Oxygen Desaturation in Term Infants in Car Safety Seats

Bass, Joel L.; Bull, Marilyn J.

doi:10.1542/peds.110.2.401

Cited by 35 publications

(31 citation statements)

References 6 publications

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“…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: 88%

“…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.…”

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: 88%

Section: Discussionmentioning

confidence: 99%

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

2013

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“…Because they still have poor head control and often experience flexion of the head while in a sitting position, infants younger than 1 month in sitting devices might be at increased risk of upper airway obstruction and oxygen desaturation. [128][129][130][131][132] In addition, there is increasing concern about injuries from falls resulting from car seats being placed on elevated surfaces. [133][134][135][136][137] An analysis of CPSC data revealed 15 suffocation deaths between 1990 and 1997 resulting from car seats overturning after being placed on a bed, mattress, or couch.…”

Section: Car Seats and Other Sitting Devices Are Not Recommended For mentioning

confidence: 99%

SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment

Moon¹

2011

Pediatrics

217

115

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Despite a major decrease in the incidence of sudden infant death syndrome (SIDS) since the American Academy of Pediatrics (AAP) released its recommendation in 1992 that infants be placed for sleep in a nonprone position, this decline has plateaued in recent years. Concurrently, other causes of sudden unexpected infant death occurring during sleep (sleep-related deaths), including suffocation, asphyxia, and entrapment, and ill-defined or unspecified causes of death have increased in incidence, particularly since the AAP published its last statement on SIDS in 2005. It has become increasingly important to address these other causes of sleep-related infant death. Many of the modifiable and nonmodifiable risk factors for SIDS and suffocation are strikingly similar. The AAP, therefore, is expanding its recommendations from being only SIDS-focused to focusing on a safe sleep environment that can reduce the risk of all sleep-related infant deaths including SIDS. The recommendations described in this report include supine positioning, use of a firm sleep surface, breastfeeding, room-sharing without bed-sharing, routine immunization, consideration of a pacifier, and avoidance of soft bedding, overheating, and exposure to tobacco smoke, alcohol, and illicit drugs. The rationale for these recommendations is discussed in detail in this technical report. The recommendations are published in the accompanying “Policy Statement—Sudden Infant Death Syndrome and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment,” which is included in this issue (www.pediatrics.org/cgi/doi/10.1542/peds.2011-2220).

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“…14 Preterm infants and other infants in the NICU should be placed in the supine position for sleep as soon as the infant is medically stable and significantly before the infant's anticipated discharge, by 32 weeks' postmenstrual age. 15 [19][20][21][22][23] Infants who are younger than 4 months are particularly at risk, because they might assume positions that can create risk of suffocation or airway obstruction. When infant slings and cloth carriers are used for carrying, it is important to ensure that the infant's head is up and above the fabric, the face is visible, and that the nose and mouth are clear of obstructions.…”

Section: Introductionmentioning

confidence: 99%

SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment

Moon¹

2011

Pediatrics

540

113

View full text Add to dashboard Cite

Despite a major decrease in the incidence of sudden infant death syndrome (SIDS) since the American Academy of Pediatrics (AAP) released its recommendation in 1992 that infants be placed for sleep in a nonprone position, this decline has plateaued in recent years. Concurrently, other causes of sudden unexpected infant death that occur during sleep (sleep-related deaths), including suffocation, asphyxia, and entrapment, and ill-defined or unspecified causes of death have increased in incidence, particularly since the AAP published its last statement on SIDS in 2005. It has become increasingly important to address these other causes of sleep-related infant death. Many of the modifiable and nonmodifiable risk factors for SIDS and suffocation are strikingly similar. The AAP, therefore, is expanding its recommendations from focusing only on SIDS to focusing on a safe sleep environment that can reduce the risk of all sleep-related infant deaths, including SIDS. The recommendations described in this policy statement include supine positioning, use of a firm sleep surface, breastfeeding, room-sharing without bed-sharing, routine immunizations, consideration of using a pacifier, and avoidance of soft bedding, overheating, and exposure to tobacco smoke, alcohol, and illicit drugs. The rationale for these recommendations is discussed in detail in the accompanying “Technical Report—SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment,” which is included in this issue of Pediatrics (www.pediatrics.org/cgi/content/full/128/5/e1341).

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Oxygen Desaturation in Term Infants in Car Safety Seats

Cited by 35 publications

References 6 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

SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment

SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment

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