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.