1. This retrospective cohort of 220 full-term, low birth weight infants had a car seat tolerance screening failure incidence of 4.8%. Maternal opiate use was associated with car seat tolerance screen failure.
2. Gender, race, delivery mode, single vs. multiple gestation, birth weight, birth gestational age, Apgar score, and positive pressure ventilation use or respiratory support were not associated with car seat tolerance screening failure.
Evidence Rating Level: 2 (Good)
Study Rundown: Car seat tolerance screening (CSTS) for an observation period of 90 to 120 minutes or the duration of the car ride home is recommended for all preterm infants (less than 37 weeks gestational age). However, CSTS practices for low birth weight (LBW, < 2.5 kg) infants varies among institution. This retrospective study sought to identify factors associated with CSTS failure in low birth weight infants. There was an overall CSTS failure rate of 4.8% over the 4-year study period. Maternal urine toxicology screen positive for opiates was associated with an increased incidence of failed car seat tolerance. Otherwise, birth factors including gender, race, delivery mode, singleton vs. multiple gestation, maternal anesthesia, maternal morphine, birth weight, birth gestational age, Apgar score, positive pressure ventilation use, or respiratory support were not associated with CSTS failure. This study was limited by retrospective design and a conservative saturation failure of < 88% that is not universal among hospitals. However, this study identifies that LBW infants exposed to in utero opiates may have a higher risk of CSTS failure and physicians may seek to selectively screen this population.
In-Depth [retrospective cohort]: A total of 220 full-term (gestational age > 37 weeks) LBW infants participated in the study over a 4-year study period. CSTS involved a period of observation reater than or equal to 90 minutes or estimated duration of travel time home, whichever is longer. Failure was defined as apnea, absence of respirations of > 20 seconds, bradycardia (heart rate < 80 beats per minute) and oxygen desaturation to <88%. Of the 187 infants with complete data, 49% were male, 86.4% were black and 8.5% were white, and 66.3% were born via vaginal delivery. Overall incidence of car seat tolerance screen failure was 4.8% in this cohort. Among the 9 infants who failed the screen, 2 (22.2%) had mothers with positive urine opiate screen, compared to 10 (5.6%) infants who passed the car seat tolerance screen (p = 0.0473). No other factors were associated with car seat tolerance screen failure.
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