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In 1996, Young et al ( 19) reported that 24% of the infants who failed in the study were tested at a mean adjusted age of 39 weeks. The criteria of less than 37 weeks’ gestation at delivery recommended by the AAP appears to be based on the initial selection criteria by Willett et al ( 14, 15), who reported a failure rate of 30% to 60% in preterm babies undergoing cardiorespiratory monitoring in car seats before discharge.
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However, health care professionals should also be aware that apparent cardiorespiratory abnormalities in infants born prematurely are common at the time of hospital discharge, and there are no monitoring criteria that predict an increased risk of SIDS ( 23). Because little epidemiological evidence exists, health care professionals may rely on relevant studies completed in hospitals, with the expectation that the outcome measures of detected episodes of hypoxemia, apnea and/or bradycardia may have serious long term adverse effects on at least some of these babies. SIDS rates have not declined in very low birth weight babies as they have in larger babies ( 22).Īlthough some hospitals routinely assess selected babies before discharge, this does not occur in the majority of Canadian centres ( 19). It is not known what percentage of deaths were specifically related to car seat use and how many of these babies were born prematurely. In Alberta, the percentage of babies dying while in a car seat, snow sled, carriage stroller or swing increased from 2.9% of total sudden infant death syndrome (SIDS) deaths in 1977 to 1981 to 8.2% in 1992 to 1996 ( 21), primarily because of a reduction in SIDS deaths in other situations. A MEDLINE search from 1980 to 1998 using key words of ‘neonate’, ‘newborn’, ‘car’ and ‘seat’ failed to reveal any studies indicating death or disability associated with the use of car seats, although deaths in babies who were ‘wedged’ in other sitting positions were reported ( 2). There is little knowledge of the potential long term effects for preterm babies who may have been discharged without prior observation or monitoring in car seats. The magnitude of potential problems seems greatest in preterm infants who may ‘fail’ testing in car seats 11% to 60% of the time. Infants may also be exposed to a variety of dangerous situations while sleeping in cots, chairs or beds ( 20).
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WHAT IS THE MAGNITUDE OF THE CARDIORESPIRATORY RISKS FOR BABIES IN CAR SEATS?Įvidence indicates that babies born before term are at increased risk of adverse cardiorespiratory effects when placed in a semi-upright position, such as that typical with usual infant care seats ( 13– 19). The use of car seats is recommended for all babies during automobile travel, but this manoeuvre may expose such infants to other potential risks. Predischarge respiratory recordings in very low birth weight infants may reveal significant apnea in many babies otherwise ready for discharge ( 12). Hypoxemia related to positioning and apneic episodes are common in infants born before term in whom apnea may persist up to and beyond term gestation ( 10, 11). Babies born before term may present particular challenges, and the American Academy of Pediatrics (AAP) has recommended that babies born at less than 37 weeks’ gestation have a period of observation in a car seat before discharge to monitor for possible apnea, bradycardia or oxygen desaturation ( 1). An infant with special needs should never be transported in a vehicle in the parent’s arms, a cot or other device.Įducation is important to ensure car seats are used appropriately for all infants ( 3, 4, 7– 9). Special care beds offer a high level of protection for infants with special needs. Commercially available infant seats offer the optimum protection for healthy babies born at term. Car seats should always be used, including the initial automobile ride ( 6). Car seats have been strongly advocated to reduce mortality and morbidity associated with automobile accidents in infants and children ( 1– 5).