Variation in Car Seat Tolerance Screen Performance in Newborn Nurseries

Area of Science:

• Neonatal care
• Pediatric safety
• Healthcare policy

Background:

• Car seat tolerance screens (CSTSs) are recommended for premature infants.
• Implementation of CSTSs in newborn nurseries (NBNs) is not well-documented.
• Late-preterm infants often receive care exclusively in NBNs.

Purpose of the Study:

• To determine management strategies for CSTSs in NBNs nationwide.
• To identify variations in CSTS practices across the United States.
• To assess provider attitudes towards CSTS.

Main Methods:

• Survey of NBNs across 35 states via the Better Outcomes through Research for Newborns (BORN) network.
• Data collection on CSTS performance, inclusion/failure criteria, and follow-up protocols.
• Inquiry into provider recommendations for infants requiring CSTS.

Main Results:

• 90.5% of surveyed NBNs perform predischarge CSTSs.
• Common failure criteria include low saturation, bradycardia, and apnea; hypotonia and prior oxygen use are frequent inclusion criteria.
• Most NBNs retest infants after a failed CSTS, with few automatically discharging to car beds.

Conclusions:

• Significant variability exists in CSTS implementation and criteria within NBNs.
• There is a need for standardized guidance on CSTS screening practices and failure criteria.
• Further research can inform future policy and best practices for infant car seat safety.