Published online August 24, 2009
PEDIATRICS (doi:10.1542/peds.2009-0160)

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A Comparison of Respiratory Patterns in Healthy Term Infants Placed in Car Safety Seats and Beds

Lilijana Kornhauser Cerar, MD^a, Christina V. Scirica, MD, MPH^b, Irena tucin Gantar, MD^a, Damjan Osredkar, MD^c, David Neubauer, MD^c, T. Bernard Kinane, MD^c

^aDivision of Neonatology and Department of Obstetrics and Gynecology;
^cDivision of Neurology and Department of Pediatrics, University Medical Centre, Ljubljana, Slovenia; and
^bDivision of Pediatric Pulmonary and Department of Pediatrics, Mass General Hospital for Children, Harvard Medical School, Boston, Massachusetts

Objective The purpose of this work was to compare the incidence of apnea, hypopnea, bradycardia, or oxygen desaturation in healthy term newborns placed in hospital cribs, infant car safety beds, or infant car safety seats.

Methods A consecutive series of 200 newborns was recruited on the second day of life. Each subject was studied while placed in the hospital crib (30 minutes), car bed (60 minutes), and car seat (60 minutes). Physiologic data, including oxygen saturation, frequency, and type of apnea, hypopnea, and bradycardia were obtained and analyzed in a blinded manner.

Results The mean oxygen saturation level was significantly different among all of the positions (97.9% for the hospital crib, 96.3% for the car bed, and 95.7% for the car seat; P < .001). The mean minimal oxygen saturation level was lower while in both safety devices (83.7% for the car bed and 83.6% for the car seat) compared with in the hospital crib (87.4%) (P < .001). The mean total time spent with an oxygen saturation level of <95% was significantly higher (P = .003) in both safety devices (car seat: 23.9%; car bed: 17.2%) when compared with the hospital crib (6.5%). A second study of 50 subjects in which each infant was placed in each position for 120 minutes yielded similar results.

Conclusions In healthy term newborns, significant desaturations were observed in both car beds and car seats as compared with hospital cribs. This study was limited by lack of documentation of sleep stage. Therefore, these safety devices should only be used for protection during travel and not as replacements for cribs.

Key Words: car seat • car bed • newborn • apnea • bradycardia • oxygen desaturation

Abbreviations: REM, rapid eye movement

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Accepted Apr 10, 2009.

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