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Parental Experiences of Infant Car Bed Use After Failure of Car Seat Tolerance Screen. Adv Neonatal Care 2021; 21:503-512. [PMID: 33783384 DOI: 10.1097/anc.0000000000000844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Failure of the car seat tolerance screen (CSTS) during hospitalization often leads to a recommendation for automobile travel within a car bed at discharge. PURPOSE To describe the parental experience utilizing a car bed for infant automobile transportation. METHODS A descriptive, qualitative study design was undertaken with a purposive sample of parents recruited for a single interview in the pulmonary clinic at the time of the follow-up CSTS, approximately 1 month after hospital discharge. Interviews, guided by a semistructured interview tool, provided a holistic understanding of the parental experience utilizing car bed travel. FINDINGS/RESULTS Data from 15 parental interviews revealed an overarching emotional journey consisting of 5 themes: (1) an adjustment period; (2) decision-making related to the car bed purchase; (3) encounters with varied provider education and knowledge; (4) safety and security of the car bed during transit; and (5) space and mobility restrictions imposed by the car bed. IMPLICATIONS FOR PRACTICE While recommendations exist for infant travel in a car seat, supportive recommendations for parents with an infant who needs to travel in a car bed do not exist. Based on study findings, providing parents supportive guidelines, education, and recommendations for their infant requiring travel in a car bed may be a strategy to ease the stress experienced in this situation. IMPLICATIONS FOR RESEARCH Findings indicated a need to develop policies and standards, as well as comprehensive education, for providers and parents related to car bed travel. Further research is needed to identify strategies to best support parents and infants.
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McLaurin-Jiang S, Hannon EA, Seashore C, Orr CJ, Ritter V, Flower KB. Recent Trends in Infant Car Seat Tolerance Screening Failure Within a Large Health Care System, 2014-2018. Hosp Pediatr 2019; 9:813-817. [PMID: 31527051 DOI: 10.1542/hpeds.2019-0078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES 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 χ2 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 = 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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Affiliation(s)
- Skyler McLaurin-Jiang
- Department of Pediatrics, School of Medicine,
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and
| | - Emily A Hannon
- Department of Pediatrics, School of Medicine, Duke University, Durham, North Carolina
| | | | - Colin J Orr
- Department of Pediatrics, School of Medicine
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and
| | - Victor Ritter
- Department of Biostatistics, Gilling's School of Public Health, and
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Use of car beds for infant travel: a review of the literature. J Perinatol 2018; 38:1287-1294. [PMID: 30097654 DOI: 10.1038/s41372-018-0195-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 07/16/2018] [Accepted: 07/27/2018] [Indexed: 11/08/2022]
Abstract
Discharging neonates in a proper car safety seat is standard of care in the United States and many other countries. However, not every neonate can be safely positioned in a standard semi-upright car seat. In these cases, providers may opt for a travel device that allows the infant to lie flat, either supine or prone, known as a car bed. Minimal evidence exists to guide providers on car bed safety and help determine which infants would benefit from discharge in a car bed. In this article, we provide a comprehensive summary of existing literature on the safety of car beds for motor vehicle travel, car bed use in specific patient populations, and car beds vs. car seats for infants at risk of adverse cardiorespiratory events, including preterm infants with Hg-O2 desaturations in the car seat. We discuss recommendations for the follow-up of infants discharged in a car bed in order to safely transition back to a car seat.
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Jensen EA, Foglia EE, Dysart KC, Aghai ZH, Cook A, Greenspan JS, DeMauro SB. Car Seat Tolerance Screening in the Neonatal Intensive Care Unit: Failure Rates, Risk Factors, and Adverse Outcomes. J Pediatr 2018; 194:60-66.e1. [PMID: 29269198 PMCID: PMC5826836 DOI: 10.1016/j.jpeds.2017.11.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 10/11/2017] [Accepted: 11/01/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To characterize the epidemiology of Car Seat Tolerance Screening (CSTS) failure and the association between test failure and all-cause 30-day postdischarge mortality or hospital readmission in a large, multicenter cohort of preterm infants receiving neonatal intensive care. STUDY DESIGN This retrospective cohort study used the prospectively collected Optum Neonatal Database. Study infants were born at <37 weeks of gestation between 2010 and 2016. We identified independent predictors of CSTS failure and calculated the risk-adjusted odds of all-cause 30-day mortality or hospital readmission associated with test failure. RESULTS Of 7899 infants cared for in 788 hospitals, 334 (4.2%) failed initial CSTS. Greater postmenstrual age at testing and African American race were independently associated with decreased failure risk. Any treatment with an antacid medication, concurrent use of caffeine or supplemental oxygen, and a history of failing a trial off respiratory support were associated with increased failure risk. The mean adjusted post-CSTS duration of hospitalization was 3.1 days longer (95% CI, 2.7-3.6) among the infants who failed the initial screening. Rates of 30-day all-cause mortality or readmission were higher among infants who failed the CSTS (2.4% vs 1.0%; P = .03); however, the difference was not significant after confounder adjustment (OR, 0.38; 95% CI, 0.11-1.31). CONCLUSION CSTS failure was associated with longer post-test hospitalization but no difference in the risk-adjusted odds for 30-day mortality or hospital readmission. Whether CSTS failure unnecessarily prolongs hospitalization or results in appropriate care that prevents adverse postdischarge outcomes is unknown. Further research is needed to address this knowledge gap.
