Car Seat Challenges Might Be More of a Challenge for Some Hospitals Than You Might Expect :

The American Academy of Pediatrics recommends that all preterm infants be screened with a car seat “challenge” or tolerance test prior to discharge and if that test is not successful, a repeat test in a car bed to assure that infant is safe to travel home without breathing difficulties. One would expect adherence to these recommendations by most if not all newborn nurseries (NBNs)—but not necessarily as it turns out, based on findings in a new study being released this month in our journal by Davis et al (10.1542/peds.2019-3593). The authors surveyed 84 NBNs in 35 states who were part of a newborn research network to determine what percentage were performing these tests, what their criteria were for failure, and whether a follow-up test ensued in a car bed or the car seat again if the initial test was not successful. Some (10%) of NBNs are not doing these challenges pre-discharge in preterm infants, and the criteria for who gets one varied by nursery. 55% test infants with hypotonia and 34% test infants requiring supplemental oxygen while other nurseries either do not test or test for other indicators. There was aenormous variability in when to retest and what the criteria are for failure (e.g., oxygen saturation, heart rate). The discussion section of this paper is extremely helpful in framing the significance of the variations and what we might do about reducing this variation. Fasten your seat belt and check out the information in this study. Then review your own hospital policies for who qualifies for the challenge and what the criteria are for success, failure, and next steps in the setting of a failure.  You and the preterm infant headed home will be glad you did.