Car Bed Research Articles

Parental Experiences of Infant Car Bed Use After Failure of Car Seat Tolerance Screen.

Failure of the car seat tolerance screen (CSTS) during hospitalization often leads to a recommendation for automobile travel within a car bed at discharge. To describe the parental experience utilizing a car bed for infant automobile transportation. A descriptive, qualitative study design was undertaken with a purposive sample of parents recruited for a single interview in the pulmonary clinic at the time of the follow-up CSTS, approximately 1 month after hospital discharge. Interviews, guided by a semistructured interview tool, provided a holistic understanding of the parental experience utilizing car bed travel. Data from 15 parental interviews revealed an overarching emotional journey consisting of 5 themes: (1) an adjustment period; (2) decision-making related to the car bed purchase; (3) encounters with varied provider education and knowledge; (4) safety and security of the car bed during transit; and (5) space and mobility restrictions imposed by the car bed. While recommendations exist for infant travel in a car seat, supportive recommendations for parents with an infant who needs to travel in a car bed do not exist. Based on study findings, providing parents supportive guidelines, education, and recommendations for their infant requiring travel in a car bed may be a strategy to ease the stress experienced in this situation. Findings indicated a need to develop policies and standards, as well as comprehensive education, for providers and parents related to car bed travel. Further research is needed to identify strategies to best support parents and infants.

Variation in Car Seat Tolerance Screen Performance in Newborn Nurseries.

Currently, car seat tolerance screens (CSTSs) are recommended for all infants born prematurely in the United States. Although many late-preterm infants are cared for exclusively in newborn nurseries (NBNs), data on implementation of CSTS in nurseries are limited. Our objective for this study was to determine management strategies and potential variation in practice of CSTS in NBNs across the nation. We surveyed NBNs across 35 states using the Better Outcomes through Research for Newborns (BORN) network to determine what percentage perform CSTSs, inclusion and failure criteria, performance characteristics, follow-up of failed CSTSs including use of car beds, and provider attitudes toward CSTS. Of the 84 NBNs surveyed, 90.5% performed predischarge CSTSs. The most common failure criteria were saturation <90%, bradycardia <80 beats per minute, and apnea >20 seconds. More than 55% noted hypotonia as an additional inclusion criterion for testing, and >34% tested any infant who had ever required supplemental oxygen. After an initial failed CSTS, >93% of NBNs retested in a car seat at a future time point, whereas only ∼1% automatically discharged infants in a car bed. When asked which infants should undergo predischarge CSTS, the most common recommendations by survey respondents included infants with hypotonia (83%), airway malformations (78%), hemodynamically significant congenital heart disease (63%), and prematurity (61%). There is a large degree of variability in implementation of CSTS in NBNs across the United States. Further guidance on screening practices and failure criteria is needed to inform future practice and policy.

A National Survey of Car Seat Tolerance Screening Protocols in Neonatal Intensive Care Units.

A predischarge car seat tolerance screen (CSTS) is currently recommended for all infants born prematurely in the United States to monitor for adverse cardiorespiratory events while in the semi-upright car seat. However, specific guidelines for failure criteria, timing of testing, and follow-up of failed CSTS do not exist. Our objective was to perform a national survey of neonatal intensive care units (NICUs) in order to identify common features and variation in CSTS protocols. We surveyed Level II-IV NICUs representing all 50 states to determine whether each performed CSTS, inclusion and failure criteria, timing of CSTS prior to discharge and in relation to feeds, follow-up of initial and subsequent CSTS failures, use of car beds, and outpatient referrals after failed CSTS. Of the 199 NICUs surveyed, 96.5% perform a CSTS. The most common failure saturation cutoff was <90%, but values ranged from <80% to <92%. The most common failure bradycardia definition was <80 bpm but ranged from <70 bpm to <100 bpm. After an initial failed CSTS, 86.5% will perform a repeat CSTS after a period of observation that ranged from <12 hours to 3 or more days. When discharging in a car bed, 20% do not routinely perform a car bed test, and >70% refer only to the primary care physician for car bed follow-up. Despite widespread implementation, significant variation exists in CSTS protocols and follow-up after NICU discharge. A stronger evidence base is needed to define appropriate testing parameters and inform more explicit guidelines.

