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Car Seat Tolerance Screening for Late-Preterm Infants
Aimee Magnarelli1, Nina Shah Solanki2, Natalie L Davis3
1National Institutes of Health, Bethesda, Maryland; and.
Pediatrics
|December 22, 2019
Summary
Many late-preterm infants fail car seat tolerance screens (CSTSs), indicating cardiorespiratory immaturity. Infants admitted to both NICU and nursery had the highest failure rate, highlighting the need for careful assessment before discharge.
Area of Science:
- Neonatal care
- Pediatric pulmonology
Background:
- Late-preterm infants are often presumed to have cardiorespiratory maturity similar to term infants.
- This assumption leads to limited car seat tolerance screening (CSTS) for early preterm infants.
Purpose of the Study:
- To evaluate the incidence and predictors of CSTS failure specifically in late-preterm infants.
- To determine if CSTS results impact length of hospital stay.
Main Methods:
- Retrospective review of late-preterm infants (2013-2017).
- Analysis of CSTS failure rates and predictors, including location of admission.
- Multivariable linear regression to assess CSTS results' effect on length of stay (LOS).
Main Results:
- 4.6% of 918 infants failed CSTS; highest failure rate (8.5%) in infants admitted to both NICU and nursery.
- 24% of those failing CSTS failed ≥2 screens; 20% had obstructive apnea/desaturations.
- 40% of failures required supplemental oxygen for safe discharge; CSTS results did not significantly predict LOS after controlling for other factors.
Conclusions:
- A significant number of late-preterm infants show respiratory instability during CSTS.
- Repeat CSTS failures often indicate underlying respiratory morbidities requiring escalated care.
- Length of stay is associated with cardiorespiratory immaturity identified by CSTS, not the screening result itself.
