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Variation in Car Seat Tolerance Screen Performance in Newborn Nurseries
Natalie L Davis1, Benjamin D Hoffman2, Eric C Eichenwald3
1Division of Neonatology, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Baltimore, Maryland; natalie.davis@som.umaryland.edu.
Insights
Car seat tolerance screens (CSTSs) are widely implemented in newborn nurseries, but practices vary significantly. Guidance is needed to standardize screening criteria and improve care for premature infants.
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.
Background:
Currently, car seat tolerance screens (CSTSs) are recommended for all infants born prematurely in the United States. Although many late-preterm infants are cared for exclusively in newborn nurseries (NBNs), data on implementation of CSTS in nurseries are limited. Our objective for this study was to determine management strategies and potential variation in practice of CSTS in NBNs across the nation.
Methods:
We surveyed NBNs across 35 states using the Better Outcomes through Research for Newborns (BORN) network to determine what percentage perform CSTSs, inclusion and failure criteria, performance characteristics, follow-up of failed CSTSs including use of car beds, and provider attitudes toward CSTS.
Results:
Of the 84 NBNs surveyed, 90.5% performed predischarge CSTSs. The most common failure criteria were saturation <90%, bradycardia <80 beats per minute, and apnea >20 seconds. More than 55% noted hypotonia as an additional inclusion criterion for testing, and >34% tested any infant who had ever required supplemental oxygen. After an initial failed CSTS, >93% of NBNs retested in a car seat at a future time point, whereas only ∼1% automatically discharged infants in a car bed. When asked which infants should undergo predischarge CSTS, the most common recommendations by survey respondents included infants with hypotonia (83%), airway malformations (78%), hemodynamically significant congenital heart disease (63%), and prematurity (61%).
Conclusions:
There is a large degree of variability in implementation of CSTS in NBNs across the United States. Further guidance on screening practices and failure criteria is needed to inform future practice and policy.
