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Factors associated with car seat test failure in late preterm infants: A retrospective chart review
Ryan W Smith1, Adel Mohamed2, Jennifer Young2
1Department of General Paediatrics, Toronto, Ontario;; The Hospital for Sick Children and University of Toronto, Toronto, Ontario;
Insights
Late preterm infants (LPIs) have a 26% failure rate in car seat testing, often due to desaturations. Multiple gestation is a significant risk factor, suggesting testing should occur after a suitable transitional period.
Area of Science:
- Neonatal care
- Pediatric safety
- Infant transport safety
Background:
- Professional guidelines recommend car seat testing for preterm infants before hospital discharge.
- Late preterm infants (LPIs), born between 34 and 36 weeks gestational age, are at high risk for car seat test failure.
- Despite potential risks, LPIs are often perceived as well infants.
Purpose of the Study:
- To determine the incidence of car seat testing failure in late preterm infants (LPIs).
- To identify factors associated with car seat testing failure in LPIs.
Main Methods:
- Retrospective chart review of inborn LPIs admitted to various newborn care levels.
- Data collection included maternal demographics, labor and delivery history, and neonatal course.
- Backward logistic regression analysis was used to identify associative factors.
Main Results:
- Out of 313 tested LPIs, 80 (26%) failed the car seat test.
- The primary reason for failure was desaturation events (41%).
- Multiple gestation was significantly associated with failure (adjusted OR 2.45), and a trend was observed for postnatal age (P=0.05). Infants who passed had significantly higher postnatal ages.
Conclusions:
- A substantial proportion (26%) of late preterm infants fail car seat testing.
- Testing should ideally be conducted after an appropriate transitional period for LPIs.
- Further research is needed to evaluate the clinical significance and resource implications of car seat testing in this population.
Background:
Professional organizations recommend car seat testing of preterm infants before discharge from hospital. Late preterm infants (LPIs, 34(0/7) to 36(6/7) weeks' gestational age) are at the greatest risk for failure, despite often being well.
Objective:
To determine the incidence of car seat testing failure in LPIs and associative factors.
Methods:
A retrospective chart review was performed of inborn LPIs admitted to all levels of newborn care between July 1, 2012 and June 30, 2013. Data collected included maternal demographics, labour and delivery history, and neonatal course. Data were analyzed using backward logistic regression.
Results:
A total of 511 charts were reviewed and 367 LPIs were eligible for inclusion. Of the 313 LPIs tested (mean [± SD] gestational age 36 weeks ±6 days and birth weight 2614±405 g), 80 (26%) failed (95% CI 21% to 31%). Most failed due to desaturations (≥2) of <88% for ≥10 s (n=33 [41%]). Multiple gestation was associated with failure (adjusted OR 2.45 [95% CI 1.44 to 4.18]; P=0.001), and there was a trend toward statistical significance for the variable postnatal age (0.996 [95% CI 0.99 to 1.00]; P=0.05). Infants who passed their car seat test had higher postnatal ages than those who failed (mean difference 39.4 h [95% CI 12.7 h to 66.0 h]; P=0.004).
Conclusion:
Twenty-six percent of LPIs failed car seat testing. Ideally, infants should be tested after an appropriate transitional period. The authors identified factors that may be important in designing future, prospective studies in this area. Future research should evaluate the clinical significance of car seat testing and resource utilization.
