Elsevier

Academic Pediatrics

Volume 13, Issue 3, May–June 2013, Pages 272-277
Academic Pediatrics

Access and Quality of Care
Car Seat Safety for Preterm Neonates: Implementation and Testing Parameters of the Infant Car Seat Challenge

https://doi.org/10.1016/j.acap.2013.01.009Get rights and content

Abstract

Background

The American Academy of Pediatrics (AAP) recommends that all preterm neonates undergo a period of observation in a car safety seat before discharge, known as the Infant Car Seat Challenge (ICSC), to monitor for respiratory immaturity and the risk of adverse cardiopulmonary events in the upright position. However, no universal guidelines exist to define appropriate cutoffs for failure of the ICSC. We sought to evaluate regional neonatal intensive care unit (NICU) implementation of the ICSC and to evaluate variation in failure criteria.

Methods

We contacted level II and III nurseries/NICUs in New York/New England (n = 119) to determine if each performed ICSCs, their inclusion criteria, duration of testing, and failure criteria.

Results

We contacted 119 institutions and had an 87% response rate (n = 103). Of the institutions that responded, 89% (n = 89) perform ICSCs. Of these 89 with current protocols, 17% did not follow AAP guidelines to test all neonates born <37 weeks' gestation, and 45% did not follow guidelines for test duration. Despite wide variation, most units use thresholds for bradycardia of <80 bpm and desaturation of <90% to determine failure.

Conclusions

Despite AAP guidelines, implementation of ICSCs for preterm neonates is not universal in the region studied. Variation in definition of ICSC failure means that neonates are receiving differential care, not on the basis of their clinical characteristics, but on which institution performs the test. We propose standardizing the test to all infants born at <37 weeks' gestation to a duration of at least 90 minutes, along with a failure threshold for bradycardia of <80 bpm for >10 seconds, and for saturation <90% for >10 seconds.

Section snippets

Methods

We identified all existing level II and III NICUs in New England (including Connecticut, Maine, New Hampshire, Rhode Island, and Massachusetts) and New York using the 2011 AAP Section on Perinatal Pediatrics Directory of Newborn Intensive Care Units. Because there is very little information available on ICSC practices in the United States in general, we chose to focus on a narrow geographic area to assess regional agreement in testing parameters. We focused on level II and III nurseries because

Results

The survey was conducted between December 2011 and May 2012. Of the 119 qualifying institutions, 103 (87%) responded to our requests for information about their ICSC policy. Of the 103 responding institutions, 11 (11% of respondents) did not perform ICSC testing. This included 4 level II units (14% of level II units that responded) and 7 level III units (9% of level III units that responded). We found that 3 sites performed ICSCs but were in the process of updating their policy and did not

Discussion

Our survey assessed adherence to AAP guidelines for ICSC testing and attempted to identify consensus eligibility and failure criteria among level II and III NICUs in New England and New York. Our high survey response rate (87%) ensured excellent representation of the region, and we were able to identify a number of key issues related to ICSC testing. First, a large number of NICUs do not adhere to current AAP guidelines either by not performing ICSC testing, by having more restrictive

Acknowledgments

The authors would like to thank all of the institutions who took the time to participate in our survey. Research support for Dr Natalie Louise Davis was provided by the Ruth L. Kirschstein National Research Service Award (T32), PHS grant 2 T32 7466-16.

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