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A National Survey of Car Seat Tolerance Screening Protocols in Neonatal Intensive Care Units

  • Natalie L. Davis
    Correspondence
    Address correspondence to Natalie L. Davis, MD, MMSc, Division of Neonatology, Department of Pediatrics, University of Maryland Children's Hospital, University of Maryland School of Medicine, 110 S. Paca St, 8th Floor, Baltimore, MD 21201
    Affiliations
    Division of Neonatology, University of Maryland Children's Hospital, University of Maryland School of Medicine, Baltimore, Md
    Search for articles by this author
  • Savannah Cheo
    Affiliations
    Division of Neonatology, University of Maryland Children's Hospital, University of Maryland School of Medicine, Baltimore, Md
    Search for articles by this author
Published:February 07, 2020DOI:https://doi.org/10.1016/j.acap.2020.02.004

      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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