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Predischarge Car Seat Tolerance Screening in Preterm and At-Risk Full-Term Infants: A Systematic Review and
Brian C King1,2, Nisha Dalvie3, Susanne Hay1,2
1Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
JAMA Network Open
|February 9, 2026
Summary
Routine car seat tolerance screening (CSTS) for infants does not appear to reduce readmissions or mortality. Further research is needed to determine if predischarge CSTS improves outcomes for preterm or at-risk infants.
Area of Science:
- Neonatal care
- Pediatric safety
- Public health
Background:
- Predischarge car seat tolerance screening (CSTS) is recommended for preterm and at-risk infants.
- The effectiveness of routine CSTS in preventing adverse postdischarge outcomes remains unclear.
Purpose of the Study:
- To estimate the frequency of failed CSTS.
- To assess the association between CSTS and adverse postdischarge outcomes.
Main Methods:
- Systematic review and meta-analysis of 21 studies (no RCTs found).
- Included nonrandomized intervention and single-group observational studies.
- Extracted data on readmission, mortality, length of stay, and CSTS failure rates.
Main Results:
- No significant difference in 30-day mortality or readmissions between infants with and without CSTS.
- Estimated first-test failure rate of 8.62% and repeat-test failure rate of 24.40%.
Conclusions:
- Predischarge CSTS was not associated with reduced postdischarge readmission or mortality.
- Findings question the routine use of CSTS for improving outcomes in preterm or at-risk infants.
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