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Is the infant car seat challenge useful? A pilot study in a simulated moving vehicle
  1. Renu Arya1,
  2. Georgina Williams1,
  3. Anna Kilonback1,
  4. Martin Toward2,
  5. Michael Griffin2,
  6. Peter S Blair3,
  7. Peter Fleming3
  1. 1Department of Paediatrics, Great Western Hospitals NHS Foundation Trust, Swindon, UK
  2. 2Institute of Sound and Vibration Research, University of Southampton, Southampton, UK
  3. 3School of Social and Community Medicine, University of Bristol, Bristol, UK
  1. Correspondence to Professor Peter Fleming, Department of Child and Adolescent Health, University of Bristol, Bristol, UK; Peter.Fleming{at}


Background and objective The American Academy of Pediatrics recommends that preterm infants complete a predischarge ‘car seat challenge’ observation for cardiorespiratory compromise while in a car seat. This static challenge does not consider the more upright position in a car or the vibration of the seat when the car is moving. This pilot study was designed to assess the cardiorespiratory effects of vibration, mimicking the effect of being in a moving car, on preterm and term infants.

Methods A simulator was designed to reproduce vertical vibration similar to that in a rear-facing car seat at 30 mph. 19 healthy newborn term and 21 preterm infants, ready for hospital discharge, underwent cardiorespiratory measurements while lying flat in a cot (baseline), static in the seat (30°), simulator (40°) and during motion (vibration 40°).

Results Median test age was 13 days (range 1–65 days) and median weight was 2.5 kg (IQR: 2.1–3.1 kg).

Compared with baseline observations, only the total number of desaturations was significantly increased when infants were placed at 30° (p=0.03). At 40°, or with vibration, respiratory and heart rates increased and oxygen saturation decreased significantly. Profound desaturations <85% significantly increased during motion, regardless of gestational age.

Conclusions This is the first study to assess the effect of motion on infants seated in a car safety seat. Term and preterm infants showed significant signs of potentially adverse cardiorespiratory effects in the upright position at 40°, particularly with simulated motion, not identified in the standard challenge. A larger study is required to investigate the significance of these results.

  • Neonatology
  • Injury Prevention

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  • Contributors RA conceived and designed the study, obtained ethical approval and funding and performed data analysis. MT and MG designed and built the vibration simulator and obtained ethical approval for its use. AK, GW and RA participated in the enrolment of patients, performing the challenges and data collection. PF contributed to the design of the study with technical advice plus data analysis. PB undertook the statistical analysis. RA, PF and PB wrote the paper with critical revision from all authors.

  • Funding Supported by a grant from the Lullaby Trust (formerly the Foundation of the Study of Infant Deaths) project number 259.

  • Competing interests None declared.

  • Patient consent Parental/guardian consent obtained.

  • Ethics approval Approval was obtained from West of England Research Ethics Committee (no. 11/h0106/1) and from Southampton University Human Experimentation Safety and Ethics Committee for the safety and use of the vibration simulator in humans.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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