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Affiliation(s)
- Erik A. Jensen
- Department of Pediatrics, Division of Neonatology, The Children’s Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Elizabeth E. Foglia
- Department of Pediatrics, Division of Neonatology, The Children’s Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Kevin C. Dysart
- Department of Pediatrics, Division of Neonatology, The Children’s Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Zubair H. Aghai
- Division of Neonatology, Nemours/Sidney Kimmel Medical College at Thomas, Jefferson University, Philadelphia, Pennsylvania
| | | | - Jay S. Greenspan
- Division of Neonatology, Nemours/Sidney Kimmel Medical College at Thomas, Jefferson University, Philadelphia, Pennsylvania
| | - Sara B. DeMauro
- Department of Pediatrics, Division of Neonatology, The Children’s Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Abstract
BACKGROUND Premature and other at-risk infants can experience cardiorespiratory problems when positioned in their car seats. The American Academy of Pediatrics recommends that all premature and at-risk infants undergo a period of observation in their car seat to monitor for apnea, bradycardia, and oxygen desaturation before hospital discharge. This Infant Car Seat Challenge (ICSC) is used to determine readiness for infant travel in a car seat. Infants failing the ICSC are discharged home in car beds and referred for a follow-up screen in the outpatient clinic. PURPOSE The purpose of this study was to identify predictors for infants failing the follow-up ICSC after hospital discharge. METHODS/SEARCH STRATEGY A retrospective, cross-sectional study design was used to examine charts of 436 infants referred from across New England, to Boston Children's Hospital's, Center for Healthy Infant Lung Development clinic between August 2008 and May 2015 for a follow-up ICSC. FINDINGS/RESULTS Infants who failed the follow-up ICSC had statistically significant lower weights (0.27 ± 0.14 kg, difference ± standard error, P = .03) and younger postmenstrual ages (0.9 ± 0.4 weeks, P = .03). History of a cardiac condition (odds ratio, 3.6; 95% confidence interval, 1.5-8.5; P = .005) and respiratory illness (odds ratio, 2.1; confidence interval, 1.1 to 4.2; P = .03) were significant predictors of ICSC failure. IMPLICATIONS FOR PRACTICE A follow-up ICSC is recommended for the safe transition of infants from a car bed to a car seat. IMPLICATIONS FOR RESEARCH Further research is needed to investigate the causes of ICSC failure among high-risk infant populations.
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Abstract
BACKGROUND AND OBJECTIVE Car seat tolerance screening (CSTS) is a common predischarge assessment of neonates. Almost half of nurseries and NICUs have low birth weight (LBW, <2.5 kg) as an inclusion criterion, regardless of birth gestational age (GA). Little is known about the epidemiology of CSTS in this cohort. The objective of this study was to identify incidence and risk factors for CSTS failure in term LBW infants. METHODS This was a retrospective medical record review of 220 full-term LBW infants qualifying for CSTS over a 4-year period between January 2010 to December 2013. We described CSTS results and performed bivariate analyses to evaluate for predictors of failure. RESULTS Overall failure incidence was 4.8%. There were no differences between those who passed and those who failed based on birth weight, birth GA, race, gender, Apgar scores, respiratory support requirements, magnesium exposure, corrected GA, or weight at the time of CSTS. Maternal urine toxicology positive for opiates was found to be a significant predictor of CSTS failure. Of the 9 subjects who failed, 2 had a specific diagnosis identified (Prader-Willi syndrome and long QT syndrome) after a failed CSTS prompted closer examination and workup before discharge. CONCLUSIONS We found a similar incidence of failure for full-term LBW infants as has been previously reported for preterm infants. The infants who failed were more likely to have mothers who tested positive for opiates before delivery. Epidemiologic data are provided to help guide future CSTS policies and protocol development for this group.
