Original article
Car Seat or Car Bed for Very Low Birth Weight Infants at Discharge Home

https://doi.org/10.1016/j.jpeds.2006.10.068Get rights and content

Objective

To compare the incidence of apnea, bradycardia, or desaturation in a car seat with that in a car bed for preterm very low birth weight (≤1500 g) infants.

Study design

Infants were studied for 120 minutes in a car seat and in a car bed. Apnea (>20 seconds), bradycardia (heart rate <80/min for >5 seconds), desaturation (Spo2 <88% for >10 seconds), and absent nasal flow were monitored.

Results

We assessed 151 infants (median birth weight, 1120 g [range, 437 to 3105)]; median birth gestational age, 29 weeks [24 to 34]) in both devices. Twenty-three infants (15%) had ≥1 event in the car seat compared with 29 (19%) in the car bed (P = .4). Time to first event was similar in the car seat and car bed (mean, 54 to 55 minutes). In logistic regression analyses, bronchopulmonary dysplasia was a significant predictor for a car seat event and a lower gestational age at birth was a risk factor for a car bed event.

Conclusions

We found no evidence that an event is less likely in a car bed than in a car seat. Whichever device is used, very low birth weight infants require observation during travel.

Section snippets

Population

To increase the sample size and the generalizability of the findings, the study was conducted in two hospitals: Parkland Memorial Hospital (Dallas, Texas), a county hospital with a largely inborn population, and Memorial Hermann Children’s Hospital (Houston, Texas), a private hospital with a substantial proportion of maternal and neonatal referrals. All VLBW infants weighing ≤1500 g at birth and at <37 weeks’ gestational age (GA) became eligible when they were nearing discharge. At both

Results

Between February and December 2002, 178 infants met inclusion criteria. Consent was obtained for 160, and 7 were not studied because they were discharged earlier than planned. The data could not be analyzed for two infants because of monitor malfunction. Thus, we assessed 151 infants; 77 were randomly assigned to the car seat first and 74 to the car bed first. The median (range) birth weight was 1120 g (437 to 3105); weight at study, 2545 g (1750 to 5670); GA at birth, 29 weeks (24 to 34); and

Discussion

To our knowledge, this is the first randomized study comparing responses of infants to car beds and car seats. Our study has three major findings: (1) As reported by other investigators,2, 3, 4, 5 apnea, bradycardia, and desaturation episodes may still occur at discharge when VLBW infants are placed in a transportation device, particularly among infants who were born most prematurely or who are recovering from BPD; (2) we found no evidence that these episodes are less likely in a car bed than a

References (18)

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    The CSTS screen lasts much longer (90–120 min vs. ∼10 min), so unless the neonate is having persistent desaturations or bradycardia, a shorter test may miss events. Salhab et al. showed that 40% of those who had an event in the car seat did so after 60 min of observation (Salhab et al., 2007). In addition, while the etiology of desaturations in CHD is known (abnormal shunting of deoxygenated blood), the etiology of CSTS events remains unclear.

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    In apparent contravention of the AAP recommendation, 1.9% of tested infants were discharged without a record of passing the CSTS.9 Prior studies describing the incidence of CSTS failure among preterm infants reported failure rates ranging from 4.3% to as high as 83%.6,7,10,14,16,17,29-33 Consistent with our findings, the 2 prior largest studies on this topic found CSTS failure rates of 4.3% and 5.5% among infants with gestational ages of <37 weeks.10,14

  • Car seat safety for preterm neonates: Implementation and testing parameters of the Infant Car Seat Challenge

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    Increasing length of time in the car seat position has been associated with decreased saturations.13,15 In one study looking at ICSCs lasting 120 minutes, the proportion of infants whose first event occurred after 60 minutes of observation was 40%, and after 90 minutes of observation was 30%.15 A shorter testing duration may therefore miss episodes of desaturation or bradycardia.

  • The Challenge of Car Safety Seats

    2007, Journal of Pediatrics
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Equipment was supplied by CAS Medical Systems Inc and Cosco.

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