Is the infant car seat challenge useful? A pilot study in a simulated moving vehicle.
OBJECTIVE
The American Academy of Pediatrics recommends that preterm infants complete a predischarge 'car seat challenge' observation for cardiorespiratory compromise while in a car seat. This static challenge does not consider the more upright position in a car or the vibration of the seat when the car is moving. This pilot study was designed to assess the cardiorespiratory effects of vibration, mimicking the effect of being in a moving car, on preterm and term infants.


METHODS
A simulator was designed to reproduce vertical vibration similar to that in a rear-facing car seat at 30 mph. 19 healthy newborn term and 21 preterm infants, ready for hospital discharge, underwent cardiorespiratory measurements while lying flat in a cot (baseline), static in the seat (30°), simulator (40°) and during motion (vibration 40°).


RESULTS
Median test age was 13 days (range 1-65 days) and median weight was 2.5 kg (IQR: 2.1-3.1 kg).Compared with baseline observations, only the total number of desaturations was significantly increased when infants were placed at 30° (p=0.03). At 40°, or with vibration, respiratory and heart rates increased and oxygen saturation decreased significantly. Profound desaturations <85% significantly increased during motion, regardless of gestational age.


CONCLUSIONS
This is the first study to assess the effect of motion on infants seated in a car safety seat. Term and preterm infants showed significant signs of potentially adverse cardiorespiratory effects in the upright position at 40°, particularly with simulated motion, not identified in the standard challenge. A larger study is required to investigate the significance of these results.
Department of Paediatrics, Great Western Hospitals NHS Foundation Trust, Swindon, UK.
Renu
R
Arya
Department of Paediatrics, Great Western Hospitals NHS Foundation Trust, Swindon, UK.
Georgina
G
Williams
Department of Paediatrics, Great Western Hospitals NHS Foundation Trust, Swindon, UK.
Anna
A
Kilonback
Institute of Sound and Vibration Research, University of Southampton, Southampton, UK.
Martin
M
Toward
Institute of Sound and Vibration Research, University of Southampton, Southampton, UK.
Michael
M
Griffin
School of Social and Community Medicine, University of Bristol, Bristol, UK.
Peter S
PS
Blair
School of Social and Community Medicine, University of Bristol, Bristol, UK.
Peter
P
Fleming
D000072599:Cardiorespiratory Fitness; D057207:Child Restraint Systems; D005260:Female; D006321:Heart / Q000502:physiology; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D007223:Infant; D015370:Infant Equipment; D007231:Infant, Newborn; D007234:Infant, Premature; D008168:Lung / Q000502:physiology; D008297:Male; D009038:Motion; D018986:Motor Vehicles; D010092:Oximetry / Q000379:methods; D010351:Patient Discharge; D010865:Pilot Projects; D056152:Respiratory Rate / Q000502:physiology*
Injury Prevention; Neonatology
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