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Car Seat Testing
Respiratory Instability of Term and Near-Term Healthy Newborn Infants in car Safety Seats. Merchant JR, Worwa C, Porter S, et al. Pediatrics 2001 (Sep); 108: 647-52.
This study was done to evaluate the respiratory stability and safety requirements of healthy, minimally preterm infants in car seats compared with term infants. Fifty healthy non-monitored preterm infants (EGA 35.8 +/- 0.6 weeks) and 50 term infants (EGA 39.5 +/- 1.4 weeks) were tested for respiratory stability in the supine position for 30 minutes, and in car seats for 90 minutes on the day of planned discharge. Results: 24% of preterm and 4% of term newborns 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 preterm infants but no term infants had apneic or bradycardic events in their car seats.
Comments: The current AAP recommendation is that car seat testing be done on all infants who are born at < 37 weeks gestation. This study was done on infants from a well baby nursery who were never admitted to an NICU. The data support the notion that near-term well babies should also be tested for respiratory stability in car seats prior to discharge. Also, since even term babies had lower oxygen saturation while in car seats, the authors recommend that "car seats should be used only for travel, and that travel should be minimized during the first months of life". I remain skeptical, and would like to see data that supports the concept these minor desaturation episodes in car seats have any clinical significance. I’ll bet that we would find similar episodes of desaturation if we tested infants in feeding chairs or baby swings.
Date: 29 Aug 2002
Time: 19:17:48
I have a 2 mo. old, was born 35 1/2 wks. Has had 5 episodes of apnea. 4 in car
seat, 1 in swing. Last 2 had to be bagged and given cpr. We are using rolls in
the car seat now which seems to help, and no events have taken place since. However,
I am very leary of letting him ride alone in the car seat in the back by him self, so my
husband and I are always going together and I have become a captive of the house, because
I cant take him out in the car. I beleave more than anything else the events took
place because of the way that the car seat and swing do not give proper support.
Neither of them keep his head up and back, therefore, his head would fall forward
to his chest, and cut off the oxygen supplied from his wind pipe. He also has
serious reflux, and possibly mild Laryngomalagia. If you have any other articles
regarding respitory instability in car seats it would really be appreciated, or any other
links. Thank you so much, Sharon Petrucci
UserName: Sharon Petrucci
telephone: 586-758-0309
email: ppet1@msn.com
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