A Comparison of Respiratory Patterns in Healthy Term Infants Placed in Car Safety Seats and Beds

Cerar, Lilijana Kornhauser; Scirica, Christina V.; Gantar, Irena Štucin; Osredkar, Damjan; Neubauer, David; Kinane, T. Bernard

doi:10.1542/peds.2009-0160

Cited by 23 publications

(20 citation statements)

References 26 publications

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“…Kornhauser and colleagues, for example, have elegantly shown that term infants have many more desaturations in a car seat than while resting in a crib (mean 17 vs 6 per hour), with significantly lower mean and minimum oxygen saturations. 6 The current study confirms a similar rate of moderate desaturations during sleep. Car seats are essential for the safe transportation of infants.…”

Section: Discussionsupporting

confidence: 87%

“…Furthermore, infants sleeping in the car seat with the insert had fewer obstructive apneic events, supporting the hypothesis that the insert can help reduce obstruction of the upper airway. 9,10,13 Consistent with previous studies, 3,[6][7][8][9] episodes of transient mild to moderate desaturation were common in otherwise healthy full-term infants restrained in car safety seats. Kornhauser and colleagues, for example, have elegantly shown that term infants have many more desaturations in a car seat than while resting in a crib (mean 17 vs 6 per hour), with significantly lower mean and minimum oxygen saturations.…”

Section: Discussionsupporting

confidence: 86%

“…8 Similarly, Kornhauser et al found that the time that infants' SpO 2 was ,95% increased from 6.5% while lying in crib to 24% while restrained in a car seat. 6 Supporting possible clinically important consequences from these relatively mild falls in oxygenation that are observed under controlled circumstances, we reported that 8 healthy, full-term infants developed an apparent life-threatening event while they were restrained in their car seat. 10 Additionally, confirming previous anecdotal reports of sudden unexpected deaths of term infants who were restrained in semireclined car safety seats, 11 a Canadian population study detailed ∼10 deaths of 409 in the first year of life that were unexplained after detailed investigation occurred in sitting devices, mainly infant car seats.…”

Section: Discussionmentioning

confidence: 76%

“…1 Despite their major benefits for injury, it is well established that preterm infants and term infants with preexisting health conditions have a high risk of episodes of apnea and reduced hemoglobin oxygen saturation (SpO 2 ) while restrained in infant car safety seats [2][3][4] or car beds. 5,6 Disturbingly, there is compelling evidence that mild desaturations are also common in healthy full-term infants. [6][7][8][9] For example, Merchant et al reported that term infants showed a decline in mean SpO 2 from 97% in the supine position to 94% after 60 minutes in their car safety seats; 8% had SpO 2 values of ,90% for longer than 20 minutes.…”

Section: Discussionmentioning

confidence: 99%

“…5,6 Disturbingly, there is compelling evidence that mild desaturations are also common in healthy full-term infants. [6][7][8][9] For example, Merchant et al reported that term infants showed a decline in mean SpO 2 from 97% in the supine position to 94% after 60 minutes in their car safety seats; 8% had SpO 2 values of ,90% for longer than 20 minutes. 8 Similarly, Kornhauser et al found that the time that infants' SpO 2 was ,95% increased from 6.5% while lying in crib to 24% while restrained in a car seat.…”

Section: Discussionmentioning

confidence: 99%

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Randomized Controlled Trial of a Car Safety Seat Insert to Reduce Hypoxia in Term Infants

