The importance of avoiding head flexion in preterm infants

Post-discharge outcomes of failed car seat tolerance screens: A case-control and follow-up study

BACKGROUND

Despite widespread implementation, limited data exists relating morbidity or adverse outcomes to Car Seat Tolerance Screen (CSTS) result in preterm and low birth weight (LBW) neonates. The objective of this study was to determine longer term post-discharge outcomes of infants who failed a CSTS.

METHODS

We performed a case control study evaluating outcomes of infants born over one year who failed vs. passed an initial CSTS, utilizing both retrospective medical record review and parental survey data 2-3 years after discharge. Subjects were matched one case of failed CSTS to two controls who passed CSTS based on sex, gestational age, and BW. We performed bivariate analysis of clinical and demographic risk factors comparing those who passed vs. failed CSTS.

RESULTS

We identified 19 subjects who failed and matched to 37 controls. Cases were significantly more likely to be diagnosed with obstructive sleep apnea (p = 0.027), asthma (p = 0.016), and be treated with albuterol (p = 0.008). We did not find differences in frequency of urgent care visits or hospital admissions between the groups. Although more of the cases were noted to have developmental delays, the difference was not statistically significant.

CONCLUSION

This is the first study to evaluate longer term post-discharge outcomes of subjects having undergone CSTS. Subjects who failed CSTS had significantly increased incidence of respiratory diagnoses such as OSA and asthma than matched controls by 2-3 years after discharge. Larger studies are necessary to further evaluate these findings, but this does provide data that CSTS may be useful in identifying at risk neonates.