited by 15 publications

(12 citation statements)

References 17 publications

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“…3 A second retrospective review highlighted 14 car seat associated unexplained infant deaths out of 1465 autopsies, 10 of which were outside of travel use. 4 This supports recommendations that car seats should be used for travel only. 5 3 further articles identified from references highlighted work demonstrating reduced oxygen saturations in infants in simulated moving car seats.…”

supporting

confidence: 67%

G96(P) Are white cells in children’s urine diagnostic or a distraction, and does collection and culture method matter? new data from 4910 acutely unwell children

et al. 2018

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AimsTo describe the relationship between urine white cell count (WCC) and the microbiological diagnosis of UTI in acutely unwell children, and explore the influence of culture and collection method.MethodsMulti-centre, prospective, cohort study of acutely unwell children aged 3 months-5 years presenting to UK primary care whose urine samples were collected by clean catch or nappy pad, and cultured by both a Central Laboratory (CL) using spiral-plating, and Local NHS Laboratories (LL) using standard practice. Positive and negative predictive values (PPV and NPV) of diagnosing UTI were calculated for WCC ≥100/mm3 and WCC ≤10/mm3 respectively, comparing laboratories and sampling methods.ResultsOf 4910 samples, 1.9% had UTI in the CL and 5.3% in the LL.Table 1 outlines the PPV of WCC ≥100/mm3 and NPV of WCC ≤10/mm3 for diagnosing UTI by laboratory culture and sampling method.Abstract G96(P) Table 1 CL culture LL culture All Samples Clean Catch Nappy Pad All Samples Clean Catch Nappy Pad PPV of WCC≥ 100/mm3 23.9 % [17.5–31.6%] 33.3 % [25.0–42.8%] 0 30.3 % [22.7–39.1%] 38.7 % [29.3–49.0%] 6.9 % [1.8–23.6%] NPV of WCC≤ 10/mm3 99.0 % [98.7–99.2%] 99.3 % [98.9–99.5%] 98.6 % [98.3–98.9%] 95.8 % [95.4–96.2%] 97.7 % [97.2–98.2%] 93.6 % [92.9–94.2%] ConclusionsLocal NHS Labs diagnose almost 3x more UTIs than a reference Central Laboratory. Many of these may be false positives.A WCC ≥100/mm3 poorly predicts UTI on culture in acutely unwell young children consulting in primary care.Despite WCC≤10/mm3 having a good NPV regardless of collection or culture method, 37 of the 92 positive CL cultures (40%) had WCC≤10/mm3.RecommendationWe propose a diagnostic algorithm selectively utilising spiral-plating culture methods to potentially minimise unnecessary treatment and investigation for 9000 children per year across England and Wales.

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supporting

confidence: 67%

G96(P) Are white cells in children’s urine diagnostic or a distraction, and does collection and culture method matter? new data from 4910 acutely unwell children

et al. 2018

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“…The significance and potential impact of these problems is not clear, 8 9 but there have been reports of deaths of infants who have been left in a sitting position, including in car seats-both on journeys, and when parents have used it as an alternative to a pushchair or cot for the infant to sleep in. [10][11][12][13] One survey noted that 94% of infants, below 5 months of age, spent over 30 min a day in seating devices including car seats. 14 The mean was 5.7 ±3.5 hours.…”

Section: Introductionmentioning

confidence: 99%

Is the infant car seat challenge useful? A pilot study in a simulated moving vehicle

Arya

Williams

Kilonback

et al. 2016

Arch Dis Child Fetal Neonatal Ed

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Background and objectiveThe American Academy of Pediatrics recommends that preterm infants complete a predischarge ‘car seat challenge’ observation for cardiorespiratory compromise while in a car seat. This static challenge does not consider the more upright position in a car or the vibration of the seat when the car is moving. This pilot study was designed to assess the cardiorespiratory effects of vibration, mimicking the effect of being in a moving car, on preterm and term infants.MethodsA simulator was designed to reproduce vertical vibration similar to that in a rear-facing car seat at 30 mph. 19 healthy newborn term and 21 preterm infants, ready for hospital discharge, underwent cardiorespiratory measurements while lying flat in a cot (baseline), static in the seat (30°), simulator (40°) and during motion (vibration 40°).ResultsMedian test age was 13 days (range 1–65 days) and median weight was 2.5 kg (IQR: 2.1–3.1 kg).Compared with baseline observations, only the total number of desaturations was significantly increased when infants were placed at 30° (p=0.03). At 40°, or with vibration, respiratory and heart rates increased and oxygen saturation decreased significantly. Profound desaturations <85% significantly increased during motion, regardless of gestational age.ConclusionsThis is the first study to assess the effect of motion on infants seated in a car safety seat. Term and preterm infants showed significant signs of potentially adverse cardiorespiratory effects in the upright position at 40°, particularly with simulated motion, not identified in the standard challenge. A larger study is required to investigate the significance of these results.

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“…In most of the other 10 cases under study, car seats were being used inappropriately outside of a moving vehicle; in one case the infant died while left unattended. (15) One Canadian study identified 17 deaths over a 10-year period that occurred while infants were in a car seat. Of these, seven were explained by comorbid conditions.…”

Section: What Is the Evidence Linking Adverse Outcomes With Placement In Car Seats?mentioning

confidence: 99%

Assessment of cardiorespiratory stability using the infant car seat challenge before discharge in preterm infants (<37 weeks’ gestational age)

Narvey¹

2016

Paediatrics &Amp; Child Health

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Preterm infants younger than 37 weeks corrected gestational age are at increased risk for abnormal control of respiration. The infant car seat challenge has been used as a screening tool to ensure cardiorespiratory stability before discharging preterm infants from many hospitals in Canada. While it is clear that infants placed in a car seat are more likely to experience oxygen desaturation and/or bradycardia than when they are supine, neither positioning predicts an adverse neurodevelopmental outcome or mortality post-discharge. A review of the literature yielded insufficient evidence to recommend routine use of the infant car seat challenge as part of discharge planning for preterm infants. This finding has prompted a change in recommendation from a previous Canadian Paediatric Society position statement published in 2000.

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Sudden unexpected infant deaths associated with car seats

Cited by 15 publications

References 17 publications

G96(P) Are white cells in children’s urine diagnostic or a distraction, and does collection and culture method matter? new data from 4910 acutely unwell children

G96(P) Are white cells in children’s urine diagnostic or a distraction, and does collection and culture method matter? new data from 4910 acutely unwell children

Is the infant car seat challenge useful? A pilot study in a simulated moving vehicle

Assessment of cardiorespiratory stability using the infant car seat challenge before discharge in preterm infants (<37 weeks’ gestational age)

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