2013

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WHAT'S KNOWN ON THIS SUBJECT: Brief periods of low oxygen saturation are common in infants while restrained in car safety seats. There is some evidence that an insert that allows the infant head to rest in a neutral position in sleep may reduce hypoxic episodes. WHAT THIS STUDY ADDS:This randomized controlled study shows that the insert reduced numbers of obstructive apneas and the severity of desaturation events but did not significantly reduce the overall rate of moderate desaturations.abstract OBJECTIVE: To test the hypothesis that a foam plastic insert that allows the infant head to rest in a neutral position in sleep may prevent obstruction of the upper airway and thus reduce episodes of reduced oxygenation in term infants in car seats. METHODS:Healthy full-term babies were randomized to be studied during sleep while restrained in an infant car safety seat either with or without the insert, with continuous polysomnographic recordings with sleep video.RESULTS: Seventy-eight infants (39 in each group) had polysomnogram recordings at a mean of 8 days of age. Both groups showed a small fall in mean hemoglobin oxygen saturation (SpO 2 ) over the first hour of sleep. There was no difference between insert and no insert in the rate of moderate desaturations (a fall in SpO 2 $4% lasting for $10 seconds, mean 6 SEM, 17.0 6 1.5 vs 17.2 6 1.5/hour), or mean SpO 2 during sleep. The insert was associated with a significant reduction in the rate of obstructive apnea (0.3 6 0.1 vs 0.9 6 1.5/hour, P , .03), the severity of desaturation events (minimum SpO 2 82% 6 1% vs 74% 6 2%, P , .001), and time with SpO 2 ,85% (0.6% 6 0.3% vs 1.8% 6 1.4%, P = .03). CONCLUSIONS:In full-term newborn infants, a car seat insert that helps the head to lie in a neutral position was associated with reduced severity of desaturation events but not the overall rate of moderate desaturations. Pediatrics 2013;132:326-331

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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Randomized Controlled Trial of a Car Safety Seat Insert to Reduce Hypoxia in Term Infants

2013

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Exploring infant hip position and muscle activity in common baby gear and orthopedic devices

Siddicky

Wang

Rabenhorst

et al. 2020

Journal Orthopaedic Research

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Infant positioning in daily life may affect hip development. While neonatal animal studies indicate detrimental relationships between inactive lower extremities and hip development and dysplasia, no research has explored infant hip biomechanics experimentally. This study evaluated hip joint position and lower-extremity muscle activity of healthy infants in common body positions, baby gear, and orthopedic devices used to treat hip dysplasia (the Pavlik harness and the Rhino cruiser abduction brace). Surface electromyography (EMG) and marker-based motion capture recorded lower-extremity muscle activity and kinematics of 22 healthy full-term infants (4.2 ± 1.6 months, 13 M/9 F) during five conditions: Pavlik harness, Rhino brace, inward-facing soft-structured baby carrier, held in arms facing inwards, and a standard car seat. Mean filtered EMG signal, time when muscles were active, and hip position (angles) were calculated. Compared to the Pavlik harness, infants exhibited similar adductor activity (but lower hamstring and gluteus maximus activity) in the Rhino abduction brace, similar adductor and gluteus maximus activity(but lower quadriceps and hamstring activity) in the baby carrier, similar but highly variable muscle activity in-arms, and significantly lower muscle activity in the car seat. Hip position was similar between the baby carrier and the Pavlik harness. This novel infant biomechanics study illustrates the potential benefits of using inwardfacing soft-structured baby carriers for healthy hip development and highlights the potential negative impact of using supine-lying container-type devices such as car seats for prolonged periods of time. Further study is needed to understand the full picture of how body position impacts infant musculoskeletal development.

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Cervical collars and immobilisation: A South African best practice recommendation

Stanton

Hardcastle

Muhlbauer

et al. 2017

African Journal of Emergency Medicine

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IntroductionThe consequences of spinal injury as a result of trauma can be devastating. Spinal immobilisation using hard trauma boards and rigid cervical collars has traditionally been the standard response to suspected spinal injury patients even though the risk may be extremely low. Recently, adverse events due to the method of immobilisation have challenged the need for motion restriction in all trauma patients. International guidelines have been published for protection of the spine during transport and this article brings those guidelines into the South African context.RecommendationsTrauma patients need to be properly assessed using both an approved list of high and low risk factors, as well as a thorough examination. They should then be managed accordingly. Internationally validated assessment strategies have been developed, and should be used as part of the patient assessment. The method of motion restriction should be selected to suit the situation. The use of a vacuum mattress is the preferable technique, with the use of a trauma board being the least desirable.ConclusionThe need for motion restriction in suspected spinal injury should be properly evaluated and appropriate action taken. Not all trauma patients require spinal motion restriction.

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A Comparison of Respiratory Patterns in Healthy Term Infants Placed in Car Safety Seats and Beds

Cited by 23 publications

References 26 publications

Randomized Controlled Trial of a Car Safety Seat Insert to Reduce Hypoxia in Term Infants

Randomized Controlled Trial of a Car Safety Seat Insert to Reduce Hypoxia in Term Infants

Exploring infant hip position and muscle activity in common baby gear and orthopedic devices

Cervical collars and immobilisation: A South African best practice recommendation

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