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The car seat test for preterm infants: Comparison with polysomnography
  1. Dawn Elizabeth Elder (dawn.elder{at}otago.ac.nz)
  1. Wellington School of Medicine and Health Sciences, New Zealand
    1. Letitia Russell
    1. Capital and Coast District Health Board, New Zealand
      1. Deidre Sheppard
      1. Wellington School of Medicine and Health Sciences, New Zealand
        1. Gordon Purdie
        1. Wellington School of Medicine and Health Sciences, New Zealand
          1. Angela Campbell
          1. Wellington School of Medicine and Health Sciences, New Zealand

            Abstract

            Objective: To monitor preterm infants in a cot and a car seat and compare an observed car seat trial with polysomnography (PSG).

            Design: Non-randomised controlled trial.

            Setting: Regional Neonatal Unit.

            Patients: Preterm infants pre-discharge.

            Interventions: Nap PSG respiratory and sleep variables were measured including gastro-oesophageal pH. Nurse observations included respiratory distress, apnoea measured by apnoea alarm, oxygen saturation and heart rate. Infants were studied supine in a cot and then in a car seat. Nursing observations were compared with PSG during the car seat trial only. Criteria for failure of the PSG and observed tests were predefined.

            Main Outcome Measures: Difference in respiratory instability between cot and car seat. Concurrence regarding failure of the car seat trial between nurse-observed data and PSG.

            Results: 20 infants were studied. Median gestation was 33 weeks (range 28-35) and median post-menstrual age (PMA) at study 36.5 weeks (range 35-38 weeks). 18 infants had sufficient car seat data for comparison. Central apnoeas and arousals were less in the cot than car seat (p = 0.047 and p = 0.024 respectively). Airway obstruction was not more frequent in the car seat. Younger PMA at time of study predicted failure in both car seat (p = 0.022) and cot (p = 0.022). The nurse-observed test had low sensitivity for predicting PSG failure but more accurately predicted airway obstruction on PSG.

            Conclusions: Immature infants exhibit respiratory instability in cots and car seats. A car seat test did not accurately detect all adverse events during sleep in the seat.

            • apnoea
            • car seat
            • obstruction
            • polysomnography
            • preterm infant

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