TY - JOUR
T1 - Variation in car seat tolerance screen performance in newborn nurseries
AU - Davis, Natalie L.
AU - Hoffman, Benjamin D.
AU - Eichenwald, Eric C.
N1 - Publisher Copyright:
© 2020 by the American Academy of Pediatrics
PY - 2020/8/1
Y1 - 2020/8/1
N2 - BACKGROUND: Currently, car seat tolerance screens (CSTSs) are recommended for all infants born prematurely in the United States. Although many late-preterm infants are cared for exclusively in newborn nurseries (NBNs), data on implementation of CSTS in nurseries are limited. Our objective for this study was to determine management strategies and potential variation in practice of CSTS in NBNs across the nation. METHODS: We surveyed NBNs across 35 states using the Better Outcomes through Research for Newborns (BORN) network to determine what percentage perform CSTSs, inclusion and failure criteria, performance characteristics, follow-up of failed CSTSs including use of car beds, and provider attitudes toward CSTS. RESULTS: Of the 84 NBNs surveyed, 90.5% performed predischarge CSTSs. The most common failure criteria were saturation,90%, bradycardia,80 beats per minute, and apnea.20 seconds. More than 55% noted hypotonia as an additional inclusion criterion for testing, and.34% tested any infant who had ever required supplemental oxygen. After an initial failed CSTS,.93% of NBNs retested in a car seat at a future time point, whereas only ∼1% automatically discharged infants in a car bed. When asked which infants should undergo predischarge CSTS, the most common recommendations by survey respondents included infants with hypotonia (83%), airway malformations (78%), hemodynamically significant congenital heart disease (63%), and prematurity (61%). CONCLUSIONS: There is a large degree of variability in implementation of CSTS in NBNs across the United States. Further guidance on screening practices and failure criteria is needed to inform future practice and policy.
AB - BACKGROUND: Currently, car seat tolerance screens (CSTSs) are recommended for all infants born prematurely in the United States. Although many late-preterm infants are cared for exclusively in newborn nurseries (NBNs), data on implementation of CSTS in nurseries are limited. Our objective for this study was to determine management strategies and potential variation in practice of CSTS in NBNs across the nation. METHODS: We surveyed NBNs across 35 states using the Better Outcomes through Research for Newborns (BORN) network to determine what percentage perform CSTSs, inclusion and failure criteria, performance characteristics, follow-up of failed CSTSs including use of car beds, and provider attitudes toward CSTS. RESULTS: Of the 84 NBNs surveyed, 90.5% performed predischarge CSTSs. The most common failure criteria were saturation,90%, bradycardia,80 beats per minute, and apnea.20 seconds. More than 55% noted hypotonia as an additional inclusion criterion for testing, and.34% tested any infant who had ever required supplemental oxygen. After an initial failed CSTS,.93% of NBNs retested in a car seat at a future time point, whereas only ∼1% automatically discharged infants in a car bed. When asked which infants should undergo predischarge CSTS, the most common recommendations by survey respondents included infants with hypotonia (83%), airway malformations (78%), hemodynamically significant congenital heart disease (63%), and prematurity (61%). CONCLUSIONS: There is a large degree of variability in implementation of CSTS in NBNs across the United States. Further guidance on screening practices and failure criteria is needed to inform future practice and policy.
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U2 - 10.1542/peds.2019-3593
DO - 10.1542/peds.2019-3593
M3 - Review article
C2 - 32641358
AN - SCOPUS:85089128070
SN - 0031-4005
VL - 146
JO - Pediatrics
JF - Pediatrics
IS - 2
M1 - e20193593
ER -