The Infant Car Seat Challenge: Determining and Managing an “Abnormal” Result

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In this issue of Pediatrics , DeGrazia et al1 provide important information on whether weight and age are predictors for passing the Infant Car Seat Challenge (ICSC). Because they found they were not, the authors recommend repeat testing if the test is initially failed. They also point out the need for standardization of the ICSC. This is an issue of great importance, because meaningful clinical decisions and research on testing cannot go forward without standardization. The most recent American Academy of Pediatrics (AAP) clinical report on the subject2 provided some advice regarding the duration of the test (90–120 minutes or duration of travel if longer). Identification of oxygen desaturation, episodes of apnea, and bradycardia were mentioned as the outcomes to denote failure. Although there are standard and widely accepted definitions of apnea (20 seconds) and bradycardia (<80 beats per minute [bpm]), the lower-limit-of-normal pulse oximeter saturation (Spo2) has not been universally recognized. Authors of the first … Address correspondence to Joel L. Bass, MD, Department of Pediatrics, Newton-Wellesley Hospital, 2014 Washington St, Newton, MA 02462. E-mail: jbass{at}partners.org