Related Experiment Video
Updated: May 9, 2026
A Swine Model of Neonatal Asphyxia
Published on: October 11, 2011
Randomized controlled trial of a car safety seat insert to reduce hypoxia in term infants
Christine G McIntosh1, Shirley L Tonkin, Alistair Jan Gunn
1Department of Physiology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
Insights
A car seat insert promoting neutral head position reduced obstructive apnea and desaturation severity in newborns. However, it did not decrease the overall rate of moderate oxygen desaturation events during sleep.
Area of Science:
- Neonatal care
- Pediatric sleep medicine
- Infant safety
Background:
- Infant car seats can compromise airway patency during sleep.
- Reduced oxygenation in infants is a significant concern.
Purpose of the Study:
- To evaluate if a foam insert in car seats can prevent upper airway obstruction and reduce oxygenation issues in term infants.
Main Methods:
- Healthy term infants were randomized to sleep in car seats with or without a foam insert.
- Continuous polysomnographic recordings with sleep video were used to monitor infants.
Main Results:
- The insert significantly reduced obstructive apnea events (0.3 vs 0.9/hour).
- It decreased the severity of desaturation events (minimum SpO2 82% vs 74%) and time with SpO2 <85% (0.6% vs 1.8%).
- No significant difference was observed in the rate of moderate desaturations or mean SpO2.
Conclusions:
- A car seat insert promoting neutral head position reduced the severity of desaturation events in term newborns.
- The insert did not reduce the overall rate of moderate desaturation events.
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 (SpO2) over the first hour of sleep. There was no difference between insert and no insert in the rate of moderate desaturations (a fall in SpO2 ≥ 4% lasting for ≥ 10 seconds, mean ± SEM, 17.0 ± 1.5 vs 17.2 ± 1.5/hour), or mean SpO2 during sleep. The insert was associated with a significant reduction in the rate of obstructive apnea (0.3 ± 0.1 vs 0.9 ± 1.5/hour, P < .03), the severity of desaturation events (minimum SpO2 82% ± 1% vs 74% ± 2%, P < .001), and time with SpO2 <85% (0.6% ± 0.3% vs 1.8% ± 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.
