Newborn Car Bed Testing in a Community Hospital: Implementing the American Academy of Pediatrics Recommendations

Abstract

Objective This study was designed to describe our experience in implementing the American Academy of Pediatrics (AAP) recommendation to test infants in a car bed if they fail a car seat challenge test.

Study Design Car seat challenge testing was performed for 90 minutes or the anticipated duration of the trip home, whichever was longer. Based on the pulse oximetry saturation values (90–92% or < 90%) two categories of test failure were used. Infants who failed in the car seat were tested in the car bed. Testing took place in both the normal newborn nursery (NBN) and special care nursery (SCN). NBN babies who failed in the car bed were transferred to our SCN for additional assessment and management.

Results A total of 197 infants were tested in car seats out of which 177 (89.8%) passed the test. Of the 20 infants who failed, 16 passed the car bed challenge test on the first attempt and were discharged in those devices. All infants who failed the car bed challenge were NBN patients.

Conclusions Using 93% as the acceptable lower limit of oxygenation we successfully implemented the AAP recommendations for car bed challenge testing in our nursery.

Keywords

car seats - car beds - oxygen desaturation - apnea - bradycardia

• References

• 1 Bull MJ, Engle WA ; Committee on Injury, Violence, and Poison Prevention and Committee on Fetus and Newborn; American Academy of Pediatrics. Safe transportation of preterm and low birth weight infants at hospital discharge. Pediatrics 2009; 123 (5) 1424-1429
• 2 Bass JL. The infant car seat challenge: determining and managing an “abnormal” result. Pediatrics 2010; 125 (3) 597-598
• 3 Tonkin SL, Vogel SA, Bennet L, Gunn AJ. Apparently life threatening events in infant car safety seats. BMJ 2006; 333 (7580) 1205-1206
• 4 Côté A, Bairam A, Deschenes M, Hatzakis G. Sudden infant deaths in sitting devices. Arch Dis Child 2008; 93 (5) 384-389
• 5 Degrazia M, Guo CY, Wilkinson AA, Rhein L. Weight and age as predictors for passing the infant car seat challenge. Pediatrics 2010; 125 (3) 526-531
• 6 Bass JL, Mehta KA. Oxygen desaturation of selected term infants in car seats. Pediatrics 1995; 96 (2 Pt 1) 288-290
• 7 Bass JL, Corwin M, Gozal D , et al. The effect of chronic or intermittent hypoxia on cognition in childhood: a review of the evidence. Pediatrics 2004; 114 (3) 805-816
• 8 Jones KL, Krous HF, Nadeau J, Blackbourne B, Zielke HR, Gozal D. Vascular endothelial growth factor in the cerebrospinal fluid of infants who died of sudden infant death syndrome: evidence for antecedent hypoxia. Pediatrics 2003; 111 (2) 358-363
• 9 Kinney HC, Thach BT. The sudden infant death syndrome. N Engl J Med 2009; 361 (8) 795-805
• 10 Poets CF. When do infants need additional oxygen? A review of current literature. Pediatr Pulmonol 1998; 26: 424-428
• 11 DeGrazia M. Stability of the infant car seat challenge and risk factors for oxygen desaturation events. J Obstet Gynecol Neonatal Nurs 2007; 36 (4) 300-307
• 12 Cerar LK, Scirica CV, Gantar IS, Osredkar D, Neubauer D, Kinane TB. A comparison of respiratory patterns in healthy term infants placed in car safety seats and beds. Pediatrics 2009; 124 (3) e396-e402
• 13 Bass JL, Stening W, Nitsch P, Roth B. O2 saturation and slings. Pediatrics 2004; 113 (1 Pt 1) 169-170, author reply 169–170
• 14 News from CPSC. Infant deaths prompt CPSC warning about sling carriers for babies. United States Consumer Product Safety Commission. March 12, 2010:Release 10165