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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.
Insights
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.
Background:
The belief that late-preterm infants have similar cardiorespiratory maturity to term infants has led many institutions to limit car seat tolerance screens (CSTSs) to those born early preterm. The objective of this study was to evaluate the incidence and predictors of CSTS failure, focusing on late-preterm infants.
Methods:
We performed a retrospective review of late-preterm infants born from 2013 to 2017 to identify the incidence and predictors of CSTS failure, focusing on location of admission. We performed multivariable linear regression to assess the effect of CSTS results on length of stay (LOS).
Results:
We identified 918 subjects who underwent CSTSs, of whom 4.6% failed. Those infants who were admitted to both the NICU and nursery before discharge had the highest failure rate (8.5%). Of those who failed, 24% failed ≥2 CSTSs. Of these, 20% (all from the nursery) were found to have obstructive apnea and desaturations, and a total of 40% required supplemental oxygen for safe discharge from the hospital. Although crude LOS was longer for those who failed an initial CSTS, when accounting for location of admission, level of prematurity, and respiratory support requirements, the CSTS result was not a significant predictor of longer LOS.
Conclusions:
A concerning number of late-preterm infants demonstrated unstable respiratory status when placed in their car seat. Those who failed repeat CSTSs frequently had underlying respiratory morbidities that required escalation of care. Although further study is warranted, LOS was not associated with CSTS results but rather with the cardiorespiratory immaturity noted or discovered by performing a CSTS.
