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] *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html