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Affiliation(s)
- Natalie L Davis
- Division of Neonatology, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland
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Davis NL. Screening for cardiopulmonary events in neonates: a review of the infant car seat challenge. J Perinatol 2015; 35:235-40. [PMID: 25675050 DOI: 10.1038/jp.2015.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 12/16/2014] [Accepted: 01/05/2015] [Indexed: 11/09/2022]
Abstract
The infant car seat challenge (ICSC), or period of observation in a car safety seat before discharge to monitor for episodes of apnea, bradycardia and desaturation, is one of the most common tests performed on preterm neonates in the United States. However, the utility of the ICSC to identify infants at risk for adverse cardiopulmonary events in the car seat remains unclear. Minimal evidence exists to guide clinicians in performance of this test including appropriate inclusion criteria and failure criteria. In this article, the origins of the ICSC are discussed as well as potential etiologies of desaturations and bradycardia in the car seat position. Current literature on implementation, inclusion and failure criteria, incidence of failure and data on the meaning of a 'passed' vs 'failed' ICSC are discussed. Emphasis is made on minimizing time in car seats and seated devices given concern over the risk of desaturations.
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Affiliation(s)
- N L Davis
- Department of Pediatrics, Division of Neonatology, University of Maryland Children's Hospital, University of Maryland School of Medicine, Baltimore, MD, USA
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Schutzman DL, Salvador A, Janeczko M, Weisberg L, Tran N, Porat R. A comparison of the infant car seat challenge and the polysomnogram at the time of hospital discharge. Arch Dis Child Fetal Neonatal Ed 2013; 98:F411-5. [PMID: 23402887 DOI: 10.1136/archdischild-2012-303244] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The American Academy of Pediatrics recommends all infants born at <37 weeks gestation spend a period of observation in a car seat prior to hospital discharge to assess for apnoea, bradycardia or oxygen desaturation. The most recent Cochrane review suggested further studies to determine if the infant car seat challenge (ICSC) accurately predicts the risk of clinically adverse events. We reviewed our experience with the ICSC and the polysomnogram (PSG) to determine if the ICSC accurately predicts the risk of adverse events when compared with the PSG. STUDY DESIGN Retrospective chart review of all infants in our institution who had an ICSC and a PSG between January 2005 and December 2008. RESULT 785 infants had ICSCs. In addition, 313 infants (56.6%) had an abnormal PSG, even though the vast majority, 158 (88.3%), passed their ICSC. There were no significant differences in gestational age at birth, birth weight, chronological age at study or postmenstrual age at study between infants who either passed or failed the ICSC with those who passed or failed the PSG. The sensitivity of the ICSC was 0.11 and specificity was 0.96. The positive predictive value of the ICSC was 0.77 and the negative predictive value was 0.45. CONCLUSIONS The ICSC has a low negative predictive value (0.45) when compared with the PSG as a reference standard for identifying adverse cardiorespiratory events. Although less time consuming and cumbersome than extended polysomnography, the ICSC is not a reliable substitute.
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Affiliation(s)
- David L Schutzman
- Division of Neonatology, Department of Pediatrics, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA.
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Abstract
OBJECTIVES The American Academy of Pediatrics recommends all neonates born at <37 weeks' gestation receive a predischarge Infant Car Seat Challenge (ICSC), a resource-intensive test with little information on failure rates and risk factors. We sought to determine incidence and predictors of failure to allow more selective testing. METHODS We conducted a retrospective medical record review of 1173 premature neonates qualifying for the ICSC between 2009 and 2010. We looked at ICSC result and potential risk factors and then performed bivariate and multivariable logistic analyses to evaluate for predictors of failure. RESULTS Overall incidence of failure was 4.3%. Infants who failed were less premature and had higher birth weights. Late-preterm infants made up 60% of our study population but accounted for 78% of failures (P = .019). Infants who passed had older chronologic ages at time of testing, were more likely to have been exposed to caffeine, and were more likely to have required some type of respiratory support than those that failed. Final multivariable model demonstrated that increasing birth gestational age (GA) increased the odds of failure when corrected for gender, race, and small for GA status. For every 1-day increase in birth GA the odds ratio of failure was 1.03 (95% confidence interval 1.01-1.05). CONCLUSIONS We found that increasing birth GA was a significant predictor of failure, and that late-preterm infants comprised a significant percentage of infants who failed. This suggests that limiting testing to extremely premature infants would miss most cases of ICSC failure.
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Affiliation(s)
- Natalie Louise Davis
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA 02115, USA.
| | - Freeman Condon
- Respiratory Diseases, Boston Children’s Hospital, Boston, Massachusetts
| | - Lawrence M. Rhein
- Divisions of Newborn Medicine, and,Respiratory Diseases, Boston Children’s Hospital, Boston, Massachusetts
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Affiliation(s)
- Joel L. Bass
- Department of Pediatrics, Newton-Wellesley Hospital, Newton, Massachusetts
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