The Infant Car
Seat Challenge
Pam Homiak, MPH RN CPST-I
MIEMSS
&
Michelle Spencer, RN CPST-I
Frederick Memorial Hospital
The Infant Car Seat Challenge
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“Hot topic” right now in CPS and for hospitals
The only available method of testing to see if
a conventional car seat is appropriate for a
high-risk newborn being discharged home
from the hospital
This test has been found to be reliable
Intent is to prevent cardiorespiratory
compromise in newborns as they are being
transported home
The Infant Car Seat Challenge:
Problems
Lack of research
 Lack of standardization in
implementation
 Lack of resources
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The Infant Car Seat Challenge:
What We Know
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Certain newborns are at risk for apnea when riding in a car seat
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Periods of no breathing can be potentially dangerous
 Goal: prevent any risks to the newborn’s health & try to ensure
their safety while riding in the vehicle
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Who should be tested?
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Infants less than 37 weeks gestational age
Infants with history of apnea, bradycardia, desaturations
Infants with any medical conditions that put them at risk
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Lung disease requiring oxygen
Neurologic diseases
Additional airway problems
A car seat must be appropriate for the maturity & medical
condition of the infant
The Infant Car Seat Challenge:
Sources of Information
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Where are we getting information on the car seat
challenge?
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American Academy of Pediatricians (AAP)
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Clinical Report (2009)
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Not a set of rules for physicians, based on systematic review,
standard of care, or a legal document
Does not specify parameters for fail
Riley Children’s Hospital (Dr. Marilyn Bull)
Children’s Hospital Boston (Michele DeGrazia, NNP)
KIM Conference (Kidz in Motion), annual child passenger
safety conference with pre-conference focused on NICU
topics
Highlights from the AAP
Clinical Report (2009)
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Car seat monitoring is recommended to determine
physiologic maturity and stable cardiorespiratory
function for infants < 37 weeks gestational age (and
with other risk factors for apnea, bradycardia,
desaturation)
Use the infant’s own car seat, according to
manufacturer instructions (esp. recline angle!)
Recommended duration: 90-120 minutes, or length
of travel (whichever is longer)
Highlights from the AAP
Clinical Report (2009)
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Use of car safety seats should be limited to travel to
prevent complications (i.e. exacerbation of GERD)
Conventional car seat with a semi-upright seating
position should be used whenever possible
Portable medical equipment
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Should be secured to prevent injury
Monitors should have self-contained power source available
that will last for twice the duration of travel
Highlights from the AAP
Clinical Report (2009)
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If an infant fails the monitoring period in a conventional
car seat, use of a car bed (and another monitoring
period) should be considered
Before transitioning from a car bed, another monitoring
in a car seat should be performed
Limit use of other devices that may cause similar
respiratory compromise (swings, carriers, backpacks)
One parent should ride in the back seat with the car
seat or car bed to observe the child
Children should never be left unattended in their car
seats (in or out of the vehicle)
Car Bed Options
Angel Guard
(birth – 9 pounds,
up to 21.5 inches)
Dream Ride
(birth – 20 pounds,
19-26 inches)
Educational DVD for Hospitals
One copy sent to each hospital in the state
for educating staff on the car seat
challenge
 Educational sessions being offered to
interested NICUs and newborn nurseries
around the state
 Request a DVD or training:
phomiak@miemss.org
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Car Seat Testing at
Frederick Memorial
History
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2003-Initial policy written for Car Seat
Testing in the SCN.
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2006-Policy updated
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2007-Policy updated to include testing in
the NBN with an Order set, Car Seat
Competency Tool for nursing staff,
Information Sheet and Informed Consent
for parents.
Car Seat Testing in the NICU
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All nurses in the NICU have been trained to
perform the car seat test.
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At present there are 3 certified car seat
technicians, 1 is an instructor.
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All infant’s regardless of gestational age are
tested prior to DC.
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Tested at least 1 hour after feeding.
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Infant sits for at least 1 hour or the length of the
car ride home, whichever is longer.
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Tested at least one to seven days prior to going
home.
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If infant fails first test, infant is retested a few
days later.
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If infant fails seat test twice, tested in a car bed
provided by the hospital, in a side-lying or
supine position.
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Parents are counseled to avoid other
upright positioning devices if infant is sent
home in a car bed.
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An appointment is made with the Wellness
Center for 2 weeks after DC to have the
infant retested in their car seat by a CPS
Instructor/nurse.
Car Seat Testing in NBN
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All newborns less than 37 weeks gestation
and/or less than 5 pounds have a car seat test
before DC from the Birthplace or Pediatric
Department.
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Newborn Nursery standing orders for car seat
testing are initiated upon the birth of any
newborn less than 37 weeks gestation and/or
less than 5 pounds.
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Parents are given an information sheet and
informed consent and have the right to waive the
car seat test.
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Parents provide car seat and infant is placed on
cardiac/respiratory monitor and pulse oximeter
in the NBN, at least 12 hours after birth.
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Test is done the same in NBN as in NICU.
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Core group of Mother-Baby nurses have been
trained to do car seat testing.
Parent Education
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If the car seat provided by the parents is to big
for the infant, the hospital has a rental program
with seats that start at 4 pounds for use until the
infant has grown into their personal seat.
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Parent education packets on Post-Partum and
the NICU provide parents with car seat
information.
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Parents are also encouraged to have help with
installing their car seats by certified technicians
in the county.
Training
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All nurses in the NICU are trained to do car seat
testing and are signed off with the Competency
Tool
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Core group of nurses on the Birthplace are
trained to do car seat testing and signed off with
the Competency Tool
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Will be a mandatory competency to complete at
this years Competency Marathon.
Retesting
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Infant’s that are discharged in a car bed are
scheduled to be retested in 2 weeks after DC.
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Infant’s return to the FMH Wellness Center and
are retested in their personal infant seat by a
Certified Car Seat Instructor using a pulse
oximeter that reads the infant’s oxygen levels
and heart rate.
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Documentation at that time is done on the Safe
Kids car seat inspection form; due to the fact
that we check the seat installation at that time as
well.
Comments
Questions?