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

Jensen, Erik A.; Foglia, Elizabeth E.; Dysart, Kevin; Aghai, Zubair H.; Cook, Alison; Greenspan, Jay S.; DeMauro, Sara B.

doi:10.1016/j.jpeds.2017.11.010

Cited by 11 publications

(21 citation statements)

References 45 publications

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“…2 Similar to previous studies, CSTS failure was more common in the nursery than the NICU. 4,11,12 Possible explanations for higher failure rates in the nursery include the following: (1) infants in the NICU undergo more cardiorespiratory evaluation, potentially leading to identification of apnea and bradycardia before CSTS and (2) wellnursery discharges often occur between 48 and 96 hours, so providers may perform the CSTS at an earlier CGA, when infants are less mature. Supporting this explanation, our data reveal that compared with infants in the nursery, infants in NICU had a higher CGA at the CSTS and more frequently passed the screen.…”

Section: Discussionmentioning

confidence: 99%

“…1,4,[14][15][16] For infants screened in the NICU, it is possible that characteristics not examined in this study may better predict CSTS failure. Factors shown to be associated with CSTS failure among infants screened in the NICU (eg, caffeine, requiring continuous positive airway pressure, maternal cesarean delivery, surfactant use, or antacid use) 11 were not examined in this study.…”

Section: Discussionmentioning

confidence: 99%

“…One study revealed that infants who failed the CSTS had lower adjusted odds of readmission by 30 days. 11 Although CSTS is routine in many US hospitals, the Canadian Pediatric Society does not recommend routine screening, citing lack of evidence to support improved outcomes and concern for potential risk. [17][18][19] One potential risk is increased cost given that each test requires a minimum of 90 minutes of direct staff and/or nursing observation.…”

Section: Discussionmentioning

confidence: 99%

“…[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%

“…Although authors of a recent large study described the epidemiology of CSTS across multiple NICUs, 11 to our knowledge no authors of previous large studies have described CSTS failure in both well-newborn and NICU settings or have described trends in failure over time.…”

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confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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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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Adherence to Car Seat Tolerance Screening Differs by Indication and Patient Characteristics

McLaurin‐Jiang

Weinberger

Ritter

et al. 2021

Matern Child Health J

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Objectives To assess whether adherence to institutional car seat tolerance screening (CSTS) guidelines differed for infants born preterm (PTM), term low birth weight (T-LBW), or both preterm and low birth weight (P-LBW), and to examine the association between CSTS adherence and patient characteristics. Study Design Within two large academic and community hospitals, we retrospectively reviewed all infants meeting institutional criteria (< 37 weeks’ gestation and/or < 2.27 kg) for CSTS from 2014 to 2018. Multivariable logistic regression evaluated the association of patient characteristics with institutional CSTS guideline adherence. Results 4374 eligible infants were born PTM (50.9%), T-LBW (6.5%), or P-LBW (42.6%). Adherence rates were 92.7% in the neonatal intensive care unit (NICU) and 95.2% in the well-baby nursery with initial CSTS failure rates of 6.1% and 9.9%, respectively. Adherence was lowest among T-LBW (80.7%) compared to PTM (95.1%) or P-LBW (92.2%) infants in the NICU (p < 0.001) and well-baby nursery (81.6%, 96.7% and 97.1%, respectively, p < 0.001). In bivariate analyses, gestational age, birth weight, insurance, race, hospital type, discharge year, and preferred language were associated with adherence. In fully-adjusted models, adherence was positively associated with lower gestational age, higher birth weight, non-Medicaid insurance, and later discharge year (NICU) and lower gestational age and later discharge year (well-baby nursery). Conclusions Adherence was lower for T-LBW than PTM or P-LBW infants, despite similar CSTS failure rates. Disparities in adherence among Medicaid-insured patients in the NICU warrant further study. Future studies are needed to clarify the benefit of CSTS and increase adherence in high-risk populations. Supplementary Information The online version contains supplementary material available at 10.1007/s10995-021-03220-5.

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A National Survey of Car Seat Tolerance Screening Protocols in Neonatal Intensive Care Units

Davis

Cheo

2021

Academic Pediatrics

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

Cited by 11 publications

References 45 publications

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

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

Adherence to Car Seat Tolerance Screening Differs by Indication and Patient Characteristics

A National Survey of Car Seat Tolerance Screening Protocols in Neonatal Intensive Care Units

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