Car seat challenge tests, also known as car seat tolerance screenings (CSTS), are often used around the time of discharge for Early preterm infants who may not tolerate being positioned upright in a car seat without becoming apneic. Should we also be testing late preterm infants? Magnarelli et al (10.1542/peds.2019-1703) evaluated this question through a review using of late preterm infants born 2013-17 to determine the incidence of CSTS failure. The authors found that 4.6% of the late preterm infants failed their CSTS. These infants had signs of obstructive apnea with significant oxygen desaturation, and 40% were discharged on supplemental oxygen.
So, should we test all late preterms with a CSTS prior to discharge? To answer that question, we asked Dr. Marilyn Bull, an expert on car seat safety, to provide us with an accompanying commentary (10.1542/peds.2019-3369). She points out a number of strengths of this study but also some limitations such as lack of a description as to whether infants who failed the CSTS were more likely to have had underlying congenital or neuromuscular abnormalities. Most notably she reminds us of the seriousness of infants who die in car seats that are being used out of the car at home or in child care settings (10.1542/peds.2018-2576) and that we need to remind families that these seats should only be used for car travel and not for napping when not fastened properly into a car. Dr. Bull also finds this study an excellent motivator to make sure that hospitals have careful discharge policies for ensuring that all infants are stable and able to be sent home in an upright car seat. If your hospital doesn’t have a discharge policy and staff to reliably perform a CSTS as part of that policy, this study and commentary should challenge you to consider this.