Use of car beds for infant travel: a review of the literature.

Discharging neonates in a proper car safety seat is standard of care in the United States and many other countries. However, not every neonate can be safely positioned in a standard semi-upright car seat. In these cases, providers may opt for a travel device that allows the infant to lie flat, either supine or prone, known as a car bed. Minimal evidence exists to guide providers on car bed safety and help determine which infants would benefit from discharge in a car bed. In this article, we provide a comprehensive summary of existing literature on the safety of car beds for motor vehicle travel, car bed use in specific patient populations, and car beds vs. car seats for infants at risk of adverse cardiorespiratory events, including preterm infants with Hg-O2 desaturations in the car seat. We discuss recommendations for the follow-up of infants discharged in a car bed in order to safely transition back to a car seat.

Predictors of Persistent Infant Car Seat Challenge Failure.

Premature and other at-risk infants can experience cardiorespiratory problems when positioned in their car seats. The American Academy of Pediatrics recommends that all premature and at-risk infants undergo a period of observation in their car seat to monitor for apnea, bradycardia, and oxygen desaturation before hospital discharge. This Infant Car Seat Challenge (ICSC) is used to determine readiness for infant travel in a car seat. Infants failing the ICSC are discharged home in car beds and referred for a follow-up screen in the outpatient clinic. The purpose of this study was to identify predictors for infants failing the follow-up ICSC after hospital discharge. A retrospective, cross-sectional study design was used to examine charts of 436 infants referred from across New England, to Boston Children's Hospital's, Center for Healthy Infant Lung Development clinic between August 2008 and May 2015 for a follow-up ICSC. Infants who failed the follow-up ICSC had statistically significant lower weights (0.27 ± 0.14 kg, difference ± standard error, P = .03) and younger postmenstrual ages (0.9 ± 0.4 weeks, P = .03). History of a cardiac condition (odds ratio, 3.6; 95% confidence interval, 1.5-8.5; P = .005) and respiratory illness (odds ratio, 2.1; confidence interval, 1.1 to 4.2; P = .03) were significant predictors of ICSC failure. A follow-up ICSC is recommended for the safe transition of infants from a car bed to a car seat. Further research is needed to investigate the causes of ICSC failure among high-risk infant populations.

1B32 Basic research on semi-active child car bed with joint application of regular and inverted pendulum mechanisms : Study on the control system(The 12th International Conference on Motion and Vibration Control)

To reduce the collision shock and injury risk to an infant in a child car bed (or child safety bed or in-car crib) during a car crash, it is necessary to keep the force acting on the bed constant and below a certain allowable value. To this end, we propose a semi-active child car bed with joint application of regular and inverted pendulum mechanisms. The bed is supported like a pendulum by arms, and the pendulum system is supported like an inverted pendulum by arms. This system not only reduces the impulsive force but also transfers the force to the infant's back using a spin control system, i.e., the force acts perpendicularly on the bed. The spin control system was developed previously. In the present study, an acceleration control system is developed. One of the characteristics is that this system has the merits of both a regular pendulum-style child car bed and an inverted pendulum-style child car bed. The regular pendulum-style one is suitable when moderate impulsive forces are involved because the bed moves smoothly soon after the force begins to affect the bed. The inverted pendulum-style one is suitable when large impulsive forces are involved because the arm that is initially tilted backward, which constitutes the inverted pendulum, is difficult to move under weak forces. Therefore, the proposed child car bed is able to increase the acceleration of the bed gradually and maintain it around the target value. This paper focuses on the control system. The control law is introduced, and the robustness is examined using numerical simulation.

