Restraint device for airway management in low-birthweight infants

Abstract

Low-birthweight infants are at an increased risk of a compromised airway when restrained in a child safety seat (CSS). Neonatal intensive care units (NICUs) use rolled towels and other positioning aids with a variety of unique techniques and methodologies to adapt a CSS to the specialised needs of this particular population at the time of discharge. A preemie positioning device (PPD) was developed as an enhancement to the existing occupant restraints, taking into consideration infant anthropometry, materials with suitable properties and analyses of infant airway patency. A numerical model consisting of a five-point CSS with the PPD and a novel anthropomorphic testing device representing a small infant weighing less than 2.5 kg was developed. The performance of the PPD was assessed through observation of the angle of the neck in flexion–extension bending during driving scenarios which may inhibit the respiratory function of a low-birthweight infant. Three foam materials and three PPD geometries exhibited more favourable neck angles with the PPD. In braking and roundabout scenarios the neck angle was increased in the range of 10°–30°. A sharp-turn manoeuvre yielded similar results with and without the PPD in terms of the final position of the head with respect to the torso. The proposed positioning aid is predicted to reduce the likelihood of respiratory compromise resulting from repositioning of the infant due to vehicle excitations. Analyses of crash performance indicate that with proper selection of the foam the PPD has similar or improved performance over a commercial CSS.