Car seat tolerance screening for late-preterm infants

Abstract

BACKGROUND: The belief that late-preterm infants have similar cardiorespiratory maturity to term infants has led many institutions to limit car seat tolerance screens (CSTSs) to those born early preterm. The objective of this study was to evaluate the incidence and predictors of CSTS failure, focusing on late-preterm infants. METHODS: We performed a retrospective review of late-preterm infants born from 2013 to 2017 to identify the incidence and predictors of CSTS failure, focusing on location of admission. We performed multivariable linear regression to assess the effect of CSTS results on length of stay (LOS). RESULTS: We identified 918 subjects who underwent CSTSs, of whom 4.6% failed. Those infants who were admitted to both the NICU and nursery before discharge had the highest failure rate (8.5%). Of those who failed, 24% failed $2 CSTSs. Of these, 20% (all from the nursery) were found to have obstructive apnea and desaturations, and a total of 40% required supplemental oxygen for safe discharge from the hospital. Although crude LOS was longer for those who failed an initial CSTS, when accounting for location of admission, level of prematurity, and respiratory support requirements, the CSTS result was not a significant predictor of longer LOS. CONCLUSIONS: A concerning number of late-preterm infants demonstrated unstable respiratory status when placed in their car seat. Those who failed repeat CSTSs frequently had underlying respiratory morbidities that required escalation of care. Although further study is warranted, LOS was not associated with CSTS results but rather with the cardiorespiratory immaturity noted or discovered by performing a CSTS.