Car Seats vs. Car Beds

Salhab WA, Khattak A, Tyson JE et al. Car Seat or Car Bed for Very Low Birth Weight Infants at Discharge Home. J Pediatrics (March 2007); 150:224-228. Full Text | PDF

Objective: To compare the incidence of apnea, bradycardia, or desaturation in a car seat with that in a car bed for preterm very low birth weight (≤1500 g) infants.

Study design: Infants were studied for 120 minutes in a car seat and in a car bed. Apnea (>20 seconds), bradycardia (heart rate <80/min for >5 seconds), desaturation (Spo2 <88% for >10 seconds), and absent nasal flow were monitored.

Results: We assessed 151 infants (median birth weight, 1120 g [range, 437 to 3105)]; median birth gestational age, 29 weeks [24 to 34]) in both devices. Twenty-three infants (15%) had ≥1 event in the car seat compared with 29 (19%) in the car bed (P = .4). Time to first event was similar in the car seat and car bed (mean, 54 to 55 minutes). In logistic regression analyses, bronchopulmonary dysplasia was a significant predictor for a car seat event and a lower gestational age at birth was a risk factor for a car bed event.

Conclusions: We found no evidence that an event is less likely in a car bed than in a car seat. Whichever device is used, very low birth weight infants require observation during travel.

Comments: This study calls into question the validity of our current practice of doing “Car Seat Challenges” in premature infants before discharge home. While this is a common practice in most of our nurseries (and an AAP-endorsed Practice Guideline), there is little, if any, evidence to support that these tests predict safe automobile travel. Furthermore, the present study clearly shows that car beds are no safer than car seats for premature infant travel! I would suggest that we advise the parents of our preemies to avoid traveling in cars with their babies when possible, and to keep their infants under close observation when traveling in cars is necessary. ABK

A car seat challenge is done on preterm babies before discharge home from the hospital to see if they can tolerate being placed in a car seat. Typically the infant is placed in the infant car seat and monitored for an hour or so to see if they have episodes of apnea, bradycardia or desaturation. In the United States, Premature infants are commonly kept in the hospital until they can pass their car seat test. Alternatively, they may be sent home with a car bed. This is a practice guideline that is endorsed by the American Academy of Pediatrics.

Date: 12 Jun 2007
Time: 18:45:52

Your comment about avoiding automobile trips falls under the realm of common sense. I suppose you also suggest they boil their baby's drinking water and not take their baby out on buggy nights. Right on. (another archaic expression).

UserName: Sam Rogers
Institution: Avera McKennan
telephone: 6053224425
email: Sam.Rogers@Mckennan.org

UserName: Bernhard Bungert
Institution: Kinderklinik Hanau Germany
telephone:
email: bernhard_bungert@web.de

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