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Epidemiology and predictors of failure of the infant car seat challenge
Natalie Louise Davis1, Freeman Condon, Lawrence M Rhein
1Division of Newborn Medicine, Boston Children's Hospital, Boston, MA 02115, USA. natalie.davis@childrens.harvard.edu
Insights
The Infant Car Seat Challenge (ICSC) failure rate is 4.3% in premature infants. Increasing gestational age and being late-preterm are significant predictors of ICSC failure, suggesting more selective testing may be needed.
Area of Science:
- Neonatal care
- Pediatric safety
- Clinical outcomes
Background:
- The American Academy of Pediatrics recommends a predischarge Infant Car Seat Challenge (ICSC) for all neonates born before 37 weeks' gestation.
- The ICSC is resource-intensive, with limited data on failure rates and risk factors.
- There is a need to identify predictors of ICSC failure for more selective testing.
Purpose of the Study:
- To determine the incidence of ICSC failure in premature neonates.
- To identify predictors of ICSC failure.
- To inform more selective testing protocols.
Main Methods:
- Retrospective medical record review of 1173 premature neonates.
- Analysis of ICSC results and potential risk factors.
- Bivariate and multivariable logistic regression analyses to identify predictors of failure.
Main Results:
- Overall ICSC failure incidence was 4.3%.
- Infants who failed were less premature and had higher birth weights.
- Late-preterm infants constituted 60% of the study population but 78% of failures (P = .019).
- Increasing birth gestational age (GA) was a significant predictor of failure (OR 1.03 per day increase).
Conclusions:
- Increasing birth GA is a significant predictor of ICSC failure.
- Late-preterm infants represent a substantial proportion of ICSC failures.
- Selective testing based on gestational age could miss a majority of ICSC failures.
Objectives:
The American Academy of Pediatrics recommends all neonates born at <37 weeks' gestation receive a predischarge Infant Car Seat Challenge (ICSC), a resource-intensive test with little information on failure rates and risk factors. We sought to determine incidence and predictors of failure to allow more selective testing.
Methods:
We conducted a retrospective medical record review of 1173 premature neonates qualifying for the ICSC between 2009 and 2010. We looked at ICSC result and potential risk factors and then performed bivariate and multivariable logistic analyses to evaluate for predictors of failure.
Results:
Overall incidence of failure was 4.3%. Infants who failed were less premature and had higher birth weights. Late-preterm infants made up 60% of our study population but accounted for 78% of failures (P = .019). Infants who passed had older chronologic ages at time of testing, were more likely to have been exposed to caffeine, and were more likely to have required some type of respiratory support than those that failed. Final multivariable model demonstrated that increasing birth gestational age (GA) increased the odds of failure when corrected for gender, race, and small for GA status. For every 1-day increase in birth GA the odds ratio of failure was 1.03 (95% confidence interval 1.01-1.05).
Conclusions:
We found that increasing birth GA was a significant predictor of failure, and that late-preterm infants comprised a significant percentage of infants who failed. This suggests that limiting testing to extremely premature infants would miss most cases of ICSC failure.
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