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Pre-discharge car seat tolerance screening in infants with CHD: a single-centre review
Nicholas V Barresi1, Mary D Schiff2, Frederick Roberts2
1Division of Pediatric Cardiology, https://ror.org/03763ep67Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA.
Insights
Infants with congenital heart disease (CHD) have a higher car seat screening failure rate than premature infants. DiGeorge Syndrome was the only comorbidity linked to failure, which can delay hospital discharge.
Area of Science:
- Pediatrics
- Cardiology
- Neonatal Care
Background:
- Infants with congenital heart disease (CHD) require careful assessment before discharge.
- Car seat tolerance screening is crucial for infant safety, but data on CHD populations is limited.
Purpose of the Study:
- To determine the car seat screening failure rate in infants with CHD.
- To identify clinical factors associated with car seat test failure.
- To assess the impact of failed car seat tests on hospital discharge.
Main Methods:
- A retrospective study of 193 infants with CHD was conducted.
- Infants were discharged from a general cardiology service.
- Statistical analyses compared characteristics between infants who passed and failed car seat testing.
Main Results:
- The car seat test failure rate was 6.2%.
- No significant differences were found in birthweight, prematurity, or cardiac physiology between passing and failing groups.
- DiGeorge Syndrome was the only comorbidity significantly associated with a higher failure rate (25.0% vs 2.2%).
- A failed test delayed hospital discharge by a median of 1.5 days.
Conclusions:
- The car seat test failure rate in infants with CHD is higher than in premature infants.
- Cardiac physiology did not correlate with car seat test failure.
- DiGeorge Syndrome is a key comorbidity associated with car seat test failure in this population.
- Failed car seat tests can prolong hospital stays.
Objective:
To evaluate car seat tolerance screening failure rate in infants with CHD, clinical factors associated with test failure, and the impact of a failed test.
Methods:
Single-centre retrospective study of 193 infants with CHD discharged from a general cardiology service between November 2020 and November 2024. Characteristics were compared between patients who passed and failed car seat testing using Wilcoxon-Mann-Whitney tests for continuous variables, and chi-square or Fisher's exact tests for categorical variables.
Results:
Car seat test failure rate was 6.2% (12 of 193 patients). Neither median birthweight (3.2 kg vs. 3.3 kg, p = 0.68) nor the rate of prematurity (13.8% vs. 16.7%, p = 0.68) differed significantly between passing and failing groups. There was no relationship between cardiac physiology and car seat test failure (p = 0.39). There were no differences in rates of seizure (p = 0.29), stroke (p = 1.00), gastroesophageal reflux disease (p = 0.84), vocal cord dysfunction (p = 1.00), or pulmonary hypertension (p = 1.00) between passing and failing groups. Infants who failed had significantly higher rates of DiGeorge Syndrome (25.0%) compared to those who passed (2.2%) (p = 0.006). Readmission within 30 days of discharge was not different between failing (16.7%) and passing (17.1%) groups (p = 1.00). A failed test delayed discharge by a median of 1.5 days [IQR: 1.0-2.5 days].
Conclusion:
The car seat test failure rate of our CHD cohort is higher than the published failure rate for premature infants. There was no relationship between cardiac physiology and test failure. DiGeorge Syndrome was the only comorbidity associated with increased failure rate. Failed car seat tests delay hospital discharge.
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