http://www.medscape.com/viewarticle/405124_8
Nursing, September 2001 Journal Scan


From
Pediatrics
September 2001 (Volume 108, Number 3)



Respiratory Instability of Term and Near-Term Healthy Newborn Infants in
Car Safety Seats

Merchant JR, Worwa C, Porter S, Coleman JM, deRegnier RAO
Pediatrics. 2001;108(3):647-652

While infant car seats play a critical role in protecting infants during
a motor vehicle accident, it is recognized that very young infants who
cannot sit or maintain head control require special support to protect
them and maintain respiratory stability. This is particularly true for
preterm infants. The American Academy of Pediatrics has recommended that
all preterm infants < 37 weeks gestation have a period of observation in
a car safety seat before hospital discharge to monitor for apnea,
bradycardia, and/or oxygen desaturation. However, many full-term
nurseries that provide care for healthy, minimally preterm infants may
not be aware of or implement this recommendation. The purpose of this
study was to determine whether otherwise healthy infants require a
period of observation by determining the incidence of car
seat-associated events in these infants; the study also included well
full-term infants.

The study included 50 preterm infants born at 35-36 weeks gestation and
50 full-term infants. None of the infants in the study required
intensive care. The researchers attempted to recruit both infants with
normal perinatal histories as well as infants who had experienced some
difficulty during labor and delivery. In addition, the researchers
attempted to include infants who were small, average, and large for
gestational age.


Infants were observed in their own car seats if the seat provided by
parents met current safety standards and the child could be positioned
securely using blanket rolls around the head and under the crotch belt.
In this study, 35% of parents either did not have a car seat for their
child or had one that was deemed unsafe. That group of infants was
observed in a seat provided by the researchers. While not a focus of
this study, it is notable that all 100 infants required propping with
blanket rolls around the head and an additional 36% of preterm and 16%
of term infants also required a blanket roll between their legs for
secure positioning. Following adequate positioning, the seat was angled
according to manufacturer's recommendations.


Infants were tested 30-60 minutes after a feeding on either the day
before or day of hospital discharge. Heart rate, respiration, and pulse
oximetry were evaluated first in the supine position for 30 minutes and
then while infants were in the seat for an additional 90 minutes.


Preterm and term infants did not differ in their oxygen saturation rates
in either the supine or seated position. For all infants, mean
saturation rates declined throughout the 90-minute interval and were
significantly lower in the seated position within 15 minutes. Seven
infants, 4 preterm and 3 term, spent more than 20 minutes in the car
seat with saturation values between 85% and 90%.


Six preterm infants (12%), though none that were full term, experienced
significant apnea or bradycardia in their seats; 3 of these events
required stimulation or removal from the car seat to terminate the
event.


This number of infants is not insignificant, given that 4% to 6% of all
infants are born at 35-36 weeks gestation. When this 12% of infants is
added to the 24% of preterm infants that were unable to be positioned
securely in the seat supplied by their parents, the number is even
larger.


The American Academy of Pediatrics recommends that all newborns be
positioned in a car seat at the time of discharge. As this study clearly
points out, there are a number of barriers to this goal. In this study,
35% of parents either did not have a car seat or had one in which, even
with blanket rolls, the baby could not be safely and securely
positioned. This points to the need to educate parents on both the
purchase and use of car seats, something that is not routinely done in
hospital nurseries. In addition, all preterm infants, even healthy
infants who have been cared for in a full-term nursery, must have a
period of observation in their seats.


Finally, this study pointed out that all infants, both full and preterm,
are susceptible to declining oxygen saturation rates the longer they
remain in the seated position. This underscores the need to minimize
travel for infants and to discourage the use of swings and other types
of upright seating devices in the first few months of life.


Diane

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