Is the infant car seat challenge useful? A pilot study in a simulated moving vehicle

Renu Arya; Georgina Williams; Anna Kilonback; Martin Toward; Michael Griffin; Peter S Blair; Peter Fleming

doi:10.1136/archdischild-2016-310730

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Is the infant car seat challenge useful? A pilot study in a simulated moving vehicle

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Current UK practice: Infant Car Seat Challenges
Rebecca C H Towler
Published on: 16 February 2017

Published on: 16 February 2017
Current UK practice: Infant Car Seat Challenges
- Rebecca C H Towler, ST4 Paediatrics
This paper highlights some limitations in the use of infant car-seat challenges (ICSCs) to monitor for abnormal cardiorespiratory events prior to hospital discharge[1]. Current practice is non-standardised and unlikely to replicate actual infant experience.
In the USA it is recommended that all infants born <37 weeks gestation or birth-weight <2500g should have a period of observation in a car-seat prior t...
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This paper highlights some limitations in the use of infant car-seat challenges (ICSCs) to monitor for abnormal cardiorespiratory events prior to hospital discharge[1]. Current practice is non-standardised and unlikely to replicate actual infant experience.
In the USA it is recommended that all infants born <37 weeks gestation or birth-weight <2500g should have a period of observation in a car-seat prior to hospital discharge[2]. This is based on reports of preterm infants experiencing cardiorespiratory compromise in car-seats. There is no national UK guidance.
We evaluated current practice in England and Wales by conducting a postal survey of the 179 level I-III Neonatal Units between December 2013 - January 2014.
The response rate was 62.6% (n=112). Our results showed that 27.7% of respondents regularly tested infants in car-seats pre-discharge; compared to 10% of 200 UK units contacted in 2005[3] and 30% of 30 units in 2006[4].
In our survey, 51.6% of units had no gestational age or weight criteria for performing the ICSC. 25.8% had no formal failure criteria. Parameters tested and duration of monitoring varied widely.
Arya reported the static ICSC does not reflect the angle or motion of a moving vehicle. Infants, in a more upright seat (40 degrees) with vibration experienced in a car, showed significantly increased heart rate, respiratory rate and decreased oxygen saturations[1]. Of note, 83.8% of units in our survey placed the car-seat on the floor (~30 degrees) rather than more upright in a seat.
The 2006 Cochrane review of ICSCs found no eligible randomised controlled trials and concluded that further studies were required to determine if ICSCs accurately predict risk of clinically significant adverse events[5]. Schutzman compared an ICSC and polysomnogram (PSG). The ICSC negative predictive value was 0.45 when compared with PSG. They concluded that although less time consuming, the ICSC is not a reliable substitute[6]. However, current ICSCs are time consuming. In a previous study we performed 181 ICSCs over 18 months[7]. Each ICSC observation period was 120 minutes, which totaled 362 hours (30.2 working days) of nursing time. Thus, implementing a national policy that advocates ICSC would impact on nursing staff and may have a significant financial impact on neonatal units.
This is an important problem. Car-seats are vital and 71% effective in reducing infant fatality in road traffic accidents[2]. However, car- seats are frequently observed to be used inappropriately; Callahan reported infants spending a mean of 5.7+/- 3.5 hours per day in a car-seat or similar sitting device[8]. Bamber identified 14 car-seat associated deaths; 70% occurred whilst the seat was being used inappropriately or outside the car[9]. In a recent review, Davis discusses observations of infants in the semi-upright position and the continued unanswered questions regarding ICSCs[10].
Our survey highlights that significant nursing time is being spent on performing ICSCs in UK units in disparate ways. At present there is not enough evidence regarding testing or how to interpret results. Therefore, education of parents about appropriate use of car-seats must remain paramount whilst further research establishes the appropriate use of ICSCs in UK hospitals.
References:
1. Arya R, Williams G, Kilonback A et al. Is the infant car sear challenge useful? A pilot study in a simulated moving vehicle. Arch. Dis. Child. Fetal Neonatal Ed. 2016.doi:10.1136/archdischild-2016-310730.
2. Bull M, Agran P, Laraque D et al. American Academy of Pediatrics, Committee on Injury and Poison Prevention. Safe transportation of newborns at hospital discharge. Pediatrics. 1999;104:986-987.
3. N Joffe, J Hall (2006) Limiting the risks of apnoea and bradycardia in low birth weight infants using car seats.. Journal of Neonatal Nursing 12, 91-96.
4. Bhojani S., Desai P., Skeoch C. Car seat challenge - the current practice. Infant 2008; 4(6): 211-13.
5. Pilley E, McGuire W. Pre-discharge "car seat challenge" for preventing morbidity and mortality in [preterm infants. The Cochrane Library 2008 Issue 3.
6. Schutzman DL, Salvador A, Janeeczko M et al. A comparison of the infant car seat challenge and the polysomnogram at the time of hospital discharge. Arch Dis Child Fetal Neonatal Ed 2013; 98: F411-F415.
7. Towler R, Eastwood R, Ballentyne B, Arya R. The car seat challenge - 18 months experience in a district general hospital. Arch Dis Child Fetal Neonatal Ed 2013; 98: F411-F415
8. Callahan CW, Sisler C. Use of seating devices in infants too young to sit. Arch Pediatr Adolesc Med. 1997 Mar;151(3):233-5.
9. Bamber AR, Pryce J, Ashworth MT et al. Sudden unexpected infant deaths associated with car seats. Forensic Sci Med Pathol. 2014 Jun;10(2):187-92.
10. Davis NL Screening for cardiopulmonary events in neonates: a review of the infant car seat challenge. Journal of Perinatology (2015) 35, 235-240.
Conflict of Interest:
None declared
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Conflict of Interest:
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