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.


Abstract


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