Effects of child seats on the cardiorespiratory function of newborns.
Nagase H, Yonetani M, Uetani Y, Nakamura H.
Pediatr Int. 2002 Feb;44(1):60-3.
Department of Pediatrics, Kobe University School of Medicine, Chuo-ku,
Kusonoki-cho, 7-chome, 5-1 Kobe, Japan. [log in to unmask]
BACKGROUND: This study aims to determine the effect of differently
positioned infant car seats on cardio-respiratory parameters in healthy
full-term newborns. METHODS: We examined 15 healthy term newborns for
respiratory compromise due to normal restraint in a recommended infant
car seat. There are currently two types of car seats available in Japan:
a chair-shaped car seat and a bed-shaped car seat. Using a sleep apnea
recorder, we simultaneously monitored heart rate, percutaneous oxygen
saturation, chest impedance and nasal airflow in infants placed in each
of the car seats and also placed in the supine position on a nursery
cot. Episodes of oxygen desaturation below 95% and longer than 10 s
(mild desaturation) and below 90% longer and than 10 s (moderate
desaturation) were evaluated over 30 min observation period. RESULTS:
The amount of time infants spent in a sleep state was significantly
longer in the car seats than it was on the cot (P = 0.0015 for
bed-shaped, P = 0.0012 for chair-shaped) and there was no difference in
this measure between the two types of car safety seats. Mean of oxygen
saturation with the chair-shaped car seat (95.8%) was significantly
lower than that with the bed-shaped car seat (98.8%) (P = 0.0008).
Newborn infants laid on the cot showed no episodes of desaturation.
Newborn infants placed in the chair-shaped car seat had significantly
more episodes of mild desaturation (mean, 7.33 times in nine of 15
infants), whereas in the bed-shaped seat observed only once each in two
infants (P = 0.008). Moderate desaturation was observed in four of 15
infants in the chair-shaped car seat, whereas not observed in the
bed-shaped car seat (P = 0.068). CONCLUSION: The results suggest that
prior to discharge the degree of oxygen desaturation that occurs when an
infant is placed in a chair-style car seat should be checked.
Oxygen desaturation of selected term infants in car seats.
Bass JL, Mehta KA.
Pediatrics. 1995 Aug;96(2 Pt 1):288-90.
Department of Pediatrics, MetroWest Medical Center, Framingham, MA
01701, USA.
OBJECTIVES. Premature infants are known to be at risk for oxygen (O2)
desaturation and/or apnea in car seats. Since 1990, the American Academy
of Pediatrics has recommended a period of monitoring in car seats before
hospital discharge for infants born at < 37 weeks gestation. The
objective of this report is to determine if selected term infants are
also at risk for O2 desaturation, apnea, or bradycardia while in an
infant car seat. METHODS. MetroWest Medical Center is a community
hospital with a level II neonatal unit. Term infants who in the judgment
of their pediatrician were felt to be at risk for O2 desaturation or
apnea were monitored for a 90-minute period in a car seat and observed
for transcutaneous O2 desaturation, apnea, or bradycardia. In addition,
several infants who were admitted to the pediatric inpatient unit after
discharge from the nursery were monitored in a similar fashion. RESULTS.
Eight of 28 monitored infants (28.6%) had a period of O2 desaturation <
90%. In addition, five of 28 monitored infants (17.8%) had borderline
results (O2 saturation, 90 to 93%). All four infants monitored because
of genetic syndromes had abnormal results. O2 desaturation was also
observed in two term infants who had been observed to be apneic by a
parent after discharge from the nursery. CONCLUSIONS. In selected
circumstances (eg, genetic disorders or observed apnea) term infants may
be at risk for O2 desaturation in an upright car seat and monitoring
these infants in car seats before nursery discharge should be
considered. Because not all infants at risk for O2 desaturation can be
identified at birth, an alternative approach would be to recommend,
unless medically contraindicated (eg, gastroesphogeal reflux when
supine), that infants should routinely be transported in a supine
position car seat in the early months of life.
Respiratory instability of term and near-term healthy newborn infants in
car safety seats.
Merchant JR, Worwa C, Porter S, Coleman JM, deRegnier RA.
Pediatrics. 2001 Sep;108(3):647-52.
Comment in:
* Pediatrics. 2002 Apr;109(4):713; discussion 713 PMID: 11927720
* Pediatrics. 2002 Aug;110(2 Pt 1):401-2 PMID: 12165598
Children's Hospital-St Paul, St Paul, Minnesota, USA.
OBJECTIVE: Premature infants who are discharged from intensive care
nurseries are known to be at increased risk for apnea, bradycardia, and
oxygen desaturation while in the upright position. These small infants
also do not fit securely in standard infant car seats. Because of these
problems, the American Academy of Pediatrics recommends a period of
observation in a car seat for all infants who are born at <37 weeks'
gestation. It is not clear whether this recommendation should apply to
the minimally preterm infants (born at 35-36 weeks' gestation) who are
healthy at birth and are hospitalized in the normal newborn nursery. The
objective of this study was to evaluate the respiratory stability and
safety requirements of healthy, minimally preterm infants in car seats
compared with term infants. METHODS: Fifty healthy, nonmonitored,
preterm infants (mean gestational age: 35.8 +/- 0.6 weeks) and 50 term
infants (mean gestational age: 39.5 +/- 1.4 weeks) were recruited from a
level I newborn nursery in a community hospital. Appropriateness of car
seat fit was documented for each infant. Heart rate, respiratory rate,
and pulse oximetry were evaluated while infants were supine and in their
car seats. Apneic and bradycardic events were recorded in addition to a
continuous recording of oxygen saturation values. RESULTS: Twenty-four
percent of preterm and 4% of term newborn infants did not fit securely
into suitable car seats despite the use of blanket rolls. Mean oxygen
saturation values declined significantly in both preterm and term
infants from 97% in the supine position (range: 92%-100%) to 94% after
60 minutes in their car seats (range: 87%-100%). Seven infants (3
preterm and 4 term) had oxygen saturation values of <90% for longer than
20 minutes in their car seats. Twelve percent of the preterm infants
(95% confidence interval: 4.5%-24.3%) but no term infants had apneic or
bradycardic events in their car seats. CONCLUSIONS: Our data support the
current American Academy of Pediatrics recommendations that all infants
who are born at <37 weeks' gestation, including those who are admitted
to level I community hospitals, be observed for respiratory instability
and secure fit in their car seats before hospital discharge. Because
lowering of oxygen saturation values was seen uniformly in all newborn
infants, car seats should be used only for travel, and travel should be
minimized during the first months of life.
--
Catherine Watson Genna, IBCLC New York City mailto:[log in to unmask]
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