TY - JOUR
T1 - Getting Babies Safely Home
T2 - A Retrospective Chart Review of Car Safety Seat Tolerance Screening Outcomes
AU - Hoffman, Benjamin D.
AU - Gilbert, Tess A.
AU - Chan, Kelsi
AU - Ennis, Brianna
AU - Gallardo, Adrienne
AU - Carlson, Kathleen F.
N1 - Funding Information:
Authorship statement: B.D. conceived and designed the initial study, performed chart review, drafted the manuscript, and edited and critically examined the manuscript for important intellectual content. T.A.G. conceived and designed the initial study, conducted data analysis, and edited and critically examined the manuscript for important intellectual content. K.C. conceived and designed the initial study, performed chart review, and edited and critically examined the manuscript for important intellectual content. B.E. conceived and designed the initial study, performed chart review, and edited and critically examined the manuscript for important intellectual content. A.G. conceived and designed the initial study, and edited and critically examined the manuscript for important intellectual content. K.F.C. conceived and designed the initial study, conducted data analysis, and edited and critically examined the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work. The authors wish to thank the nurses and staff of the OHSU/Doernbecher MBU, NICU, and Tom Sargent Safety Center for their work in protecting infants. We also wish to acknowledge Susan DeFrancesco, JD, MPH for her review and support of the manuscript.
Publisher Copyright:
© 2021 Academic Pediatric Association
PY - 2021/11/1
Y1 - 2021/11/1
N2 - Background: The American Academy of Pediatrics recommends pre-discharge Car Seat Tolerance Screening (CSTS) for all neonates born <37 weeks estimated gestational age (EGA), or otherwise at risk for cardiorespiratory compromise. Screening is burdensome and there remains tremendous variation in testing criteria and methodology. Design/Methods: We conducted a retrospective chart review of 1,072 infants who underwent CSTS between 11/2013 and 7/2016 at a single academic health center. CSTS outcomes (failure and, separately, significant cardiorespiratory instability (CRI)), including those not meeting failure thresholds) were analyzed for all infants screened, and for preterm infants by screening location (Neonatal Intensive Care Unit (NICU) and Mother/Baby Unit (MBU)). Logistic regression was used to estimate associations between infant characteristics and CSTS outcomes. Results: Overall incidence of CSTS failure was 9.2%. Among all infants, hemodynamically significant congenital heart disease, apnea, chronic lung disease, and being small for EGA were associated with failure. Additionally, those born ≤28 weeks EGA had 2.4 times greater likelihood of failure than those 34-36 weeks EGA. Among preterm infants in the NICU and MBU, those of earlier EGA were also more likely to fail. Almost half (47.5%) of all preterm infants demonstrated CRI during CSTS. Conclusion: We found high CSTS failure rates, and identified key infant characteristics that were associated with increased likelihood of failure. Significant CRI events were remarkably common. Larger, prospective studies are needed to elucidate risk factors for instability and failure and define practical criteria for CSTS recommendations.
AB - Background: The American Academy of Pediatrics recommends pre-discharge Car Seat Tolerance Screening (CSTS) for all neonates born <37 weeks estimated gestational age (EGA), or otherwise at risk for cardiorespiratory compromise. Screening is burdensome and there remains tremendous variation in testing criteria and methodology. Design/Methods: We conducted a retrospective chart review of 1,072 infants who underwent CSTS between 11/2013 and 7/2016 at a single academic health center. CSTS outcomes (failure and, separately, significant cardiorespiratory instability (CRI)), including those not meeting failure thresholds) were analyzed for all infants screened, and for preterm infants by screening location (Neonatal Intensive Care Unit (NICU) and Mother/Baby Unit (MBU)). Logistic regression was used to estimate associations between infant characteristics and CSTS outcomes. Results: Overall incidence of CSTS failure was 9.2%. Among all infants, hemodynamically significant congenital heart disease, apnea, chronic lung disease, and being small for EGA were associated with failure. Additionally, those born ≤28 weeks EGA had 2.4 times greater likelihood of failure than those 34-36 weeks EGA. Among preterm infants in the NICU and MBU, those of earlier EGA were also more likely to fail. Almost half (47.5%) of all preterm infants demonstrated CRI during CSTS. Conclusion: We found high CSTS failure rates, and identified key infant characteristics that were associated with increased likelihood of failure. Significant CRI events were remarkably common. Larger, prospective studies are needed to elucidate risk factors for instability and failure and define practical criteria for CSTS recommendations.
KW - Car Seat Tolerance Screen
KW - car safety seat
KW - late pre-term
KW - preterm
UR - http://www.scopus.com/inward/record.url?scp=85117823974&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85117823974&partnerID=8YFLogxK
U2 - 10.1016/j.acap.2021.02.012
DO - 10.1016/j.acap.2021.02.012
M3 - Article
C2 - 33631364
AN - SCOPUS:85117823974
SN - 1876-2859
VL - 21
SP - 1355
EP - 1362
JO - Academic Pediatrics
JF - Academic Pediatrics
IS - 8
ER -