A comparison of the infant car seat challenge and the polysomnogram at the time of hospital discharge

Schutzman, David L.; Salvador, Agnes; Janeczko, Michael; Weisberg, Louis; Tran, Nghia; Porat, Rachel

doi:10.1136/archdischild-2012-303244

Cited by 13 publications

(9 citation statements)

References 23 publications

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“…Schutzman et al 28 performed a retrospective analysis of preterm infants comparing continuous PSG for 12 to 24 h within 48 h of discharge to a 60 min ICSC. Of the 313 infants who had PSG and an ICSC, 56.5% failed the PSG, defined as apnea 420 s, bradycardia o80 for 3 to 5 s and desaturation o 85% for 3 to 5 s, or evidence of reflux on pH probe.…”

Section: Icsc In Term Infantsmentioning

confidence: 99%

“…9 This evidence also demonstrates the increased risk of Hb-O 2 desaturation events with increased More recent prospective studies have had a variety of Hb-O 2 saturation failure cutoffs, generally between 85 and 90%, with 90% remaining the most commonly used cutoff in published literature. [27][28][29][30][31][32][33] The wide range in the literature reflects the wide ranges used in clinical practice, making many studies difficult to generalize.…”

Section: Introductionmentioning

confidence: 98%

“…27,33 Failure rates in the literature range widely from 4 to 30%, but studies have been limited by small sample size and lack of consensus on appropriate failure definitions. 4,5,27,28,32,48,49 Predischarge weight o 2000 g has been linked to increased risk of failure. 27 And infants with a history of apnea of prematurity also appear to be at increased risk.…”

Section: Introductionmentioning

confidence: 99%

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Screening for cardiopulmonary events in neonates: a review of the infant car seat challenge

Davis

2015

J Perinatol

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The infant car seat challenge (ICSC), or period of observation in a car safety seat before discharge to monitor for episodes of apnea, bradycardia and desaturation, is one of the most common tests performed on preterm neonates in the United States. However, the utility of the ICSC to identify infants at risk for adverse cardiopulmonary events in the car seat remains unclear. Minimal evidence exists to guide clinicians in performance of this test including appropriate inclusion criteria and failure criteria. In this article, the origins of the ICSC are discussed as well as potential etiologies of desaturations and bradycardia in the car seat position. Current literature on implementation, inclusion and failure criteria, incidence of failure and data on the meaning of a 'passed' vs 'failed' ICSC are discussed. Emphasis is made on minimizing time in car seats and seated devices given concern over the risk of desaturations.

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Section: Icsc In Term Infantsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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Screening for cardiopulmonary events in neonates: a review of the infant car seat challenge

Davis

2015

J Perinatol

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“…[1][2][3] Published CSTS failure rates range from 4.2% to 83%, although the population of infants undergoing screening and the criteria for failure vary across sites. [4][5][6][7][8][9][10] Higher failure rates among infants in the nursery compared with the NICU have been reported. 4,11,12 Other infant characteristics, such as gestational age (GA), race, low birth weight (BW), and sex, have been inconsistently associated with failure.…”

mentioning

confidence: 99%

Recent Trends in Infant Car Seat Tolerance Screening Failure Within a Large Health Care System, 2014–2018

McLaurin‐Jiang

Hannon

Seashore³

et al. 2019

Hospital Pediatrics

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To describe temporal trends in car seat tolerance screening (CSTS) failure within a large hospital system (2014-2018). METHODS: We conducted a retrospective cohort study using electronic medical record data for infants who underwent a CSTS. Our primary outcome measure was the CSTS failure rate. Covariates included year, CSTS location (well nursery or NICU), gestational age (GA), race, sex, birth weight, CSTS date, and age at CSTS. Associations of covariates with CSTS failure were examined by using x 2 tests, t tests, analysis of variance, and Wilcoxon rank tests. Multivariable logistic regression was used to determine the adjusted odds of CSTS failure. RESULTS: Of 4849 infants tested, the failure rate was 8.1% (n 5 394). Most CSTS occurred in the well nursery (79.5%) and involved late preterm (55.2%) or term infants (23.7%). In bivariate analyses, year, unit location, higher birth weight, younger chronological age at testing, and higher GA were positively associated with CSTS failure (P , .05). After stratification by CSTS location, the CSTS failure rate rose in the well nursery but remained stable in the NICU, and use of screening rose among term infants. In the adjusted model, year, GA, and corrected gestational age at CSTS were associated with failure. Each subsequent year was associated with a 19% increase in odds of CSTS failure (P , .001). CONCLUSIONS: We found a higher rate of CSTS failure in the well nursery compared with the NICU, and the difference in failure rates increased over time. Improved understanding of infants at the highest risk of CSTS failure could impact routine screening guidelines.

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“…Recent studies confirmed that some infants, including full term babies, experience transient cardiorespiratory abnormalities when positioned in a car seat. 14–18 However, no studies have determined whether CSTS accurately identifies infants who are unsafe for transport in a car safety seat and results in subsequent pre-discharge care that prevents later morbidity or mortality among those who fail screening. 11, 12, 19 Moreover, there is limited multicenter data describing the basic epidemiological characteristics of CSTS including the incidence of and risk factors for test failure.…”

mentioning

confidence: 99%

Car Seat Tolerance Screening in the Neonatal Intensive Care Unit: Failure Rates, Risk Factors, and Adverse Outcomes

Jensen

Foglia

Dysart

et al. 2018

The Journal of Pediatrics

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A comparison of the infant car seat challenge and the polysomnogram at the time of hospital discharge

Abstract: The ICSC has a low negative predictive value (0.45) when compared with the PSG as a reference standard for identifying adverse cardiorespiratory events. Although less time consuming and cumbersome than extended polysomnography, the ICSC is not a reliable substitute.

Cited by 13 publications

References 23 publications

Screening for cardiopulmonary events in neonates: a review of the infant car seat challenge

Screening for cardiopulmonary events in neonates: a review of the infant car seat challenge

Recent Trends in Infant Car Seat Tolerance Screening Failure Within a Large Health Care System, 2014–2018

Car Seat Tolerance Screening in the Neonatal Intensive Care Unit: Failure Rates, Risk Factors, and Adverse Outcomes

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