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The Association Between Routine Car Seat Screening and Subsequent Health Care Utilization
Wade N Harrison1,2, Victor S Ritter3, Kori B Flower4
1Division of Hospital Medicine.
Insights
Car seat tolerance screening (CSTS) for preterm newborns is common but may prolong hospital stays without reducing readmissions. Further research is needed to evaluate this practice for low-risk infants.
Area of Science:
- Neonatal care
- Pediatric safety
- Health services research
Background:
- The American Academy of Pediatrics recommends car seat tolerance screening (CSTS) for preterm newborns.
- Evidence supporting routine CSTS before discharge is limited.
- This study investigated healthcare utilization in screened versus unscreened late preterm and low birth weight infants.
Purpose of the Study:
- To examine the association between car seat tolerance screening (CSTS) and subsequent healthcare utilization in late preterm and low birth weight newborns.
- To compare length of stay, hospital revisits, and brief resolving unexplained events between screened (pass/fail) and unscreened infants.
Main Methods:
- Observational study of 5222 late preterm (34-36 weeks) and term low birth weight (<2268 g) newborns.
- Data collected from 2014-2018 across 4 hospitals with CSTS policies.
- Compared length of stay and 30-day hospital revisits among infants who were not screened, passed CSTS, or failed CSTS.
Main Results:
- Screening adherence was high (91%), with 8% failing the initial screen.
- Failing CSTS was associated with a significantly longer hospital length of stay (LOS), particularly for infants screened in the NICU/floor.
- No significant difference in 30-day hospital revisits was observed between screened and unscreened groups.
Conclusions:
- High adherence to CSTS recommendations was observed, with a notable failure rate.
- Routine CSTS did not appear to reduce healthcare utilization and may increase LOS.
- Prospective trials are warranted to assess the value of routine CSTS in low-risk infants.
Background And Objectives:
The American Academy of Pediatrics recommends preterm newborns undergo car seat tolerance screening (CSTS) before discharge despite limited evidence supporting the practice. We examined subsequent health care utilization in screened and unscreened late preterm and low birth weight newborns.
Methods:
This observational study included late preterm (34-36 weeks) and term low birth weight (<2268 g) newborns born between 2014 and 2018 at 4 hospitals with policies recommending CSTS for these infants. Birth hospitalization length of stay (LOS) in addition to 30-day hospital revisits and brief resolving unexplained events were examined. Unadjusted and adjusted rates were compared among 3 groups: not screened, pass, and fail.
Results:
Of 5222 newborns, 3163 (61%) were discharged from the nursery and 2059 (39%) from the NICU or floor. Screening adherence was 91%, and 379 of 4728 (8%) screened newborns failed the initial screen. Compared with unscreened newborns, adjusted LOS was similar for newborns who passed the CSTS (+5.1 hours; -2.2-12.3) but significantly longer for those who failed (+16.1; 5.6-26.7). This differed by screening location: nursery = +12.6 (9.1-16.2) versus NICU/floor = +71.2 (28.3-114.1) hours. Hospital revisits did not significantly differ by group: not screened = 7.3% (reference), pass = 5.2% (aOR 0.79; 0.44-1.42), fail = 4.4% (aOR 0.65; 0.28-1.51).
Conclusions:
Hospital adherence to CSTS recommendations was high, and failed screens were relatively common. Routine CSTS was not associated with reduced health care utilization and may prolong hospital LOS, particularly in the NICU/floor. Prospective trials are needed to evaluate this routine practice for otherwise low-risk infants.
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