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Multicenter Study
. 2018 Mar:194:60-66.e1.
doi: 10.1016/j.jpeds.2017.11.010. Epub 2017 Dec 18.

Car Seat Tolerance Screening in the Neonatal Intensive Care Unit: Failure Rates, Risk Factors, and Adverse Outcomes

Erik A Jensen  1 , Elizabeth E Foglia  2 , Kevin C Dysart  2 , Zubair H Aghai  3 , Alison Cook  4 , Jay S Greenspan  3 , Sara B DeMauro  2
Affiliations
Multicenter Study

Car Seat Tolerance Screening in the Neonatal Intensive Care Unit: Failure Rates, Risk Factors, and Adverse Outcomes

Erik A Jensen et al. J Pediatr. 2018 Mar.

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.

Keywords: car seat tolerance screening; infant car seat challenge; premature infant.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure
Figure. Study flow diagram
Car Seat Tolerance Screening (CSTS).
See this image and copyright information in PMC

References

    1. Kahane C. An Evaluation of Child Passenger Safety: The Effectiveness and Benefits of Safety Seats. Washington, DC: US Dept of Transportation; Feb, 1986. National Highway Safety Administration publication DOT HS 806889.
    1. American Academy of Pediatrics, Committee on Injury and Poison Prevention. American Academy of Pediatrics News and Comment Elk Grove. Vol. 10. Village IL: Am Acad Pediatr; 1974. Auto safety for the infant and young child; p. 11.
    1. American Academy of Pediatrics Committee on Accident and Poison Prevention. Safe transportation of newborns discharged from the hospital. Pediatrics. 1990:486–7. - PubMed
    1. Bull M, Stroup K. Premature infants in car seats. Pediatrics. 1985;75:336–9. - PubMed
    1. Bull M, Weber K, Stroup K. Automotive restraint systems for premature infants. J Pediatr. 1988;112:385–8. - PubMed

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