Newborn Car Bed Testing in a Community Hospital: Implementing the American Academy of Pediatrics Recommendations

This study was designed to describe our experience in implementing the American Academy of Pediatrics (AAP) recommendation to test infants in a car bed if they fail a car seat challenge test. Car seat challenge testing was performed for 90 minutes or the anticipated duration of the trip home, whichever was longer. Based on the pulse oximetry saturation values (90-92% or < 90%) two categories of test failure were used. Infants who failed in the car seat were tested in the car bed. Testing took place in both the normal newborn nursery (NBN) and special care nursery (SCN). NBN babies who failed in the car bed were transferred to our SCN for additional assessment and management. A total of 197 infants were tested in car seats out of which 177 (89.8%) passed the test. Of the 20 infants who failed, 16 passed the car bed challenge test on the first attempt and were discharged in those devices. All infants who failed the car bed challenge were NBN patients. Using 93% as the acceptable lower limit of oxygenation we successfully implemented the AAP recommendations for car bed challenge testing in our nursery.

Outpatient and Office-Based Car Seat/Bed Testing

Reporting the testing for safe transition from a car bed to a car seat 94780 and 94781

Weight and Age as Predictors for Passing the Infant Car Seat Challenge

The American Academy of Pediatrics recommends observation of preterm and at-risk infants in their car seat before hospital discharge to screen for breathing problems. This observation period, which we refer to as the infant car seat challenge (ICSC), is used to determine readiness for travel in a car seat. Infants who fail the ICSC are recommended to travel in a car bed. Limited data exist to identify risk factors for failing the ICSC, and no guidelines are available to facilitate transition from car beds to car seats. The purpose of this study was to determine whether weight and age are predictors for passing the ICSC. This retrospective study evaluated 43 infants referred to the Children's Hospital Boston Center for Healthy Infant Lung Development for a repeat ICSC after initial failure and 37 infants who passed or failed their initial ICSC at the Caritas Saint Elizabeth's Medical Center. Gender, birth weight, gestational age (GA), weight (ICSC weight), corrected GA, and chronological age at time of ICSC were extracted, and logistic regression analysis was performed. The average GA at birth of infants referred was 35 weeks 2 days (+/-2 weeks 3 days), and almost equal numbers of boys and girls were referred. A majority of infants passed their initial rechallenge (38 [88%] of 43). Infants who failed the repeat challenge were slightly smaller (3327 +/- 927 vs 3913 +/- 936 g) and younger at time of retesting (CGA 40 weeks 5 days vs 42 weeks 5 days; chronological age 39.2 vs 52.2 days). Neither weight nor age at initial or repeat ICSC predicted passing the ICSC. This study suggests that ICSC screenings remain the safest method for transitioning preterm infants from a car bed to a car seat.

A Comparison of Respiratory Patterns in Healthy Term Infants Placed in Car Safety Seats and Beds

The purpose of this work was to compare the incidence of apnea, hypopnea, bradycardia, or oxygen desaturation in healthy term newborns placed in hospital cribs, infant car safety beds, or infant car safety seats. A consecutive series of 200 newborns was recruited on the second day of life. Each subject was studied while placed in the hospital crib (30 minutes), car bed (60 minutes), and car seat (60 minutes). Physiologic data, including oxygen saturation, frequency, and type of apnea, hypopnea, and bradycardia were obtained and analyzed in a blinded manner. The mean oxygen saturation level was significantly different among all of the positions (97.9% for the hospital crib, 96.3% for the car bed, and 95.7% for the car seat; P < .001). The mean minimal oxygen saturation level was lower while in both safety devices (83.7% for the car bed and 83.6% for the car seat) compared with in the hospital crib (87.4%) (P < .001). The mean total time spent with an oxygen saturation level of <95% was significantly higher (P = .003) in both safety devices (car seat: 23.9%; car bed: 17.2%) when compared with the hospital crib (6.5%). A second study of 50 subjects in which each infant was placed in each position for 120 minutes yielded similar results. In healthy term newborns, significant desaturations were observed in both car beds and car seats as compared with hospital cribs. This study was limited by lack of documentation of sleep stage. Therefore, these safety devices should only be used for protection during travel and not as replacements for cribs.

