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Getting Babies Safely Home: A Retrospective Chart Review of Car Safety Seat Tolerance Screening Outcomes
Benjamin D Hoffman1, Tess A Gilbert2, Kelsi Chan1
1Department of Pediatrics, School of Medicine, and Doernbecher Tom Sargent Safety Center, Doernbecher Children's Hospital, Oregon Health and Science University (BD Hoffman, TA Gilbert, K Chan, B Ennis, and A Gallardo), Portland, Ore.
Insights
Car Seat Tolerance Screening (CSTS) failure rates are high, especially for premature infants. Key infant characteristics increase failure risk, and cardiorespiratory instability is common during testing.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Public Health
Background:
- The American Academy of Pediatrics recommends pre-discharge Car Seat Tolerance Screening (CSTS) for at-risk neonates.
- Current screening criteria and methods for CSTS show significant variation and can be burdensome.
Purpose of the Study:
- To analyze Car Seat Tolerance Screening (CSTS) outcomes in a large cohort of infants.
- To identify infant characteristics associated with CSTS failure and cardiorespiratory instability (CRI).
Main Methods:
- Retrospective chart review of 1,072 infants undergoing CSTS.
- Analysis of CSTS outcomes (failure and CRI) by infant characteristics and screening location (NICU vs. MBU).
- Logistic regression used to determine associations between infant factors and CSTS outcomes.
Main Results:
- Overall CSTS failure rate was 9.2%.
- Infants with congenital heart disease, apnea, chronic lung disease, or small for gestational age were more likely to fail.
- Infants born earlier (≤28 weeks EGA) had a 2.4x higher failure rate compared to those born later (34-36 weeks EGA).
- Nearly half (47.5%) of preterm infants experienced cardiorespiratory instability (CRI) during CSTS.
Conclusions:
- High rates of CSTS failure and significant cardiorespiratory instability (CRI) were observed.
- Specific infant characteristics are linked to increased risk of CSTS failure.
- Further research is needed to refine risk factors and establish practical CSTS criteria.
Background:
The American Academy of Pediatrics recommends pre-discharge Car Seat Tolerance Screening (CSTS) for all neonates born <37 weeks estimated gestational age (EGA), or otherwise at risk for cardiorespiratory compromise. Screening is burdensome and there remains tremendous variation in testing criteria and methodology.
Design/Methods:
We conducted a retrospective chart review of 1,072 infants who underwent CSTS between 11/2013 and 7/2016 at a single academic health center. CSTS outcomes (failure and, separately, significant cardiorespiratory instability (CRI)), including those not meeting failure thresholds) were analyzed for all infants screened, and for preterm infants by screening location (Neonatal Intensive Care Unit (NICU) and Mother/Baby Unit (MBU)). Logistic regression was used to estimate associations between infant characteristics and CSTS outcomes.
Results:
Overall incidence of CSTS failure was 9.2%. Among all infants, hemodynamically significant congenital heart disease, apnea, chronic lung disease, and being small for EGA were associated with failure. Additionally, those born ≤28 weeks EGA had 2.4 times greater likelihood of failure than those 34-36 weeks EGA. Among preterm infants in the NICU and MBU, those of earlier EGA were also more likely to fail. Almost half (47.5%) of all preterm infants demonstrated CRI during CSTS.
Conclusion:
We found high CSTS failure rates, and identified key infant characteristics that were associated with increased likelihood of failure. Significant CRI events were remarkably common. Larger, prospective studies are needed to elucidate risk factors for instability and failure and define practical criteria for CSTS recommendations.
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