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Car seat safety for preterm neonates: implementation and testing parameters of the infant car seat challenge
Natalie Louise Davis1, Yevgeniy Zenchenko, Anthony Lever
1Boston Children's Hospital Division of Newborn Medicine, Boston, MA 02115, USA. natalie.davis@childrens.harvard.edu
Insights
The Infant Car Seat Challenge (ICSC) for preterm infants is inconsistently applied, leading to varied care. Standardizing ICSC protocols is crucial for consistent infant safety monitoring.
Area of Science:
- Neonatal care
- Pediatric safety
- Cardiopulmonary monitoring
Background:
- The American Academy of Pediatrics (AAP) recommends the Infant Car Seat Challenge (ICSC) for preterm neonates to assess cardiopulmonary risks in an upright position.
- Current guidelines lack universal criteria for ICSC failure, leading to inconsistent implementation in neonatal intensive care units (NICUs).
Purpose of the Study:
- To evaluate the regional implementation of the ICSC in NICUs within New York/New England.
- To identify variations in ICSC inclusion criteria, testing duration, and failure thresholds.
Main Methods:
- A survey was conducted among 119 level II and III nurseries/NICUs in New York/New England.
- Response rate was 87% (n=103), with 89% of responding institutions performing ICSCs.
Main Results:
- 89% of surveyed NICUs perform ICSCs, but 17% do not test all infants born before 37 weeks' gestation as recommended.
- 45% of NICUs deviate from recommended test durations, and significant variation exists in failure criteria.
- Most units use bradycardia (<80 bpm) and desaturation (<90%) thresholds, but duration of these events for failure is not standardized.
Conclusions:
- Implementation of AAP-recommended ICSCs is not universal, and significant variability exists in failure criteria across NICUs.
- This inconsistency results in differential care for neonates based on their institution, not clinical status.
- Standardization of ICSC protocols, including testing all infants <37 weeks' gestation for at least 90 minutes with defined failure thresholds, is proposed.
Background:
The American Academy of Pediatrics (AAP) recommends that all preterm neonates undergo a period of observation in a car safety seat before discharge, known as the Infant Car Seat Challenge (ICSC), to monitor for respiratory immaturity and the risk of adverse cardiopulmonary events in the upright position. However, no universal guidelines exist to define appropriate cutoffs for failure of the ICSC. We sought to evaluate regional neonatal intensive care unit (NICU) implementation of the ICSC and to evaluate variation in failure criteria.
Methods:
We contacted level II and III nurseries/NICUs in New York/New England (n = 119) to determine if each performed ICSCs, their inclusion criteria, duration of testing, and failure criteria.
Results:
We contacted 119 institutions and had an 87% response rate (n = 103). Of the institutions that responded, 89% (n = 89) perform ICSCs. Of these 89 with current protocols, 17% did not follow AAP guidelines to test all neonates born <37 weeks' gestation, and 45% did not follow guidelines for test duration. Despite wide variation, most units use thresholds for bradycardia of <80 bpm and desaturation of <90% to determine failure.
Conclusions:
Despite AAP guidelines, implementation of ICSCs for preterm neonates is not universal in the region studied. Variation in definition of ICSC failure means that neonates are receiving differential care, not on the basis of their clinical characteristics, but on which institution performs the test. We propose standardizing the test to all infants born at <37 weeks' gestation to a duration of at least 90 minutes, along with a failure threshold for bradycardia of <80 bpm for >10 seconds, and for saturation <90% for >10 seconds.