Comparison of Respiratory Physiologic Features When Infants Are Placed in Car Safety Seats or Car Beds

Comparison of Respiratory Physiologic Features When Infants Are Placed in Car Safety Seats or Car Beds

Car Seats or Car Beds for Very Low Birth-Weight Infants?

From Inova Fairfax Hospital for Children, Falls Church, VA. Address correspondence to Laura A. Stokowski, RN, MS. E-mail: [email protected].

Upon Discharge, Are Preemies Better Off in Car Beds Than in Car Seats?

Because premature babies may develop bradycardia and desaturation while in car seats, the American Academy of Pediatrics recommends the “car seat

Car Seat or Car Bed for Very Low Birth Weight Infants at Discharge Home

To compare the incidence of apnea, bradycardia, or desaturation in a car seat with that in a car bed for preterm very low birth weight (< or = 1500 g) infants. Infants were studied for 120 minutes in a car seat and in a car bed. Apnea (> 20 seconds), bradycardia (heart rate < 80/min for > 5 seconds), desaturation (SpO2 < 88% for > 10 seconds), and absent nasal flow were monitored. We assessed 151 infants (median birth weight, 1120 g [range, 437 to 3105]; median birth gestational age, 29 weeks [24 to 34]) in both devices. Twenty-three infants (15%) had > or = 1 event in the car seat compared with 29 (19%) in the car bed (P = .4). Time to first event was similar in the car seat and car bed (mean, 54 to 55 minutes). In logistic regression analyses, bronchopulmonary dysplasia was a significant predictor for a car seat event and a lower gestational age at birth was a risk factor for a car bed event. We found no evidence that an event is less likely in a car bed than in a car seat. Whichever device is used, very low birth weight infants require observation during travel.

The car seat challenge - What makes sense

The standard of care prior to discharge of a preterm infant is a test of cardiorespiratory stability in the car seat to be used for transporting the infant home. Some infants do have cardiorespiratory events when placed in car seats. The car bed, which allows the infant to be flat, is viewed as a good alternative for discharge. Salhab et al performed a high quality randomized-control trial comparing predischarge respiratory events for preterm infants placed in car seats or car beds. They found no differences in events. In an editorial, Greenberg points out that there is no evidence of the validity of the “car seat challenge,” even though the evaluation is endorsed by the American Academy of Pediatrics. Perhaps it is time to evaluate the utility of car seat assessments prior to discharge of preterms. It may be more effective to simply recommend limited automobile travel for preterms in car seats, along with continual observation during travel to protect the infant from cardiorespiratory events. Car Seat or Car Bed for Very Low Birth Weight Infants at Discharge HomeThe Journal of PediatricsVol. 150Issue 3PreviewTo compare the incidence of apnea, bradycardia, or desaturation in a car seat with that in a car bed for preterm very low birth weight (≤1500 g) infants. Full-Text PDF The Challenge of Car Safety SeatsThe Journal of PediatricsVol. 150Issue 3PreviewIn newborn intensive care units and special care nurseries throughout the United States, the discharge process typically includes a ritual known as the car seat challenge. The preterm infant, now of sufficient health and size to safely venture home, is first placed in a car seat, connected to a vital signs monitor and pulse oximeter, and then observed for an extended period of time. If specified parameters are achieved, the infant is deemed ready to safely travel in a car seat without the risk of untoward cardiopulmonary compromise. Full-Text PDF

Comparison of Respiratory Physiologic Features When Infants Are Placed in Car Safety Seats or Car Beds

