The AAP recommends all preterm infants be observed in their own car seat for at least 90 minutes. However, studies have found not all hospitals do this for late-preterm infants born at least 34 weeks but less than 37 weeks.
Researchers set out to look at the risks for these late-preterm infants using data on 918 late preterm infants born in 2013-’17 who were screened for car seat tolerance at the University of Maryland Children’s Hospital.
About 4.6% failed the initial screening and 24% of those also failed a second screening, according to “Car Seat Tolerance Screening for Late-Preterm Infants,” (Magnarelli A, et al. Pediatrics. Dec. 20, 2019, https://doi.org/10.1542/peds.2019-1703).
Roughly 64% of those who failed had low blood oxygen, 12% had both a slow heartbeat and low blood oxygen, 7% had a slow heartbeat and 5% stopped breathing for more than 20 seconds. The cause for the rest was not documented.
The infants who had spent time in both the neonatal intensive care unit (NICU) and the newborn nursery had the highest failure rate (8.5%), while those who only were in the NICU or newborn nursery had failure rates of 4.2% and 4.1%, respectively.
“Although late-preterm infants are generally healthier than their early-preterm counterparts, they are still at risk for adverse cardiorespiratory events during a critical period in brain development,” authors wrote.
Infants who failed tended to need additional care and had longer hospital stays. However, an adjusted model did not find a link between failing the screening and the length of stay.
Marilyn J. Bull, M.D., FAAP, who co-authored the AAP’s recommendations on car seat screening, wrote in a commentary that the new study highlights three major issues.
“One is the importance of determining cardiorespiratory stability, especially before being tested for car seat tolerance in preparation for discharge; the second is the importance of appropriate use of car safety seats at time of hospital discharge; and the third is the value of having a hospital discharge policy in place,” she wrote.
Infants should be in the seat only during travel and need to be placed in it properly and closely monitored.