Abstract
Objective
A predischarge car seat tolerance screen (CSTS) is currently recommended for all infants
born prematurely in the United States to monitor for adverse cardiorespiratory events
while in the semi-upright car seat. However, specific guidelines for failure criteria,
timing of testing, and follow-up of failed CSTS do not exist. Our objective was to
perform a national survey of neonatal intensive care units (NICUs) in order to identify
common features and variation in CSTS protocols.
Methods
We surveyed Level II-IV NICUs representing all 50 states to determine whether each
performed CSTS, inclusion and failure criteria, timing of CSTS prior to discharge
and in relation to feeds, follow-up of initial and subsequent CSTS failures, use of
car beds, and outpatient referrals after failed CSTS.
Results
Of the 199 NICUs surveyed, 96.5% perform a CSTS. The most common failure saturation
cutoff was <90%, but values ranged from <80% to <92%. The most common failure bradycardia
definition was <80 bpm but ranged from <70 bpm to <100 bpm. After an initial failed
CSTS, 86.5% will perform a repeat CSTS after a period of observation that ranged from
<12 hours to 3 or more days. When discharging in a car bed, 20% do not routinely perform
a car bed test, and >70% refer only to the primary care physician for car bed follow-up.
Conclusions
Despite widespread implementation, significant variation exists in CSTS protocols
and follow-up after NICU discharge. A stronger evidence base is needed to define appropriate
testing parameters and inform more explicit guidelines.
Keywords
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Article info
Publication history
Published online: February 07, 2020
Accepted:
February 1,
2020
Received:
August 30,
2019
Footnotes
The authors have no conflicts of interest to disclose.
Identification
Copyright
Copyright © 2020 by Academic Pediatric Association