The objective of this study was to compare the respiratory physiologic features of healthy term infants placed in either a car bed or a car safety seat. Within the first 1 week of life, 67 healthy term infants were recruited and assigned randomly to be monitored in either a car bed (33 infants) or a car safety seat (34 infants). Physiologic data, including oxygen saturation and frequency and type of apnea, were obtained and analyzed in a blinded manner. The groups spent similar amounts of time in the devices (car bed: 71.6 minutes; car seat: 74.2 minutes). The mean oxygen saturation values were not different between the groups (car bed: 97.1%; car seat: 97.3%). The percentages of time with oxygen saturation of < 95% were also similar for the 2 groups (car bed: 11.8[corrected]%; car seat: 18.3[corrected]%). In both groups, a number of infants spent high percentages of study time with oxygen saturation of < 95%. The 6 infants with the most time at this level were all in the car safety seat group (54%-63% of study time). Values for the 6 infants in the car bed group with the most time at this level were lower (20%-42%). This difference in the duration of oxygen saturation of < 95% was not statistically significant. The mean end-tidal carbon dioxide levels and the numbers of episodes of apnea were similar for the 2 groups. The respiratory physiologic features of infants in the 2 car safety devices were observed to be similar. Of note, substantial periods of time with oxygen saturation of < 95% were surprisingly common in both groups.

Transporting Children in Body Casts

Automotive restraint systems for children in body or hip spica casts, who cannot be accommodated by conventional child restraints or seat belts, were investigated. A car bed restraint and a harness vest restraint were subjected to simulated 30-miles/h crash tests to assess their effectiveness. The successful systems were then tried by patients and their families and found to be convenient as well. Details of the testing, potential limitations of the systems, and a subsequent actual crash experience are reported.

Automotive restraint systems for premature infants

Automotive restraint systems suitable for use with low birth weight infants were crash tested using a small infant dummy developed for the study. Conventional semiupright rear-facing child restraints were tested, as well as a new car bed restraint that may be advantageous for infants who are medically fragile and who must remain in a prone or supine position. This car bed can be adapted to accommodate a very small infant effectively.

Autonomic cardiovascular effects of nasal inhalation of cigarette smoke in the rabbit.

SummaryNasopharyngeal stimulation by cigarette smoke in unanaesthetised rabbits evokes apnoea in expiration, bradycardia (to 30% of control), a rise in mean arterial (to 110%) and right atrial pressure (by 6 mm Hg) and a fall in cardiac output (to 41% of control) and systemic conductance (to 36%). Blood flow (measured by Doppler flowmeter) and conductance in the mesenteric, renal, hind limb and car beds falls uniformly between beds and to the extent that, on occasions, flow in all these beds ceases. Sagittal sinus flow and conductance, in contrast, do not change or rise. The cardiovascular response is mediated predominantly through cardiac vagal and peripheral sympathetic vasoconstrictor nervous pathways. PνO2 in animals with intact autonomic reflex mechanisms falls by 10 ± 0·4 mm Hg 25 see after the onset of apnoea, but in animals with either combined or selective blockade of vagal and sympathoadrenal pathways peripheral flow is not reduced as in animals with intact autonomic pathways, and PνO2 falls by a significantly greater but equal amount in each (av. 15 ± 0·6 mm Hg, Pdiff &lt; 0·001). The circulatory changes thus appear to conserve body oxygen stores during the induced apnoea, an effect dependent on the integration of evoked vagal and sympathetic autonomic activity.

AUTOMOTIVE RESTRAINT DEVICES FOR THE PEDIATRIC PATIENT

Last year 6,300 children under 15 years of age died in motor vehicle accidents. This number would have been reduced if all children and infants had been properly restrained. The purpose of this paper is to give information and suggestions to help enable the practicing physician to understand what restraining devices to prescribe. It is recommended that children from birth to the time they are 12 lb in weight be transported in a rear seat bassinet or car bed held in place by front and rear seat safety belts. The bassinet should be parallel to the long axis of the car, with the infant in a feet-forward position. Children from 12 to 24 lb should be placed in a properly constructed rear seat safety harness. Children from 24 to 48 lb should be placed in a rear seat, shield-type system. Children weighing more than 50 lb should use the adult lap belt, and, when their height exceeds 55 in., the adult shoulder harness should also be used. The physician is in a position to be effective in prescribing the proper device.