Monitoring Premature Infants in Car Seats: Implementing the American Academy of Pediatrics Policy in a Community Hospital

¹ From the Department of Pediatrics, MetroWest Medical Center, Framingham, MA; Boston University School of Medicine, Boston, MA; and Perinatal Nursing Services, MetroWest Medical Center, Framingham, MA.

Objectives. In 1990, the American Academy of Pediatrics (AAP) Committeee on Injury and Poison Prevention issued a policy statement which recommended that all infants born at less than 37 weeks gestational age be monitored in their car seat before discharge to identify infants at risk for apnea associated with car seat use. The objective of this report is to summarize the experience of a community hospital in implementing this recommendation, including: education of health professionals about the problem and its management, development of an effective hospital policy and procedure for testing at-risk infants, overcoming logistical difficulties for nursing staff who implement the policy, overcoming liability concerns, and summarizing the clinical results which we observed during a 15-month period.

Methods. MetroWest Medical Center, Framingham Union Campus is a community hospital with a Level II Neonatal Unit with approximately 2200 deliveries annually. Hospital procedures and policies were developed to implement the AAP policy for safe transportation of premature infants. Consequently, infants less than 37 weeks gestation at birth were monitored for a 90-minute observation period for oxygen saturation, apnea, or bradycardia in the car seat that they would be going home in from the nursery.

Results. Policies and procedures for car seat monitoring were instituted successfully during 15-month period. Sixteen of 87 (18.4%) monitored infants 26 to 36 weeks gestation had abnormal results. In addition, one 37-week gestational newborn who was monitored because of duskiness during feeds also became apneic and bradycardic in the car seat.

Conclusions. A car seat monitoring program can be incorporated effectively into a Level II community hospital nursery discharge plan provided that appropriate medical staff policies, nursing procedures, and administrative support to deal with the logistics of the program is established. Our monitoring results are consistent with previous reports that premature infants are at risk of desaturation in a car seat. In addition, we have demonstrated that a full-term neonate may also be at risk if other evidence of desaturation (eg, duskiness during feedings) is observed.

Key Words: car seats • child restraint devices • prematurity • apnea

Submitted on July 22, 1992
Accepted on December 30, 1992

CiteULike    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				M. J. Bull, W. A. Engle, and The Committee on Injury, Violence, and Poison Prev Safe Transportation of Preterm and Low Birth Weight Infants at Hospital Discharge Pediatrics, May 1, 2009; 123(5): 1424 - 1429. [Abstract] [Full Text] [PDF]

				A Cote, A Bairam, M Deschenes, and G Hatzakis Sudden infant deaths in sitting devices Arch. Dis. Child., May 1, 2008; 93(5): 384 - 389. [Abstract] [Full Text] [PDF]

				D. E Elder, L. Russell, D. Sheppard, G. L Purdie, and A. J Campbell Car seat test for preterm infants: comparison with polysomnography Arch. Dis. Child. Fetal Neonatal Ed., November 1, 2007; 92(6): F468 - F472. [Abstract] [Full Text] [PDF]

				R Narasimhan, J Moorcraft, and A H A Latif Car seat safety for premature and LBW infants Arch. Dis. Child., November 1, 2005; 90(11): 1205 - 1206. [Full Text] [PDF]

				J. L. Bass, W. Stening, P. Nitsch, and B. Roth O2 Saturation and Slings Pediatrics, January 1, 2004; 113(1): 169 - 170. [Full Text] [PDF]

				S. L. Tonkin, C. G. McIntosh, W. Hadden, C. Dakin, S. Rowley, and A. J. Gunn Simple Car Seat Insert to Prevent Upper Airway Narrowing in Preterm Infants: A Pilot Study Pediatrics, October 1, 2003; 112(4): 907 - 913. [Abstract] [Full Text] [PDF]

				J. R. Merchant, C. Worwa, S. Porter, J. M. Coleman, and R.-A. O. deRegnier Respiratory Instability of Term and Near-Term Healthy Newborn Infants in Car Safety Seats Pediatrics, September 1, 2001; 108(3): 647 - 652. [Abstract] [Full Text] [PDF]

				K. Goto, M. Mirmiran, M. M. Adams, R. V. Longford, R. B. Baldwin, M. A. Boeddiker, and R. L. Ariagno More Awakenings and Heart Rate Variability During Supine Sleep in Preterm Infants Pediatrics, March 1, 1999; 103(3): 603 - 609. [Abstract] [Full Text]

				C. W. Callahan and C. Sisler Use of Seating Devices in Infants Too Young to Sit Arch Pediatr Adolesc Med, March 1, 1997; 151(3): 233 - 235. [Abstract] [PDF]