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

Davis, Natalie L.

doi:10.1038/jp.2015.1

Cited by 9 publications

(4 citation statements)

References 53 publications

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“…If the study had been conducted in a NICU not having guidelines requiring weekly blood tests when receiving HMF and/or phosphate, there might have been fewer visits in the NICU and more videoconferences. The American Academy of Pediatrics recommends observing for cardiorespiratory compromise in preterm infants while placed in a car seat prior to discharge for 90-120 minutes [28] however, this is not standard practice in NICUs in Denmark. During NTH there was one episode of desaturation/apnoea during transportation to the NICU, but this infant suffered from respiratory syncytial virus, which is a well-known risk-factor for apnoea in preterm infants.…”

Section: Discussionmentioning

confidence: 99%

Growth and breastfeeding of preterm infants receiving neonatal tele-homecare compared to hospital-based care

Holm

Clemensen

Brødsgaard

et al. 2019

NPM

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Objective Neonatal tele-homecare implies that parents of clinically stable preterm infants can manage tube feeding and establishment of oral feeding in the home. Support is provided from the neonatal intensive care unit (NICU) through a telehealth service. The aim of this study was to compare growth and breastfeeding rates amongst infants being managed in the NICU (conventional care) and by neonatal tele-homecare. Methods A total of 96 preterm infants with tube feeding requirements participated in the observational study of neonatal tele-homecare. Retrospective data in 278 preterm infants receiving standard care in the same neonatal intensive care unit prior to implementation of neonatal tele-homecare were used for comparison. Rates of breastfeeding and growth were monitored during neonatal tele-homecare. Infant weights were converted to standard deviation weight-forage z-scores based on a reference. Results There was no significant difference in rates of exclusive breastfeeding between the neonatal tele-homecare infants and the controls. Among the very preterm singleton infants more neonatal tele-homecare infants were exclusively breastfed at discharge compared to the controls (p=0.02). There was no difference in median weight for age z-scores at discharge. Conclusion The breastfeeding rates in infants receiving neonatal tele-homecare at time of discharge were higher compared to historical controls. Growth rates remained the same amongst groups. This study demonstrates that neonatal tele-homecare may be an appropriate model of care for the management of preterm infants outside of the hospital environment; with the added benefit of higher rates of breastfeeding at time of discharge.

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Section: Discussionmentioning

confidence: 99%

Growth and breastfeeding of preterm infants receiving neonatal tele-homecare compared to hospital-based care

Holm

Clemensen

Brødsgaard

et al. 2019

NPM

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“…Studies have shown that premature infants are prone to drops in blood oxygen saturation, and apnoea or hypoventilation when restrained in car seats, [2][3][4] in up to 60% of infants studied. 5 The American Academy of Pediatrics (AAP) recommends that all preterm infants should undergo monitoring in a car seat before discharge-for apnoea, bradycardia or desaturations, 6 7 and many UK hospitals follow this advice. The significance and potential impact of these problems is not clear, 8 9 but there have been reports of deaths of infants who have been left in a sitting position, including in car seats-both on journeys, and when parents have used it as an alternative to a pushchair or cot for the infant to sleep in.…”

Section: Introductionmentioning

confidence: 99%

Is the infant car seat challenge useful? A pilot study in a simulated moving vehicle

Arya

Williams

Kilonback

et al. 2016

Arch Dis Child Fetal Neonatal Ed

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Background and objectiveThe American Academy of Pediatrics recommends that preterm infants complete a predischarge ‘car seat challenge’ observation for cardiorespiratory compromise while in a car seat. This static challenge does not consider the more upright position in a car or the vibration of the seat when the car is moving. This pilot study was designed to assess the cardiorespiratory effects of vibration, mimicking the effect of being in a moving car, on preterm and term infants.MethodsA simulator was designed to reproduce vertical vibration similar to that in a rear-facing car seat at 30 mph. 19 healthy newborn term and 21 preterm infants, ready for hospital discharge, underwent cardiorespiratory measurements while lying flat in a cot (baseline), static in the seat (30°), simulator (40°) and during motion (vibration 40°).ResultsMedian test age was 13 days (range 1–65 days) and median weight was 2.5 kg (IQR: 2.1–3.1 kg).Compared with baseline observations, only the total number of desaturations was significantly increased when infants were placed at 30° (p=0.03). At 40°, or with vibration, respiratory and heart rates increased and oxygen saturation decreased significantly. Profound desaturations <85% significantly increased during motion, regardless of gestational age.ConclusionsThis is the first study to assess the effect of motion on infants seated in a car safety seat. Term and preterm infants showed significant signs of potentially adverse cardiorespiratory effects in the upright position at 40°, particularly with simulated motion, not identified in the standard challenge. A larger study is required to investigate the significance of these results.

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“…In addition, although there is no consensus on failure criteria across the nation, our CSTS failure SpO 2 < 88% is conservative and lower than the most common cutoff of < 90%. 2,16 This may indicate that our findings are generalizable to those infants who have the more severe desaturation events. Further studies are needed to help define appropriate saturation limits for failure of CSTS.…”

Section: Discussionmentioning

confidence: 80%

Assessment of Anthropometric Measurements as Predictors of Car Seat Screening Failure

et al. 2017

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Objective The objective of this study was to determine whether anthropometric measurements such as head circumference (HC), body mass index (BMI), and body surface area (BSA) can predict car seat tolerance screen (CSTS) failure. We hypothesized that subjects with larger HC and lower BMI/BSA would have increased risk of failure. Study Design We performed retrospective medical record review of infants born in 2013 who qualified for CSTS due to being born preterm (< 37 weeks) or low birth weight (LBW). We performed bivariate analyses of clinical and demographic risk factors including anthropometrics to identify predictors of CSTS failure. Results In this study, 19 of 366 subjects failed their CSTS (5.3%). There were no significant differences in HC, length, BSA, BMI, or ratio of HC to length, BMI, or BSA between those who passed versus failed. On subgroup analysis of preterm infants, the significant predictor of failure was multiple gestation (p = 0.024). In the term LBW cohort, requiring nasal canula (NC) (p = 0.03) and having limited or no prenatal care (PNC) (p = 0.0006) were both significant predictors of failure. Conclusion Neither absolute measurements nor the ratios of HC to body measurements predicted CSTS outcome. Multiple gestation was a significant predictor of failure in preterm infants, while NC requirement and poor PNC were predictors in LBW term infants.

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

Cited by 9 publications

References 53 publications

Growth and breastfeeding of preterm infants receiving neonatal tele-homecare compared to hospital-based care

Growth and breastfeeding of preterm infants receiving neonatal tele-homecare compared to hospital-based care

Is the infant car seat challenge useful? A pilot study in a simulated moving vehicle

Assessment of Anthropometric Measurements as Predictors of Car Seat Screening Failure

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