PEDIATRICS Vol. 108 No. 3 September 2001, pp. 647-652
Respiratory Instability of Term and Near-Term Healthy Newborn Infants in Car Safety Seats
Received May 26, 2000; accepted Dec 8, 2000.
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From the * Children's Hospital-St Paul, St Paul, and
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.
Division of Neonatology, University of Minnesota School of Medicine,
Minneapolis, Minnesota.
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