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Assessment of cardiorespiratory stability using the infant car seat challenge before discharge in preterm infants
Insights
The infant car seat challenge, used for preterm infants, does not reliably predict long-term outcomes. Evidence does not support its routine use for discharge planning, updating previous recommendations.
Area of Science:
- Neonatal care
- Pediatric respiratory medicine
- Infant safety
Background:
- Preterm infants (<37 weeks corrected gestational age) face risks in respiratory control.
- The infant car seat challenge is a common screening tool in Canada for preterm infant discharge.
- Infants in car seats show higher rates of oxygen desaturation and bradycardia compared to supine positioning.
Purpose of the Study:
- To evaluate the evidence supporting the routine use of the infant car seat challenge for preterm infant discharge.
- To inform current recommendations on post-discharge monitoring for preterm infants.
Main Methods:
- A comprehensive review of existing literature was conducted.
- Evidence regarding cardiorespiratory stability and neurodevelopmental outcomes was analyzed.
Main Results:
- No clear link was found between car seat positioning and adverse neurodevelopmental outcomes or mortality.
- The literature review provided insufficient evidence to recommend the infant car seat challenge as a routine screening tool.
Conclusions:
- The routine infant car seat challenge is not recommended for discharge planning for preterm infants.
- This conclusion represents a revision of previous guidelines from 2000.
Abstract:
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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