78: Factors Predicting Car Seat Test Failure in Late Preterm Infants (LPI): A Retrospective Chart Review. Issue 6 (1st June 2014)

• Record Type: Journal Article
• Authors: Smith, RW; Mohamed, A; Young, J; Jefferies, A; Shah, V
• Is Part Of: Paediatrics & Child Health. Volume 19:Issue 6(2014)
• Page Start: e63
• Page End: e63
• Publication Date: 2014-06-01
• Subjects: Pediatrics -- Periodicals; Children -- Health and hygiene -- Periodicals; 618.92
• DOI: 10.1093/pch/19.6.e35-76
• Languages: English
• ISSNs: 1205-7088

Abstract

Abstract: BACKGROUND: Clinical practice guidelines and consensus statements recommend car seat testing of preterm infants prior to discharge from hospital with the goal of detecting those who experience hypoxic events while in sitting devices. OBJECTIVES: To determine the rate of car seat testing failure in LPI (34 0/7 to 36 6/7 weeks GA) in a tertiary level Canadian institution. A secondary objective was to identify factors predicting failure. DESIGN/METHODS: Retrospective chart review of all inborn LPI admitted to our level I, II or NICU between July 1, 2012 and June 30, 2013 was conducted. Infants with genetic disorders or congenital malformations and those transferred to another hospital before discharge were excluded. Data were collected on standardized forms and included maternal demographics, labour and delivery history, clinical course and length of stay. Infants were placed in their car seat, connected to SaO2 monitoring and tested according to hospital protocol. "Failure" criteria were symptomatic bradycardia <80 beats/min (> one desaturation <88% for >10 s, or any desaturation <80%). Data were analyzed by backward logistic regression. RESULTS: A total of 511 charts were reviewed; 364 infants were eligible. Testing was requested but not performed in 35 infants and not requested for 18 infants who met criteria. Of the 311 infants tested (GA mean [± SD] 36.0 weeks ±5 days, birth weight 2615±405 g) 80 did not pass (26%). 69 went on to have a 2-hour flat bed test; 41 did not pass (59%). Sixty also had a second car seat test, either alone or after a 2-hour flat test; 21 did not pass (35%). Forty-one infants were admitted to NICU for further investigation or monitoring. Factors predictive of car seat failure were (adjusted odds ratio); multiple gestation (2.3, P=0.004), primaparity (0.76, P=0.10) and post-natal age at testing (0.99, P=0.06). Infants failing car seat testing had lower post-natal ages than those who passed (mean difference −32.5 h [95% CI −57.6 h to −7.5 h]). CONCLUSIONS: A high number of LPI do not pass car seat probe test. In this population, it may be possible to target testing multiple gestations and primigravidas. Ideally infants should be tested after an appropriate transitional period. Future research should evaluate resource utilization, economic burden and clinical significance of car seat testing and failure.