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

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: car seat challenge; car seat test; car seat tolerance screen; prematurity.