Safe Transportation of Newborns at Hospital Discharge

RECOMMENDATIONS

1. In conjunction with their medical staff, all hospitals with services for newborns should develop policies for the discharge of newborns in car safety seats that are crash tested and meet the FMVSS 213. These policies should be developed in consultation with a car seat expert who has successfully completed the National Highway Traffic Safety Administration (NHTSA) 4-day course.⁴ Although the resources of hospitals and patients vary greatly, at dischargeevery newborn should be properly restrained in a car safety seat.

2. Pediatricians should work with these hospitals in establishing hospital policies that clearly define staff roles for each required task. Also, pediatricians should reinforce the need for compliance with these policies with both hospital staff and parents/guardians. Hospital policies related to newborns should include the following:

   • Methods by which expectant parents will be informed, before delivery, of the importance of using car safety seats and potential problems with vehicle incompatibility. Parents should be advised through prenatal classes, their obstetrical provider, or pediatric prenatal visits to obtain a car safety seat, properly secure it in their vehicle, and resolve compatibility issues before delivery. This is especially important because physicians frequently discharge infants after only a short hospital stay.

   • Designation of an individual responsible for implementing hospital policies and procedures related to discharge of newborns in car safety seats that are used properly. Hospital policy also should include designation of an individual or team specifically trained to assess the needs of infants with special health care needs with regard to the selection of the most appropriate child safety seat.^5–8 Hospitals should develop a policy to ensure provision of a period of observation in a car safety seat before hospital discharge for each infant born at <37 weeks' gestation to monitor for possible apnea, bradycardia, or oxygen desaturation.⁵

   • Provision for periodic in-service education of staff responsible for parent and guardian education on correct use of car safety seats. Those responsible for training other hospital staff and parents and guardians should have successfully completed the NHTSA 4-day course.⁴

   • Provision of regular periodic review by a designated person who has completed the NHTSA 4-day course of all materials distributed to parents and guardians of newborns about proper car safety seat use. Hospitals should ensure that information is current, relevant, and accurate, with date of publication or revision noted.⁹

   • Provisions to make available an appropriate car safety seat by sale, short-term loan, or donation to parents before discharge if the parents are unable to provide their own. Hospitals should consider giving a low-cost infant car seat, which can also be used for generic instruction, to parents at discharge as a gift.

   • Assessment of the degree of compliance with the policies and procedures on discharge in child safety seats in routine quality assurance surveillance by hospital staff. Hospital staffs should take appropriate actions to correct deficiencies when present.

Admission orders for newborns should include an order written by a physician for parent instruction about use of child safety seats. This should be included as a part of standard admission orders to ensure its completion before discharge.

Discharge policies for newborns should include the following:

• Determination of the most appropriate car safety seat for each newborn according to maturity and medical condition by a designated hospital employee.

• Provision of information and training for parents and guardians should be presented before discharge on the generic issues related to correct use of car safety seats. Hands-on teaching including “return demonstration” should be a part of this instruction. The installation of a specific car seat in a specific car must be the parent's responsibility. Resources to address these issues are available from the AAP.^{10 ,11}

• A period of observation in a car safety seat before hospital discharge should be provided to each infant born at <37 weeks' gestation to monitor for possible apnea, bradycardia, or oxygen desaturation.⁵

• Pediatricians with other child health and safety advocates should work for coverage of appropriate child restraint systems as a benefit of coverage by Medicaid, managed care organizations, and other third-party insurers. Until that time, hospitals are encouraged to have a giveaway or loan program for parents who cannot afford to purchase a car seat.

• Marilyn Bull, MD, Chairperson

• Phyllis Agran, MD, MPH

• Danielle Laraque, MD

• Susan H. Pollack, MD

• Gary A. Smith, MD, DrPH

• Howard R. Spivak, MD

• Milton Tenenbein, MD

• Susan B. Tully, MD

• Ruth A. Brenner, MD, MPH

•  National Institute of Child Health and Human Development

• Stephanie Bryn, MPH

•  Maternal and Child Health Bureau

• Cheryl Neverman, MS

•  National Highway Traffic Safety Administration

• Richard A. Schieber, MD, MPH

•  Centers for Disease Control and Prevention

• Richard Stanwick, MD

•  Canadian Paediatric Society

• Deborah Tinsworth

•  US Consumer Product Safety Commission

• William P. Tully, MD

•  Pediatric Orthopaedic Society of North America

• Victor Garcia, MD

•  Section on Surgery

• Murray L. Katcher, MD, PhD