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A National Survey of Car Seat Tolerance Screening Protocols in Neonatal Intensive Care Units
Natalie L Davis1, Savannah Cheo1
1Division of Neonatology, University of Maryland Children's Hospital, University of Maryland School of Medicine, Baltimore, Md.
Insights
Car seat tolerance screens (CSTs) are widely used for premature infants, but protocols vary significantly. This study highlights the need for standardized guidelines for CSTs and follow-up care after neonatal intensive care unit discharge.
Area of Science:
- Neonatal care
- Pediatric safety
- Cardiorespiratory monitoring
Background:
- A predischarge car seat tolerance screen (CSTS) is recommended for premature infants in the US.
- Current guidelines lack specific failure criteria, testing timing, and follow-up protocols for CSTS.
- This variability impacts the consistent assessment of infant safety in car seats.
Purpose of the Study:
- To survey neonatal intensive care units (NICUs) nationwide.
- To identify common practices and variations in CSTS protocols.
- To inform the development of standardized guidelines.
Main Methods:
- A national survey of Level II-IV NICUs across all 50 states was conducted.
- Data collected included CSTS performance, inclusion/failure criteria, timing, and follow-up procedures.
- Inquiries also covered car bed testing and outpatient referrals.
Main Results:
- 96.5% of surveyed NICUs perform CSTS.
- Significant variation exists in failure criteria (e.g., saturation <90%, bradycardia <80 bpm).
- Protocols for repeat testing and follow-up after failed CSTS also show considerable differences.
Conclusions:
- Widespread use of CSTS is confirmed, but significant protocol and follow-up variations persist.
- A lack of standardized evidence-based parameters for CSTS is evident.
- There is a critical need for explicit guidelines to ensure infant safety during car seat use.
Objective:
A predischarge car seat tolerance screen (CSTS) is currently recommended for all infants born prematurely in the United States to monitor for adverse cardiorespiratory events while in the semi-upright car seat. However, specific guidelines for failure criteria, timing of testing, and follow-up of failed CSTS do not exist. Our objective was to perform a national survey of neonatal intensive care units (NICUs) in order to identify common features and variation in CSTS protocols.
Methods:
We surveyed Level II-IV NICUs representing all 50 states to determine whether each performed CSTS, inclusion and failure criteria, timing of CSTS prior to discharge and in relation to feeds, follow-up of initial and subsequent CSTS failures, use of car beds, and outpatient referrals after failed CSTS.
Results:
Of the 199 NICUs surveyed, 96.5% perform a CSTS. The most common failure saturation cutoff was <90%, but values ranged from <80% to <92%. The most common failure bradycardia definition was <80 bpm but ranged from <70 bpm to <100 bpm. After an initial failed CSTS, 86.5% will perform a repeat CSTS after a period of observation that ranged from <12 hours to 3 or more days. When discharging in a car bed, 20% do not routinely perform a car bed test, and >70% refer only to the primary care physician for car bed follow-up.
Conclusions:
Despite widespread implementation, significant variation exists in CSTS protocols and follow-up after NICU discharge. A stronger evidence base is needed to define appropriate testing parameters and inform more explicit guidelines.
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