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Jensen EA, Foglia EE, Dysart KC, et al. Car Seat Tolerance Screening in the Neonatal Intensive Care Unit: Failure Rates, Risk Factors, and Adverse Outcomes. J Pediatr. 2017;194:60-66.e1doi: 10.1016/j.jpeds.2017.11.010.
Jensen, E. A., Foglia, E. E., Dysart, K. C., Aghai, Z. H., Cook, A., Greenspan, J. S., & DeMauro, S. B. (2018). Car Seat Tolerance Screening in the Neonatal Intensive Care Unit: Failure Rates, Risk Factors, and Adverse Outcomes. The Journal of pediatrics, 19460-66.e1. https://doi.org/10.1016/j.jpeds.2017.11.010
Jensen, Erik A, et al. "Car Seat Tolerance Screening in the Neonatal Intensive Care Unit: Failure Rates, Risk Factors, and Adverse Outcomes." The Journal of pediatrics vol. 194 (2018): 60-66.e1. doi: https://doi.org/10.1016/j.jpeds.2017.11.010
Jensen EA, Foglia EE, Dysart KC, Aghai ZH, Cook A, Greenspan JS, DeMauro SB. Car Seat Tolerance Screening in the Neonatal Intensive Care Unit: Failure Rates, Risk Factors, and Adverse Outcomes. J Pediatr. 2018 Mar;194:60-66.e1. doi: 10.1016/j.jpeds.2017.11.010. Epub 2017 Dec 18. PMID: 29269198; PMCID: PMC5826836.
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J Pediatr. 2018 Mar;194:60-66.e1. doi: 10.1016/j.jpeds.2017.11.010. Epub 2017 Dec 18.

Car Seat Tolerance Screening in the Neonatal Intensive Care Unit: Failure Rates, Risk Factors, and Adverse Outcomes.

The Journal of pediatrics

Erik A Jensen, Elizabeth E Foglia, Kevin C Dysart, Zubair H Aghai, Alison Cook, Jay S Greenspan, Sara B DeMauro

Affiliations

  1. Department of Pediatrics, Division of Neonatology, The Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. Electronic address: [email protected].
  2. Department of Pediatrics, Division of Neonatology, The Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
  3. Division of Neonatology, Nemours/Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA.
  4. Optum, Inc., Eden Prairie, MN.

PMID: 29269198 PMCID: PMC5826836 DOI: 10.1016/j.jpeds.2017.11.010

Abstract

OBJECTIVE: To characterize the epidemiology of Car Seat Tolerance Screening (CSTS) failure and the association between test failure and all-cause 30-day postdischarge mortality or hospital readmission in a large, multicenter cohort of preterm infants receiving neonatal intensive care.

STUDY DESIGN: This retrospective cohort study used the prospectively collected Optum Neonatal Database. Study infants were born at <37 weeks of gestation between 2010 and 2016. We identified independent predictors of CSTS failure and calculated the risk-adjusted odds of all-cause 30-day mortality or hospital readmission associated with test failure.

RESULTS: Of 7899 infants cared for in 788 hospitals, 334 (4.2%) failed initial CSTS. Greater postmenstrual age at testing and African American race were independently associated with decreased failure risk. Any treatment with an antacid medication, concurrent use of caffeine or supplemental oxygen, and a history of failing a trial off respiratory support were associated with increased failure risk. The mean adjusted post-CSTS duration of hospitalization was 3.1 days longer (95% CI, 2.7-3.6) among the infants who failed the initial screening. Rates of 30-day all-cause mortality or readmission were higher among infants who failed the CSTS (2.4% vs 1.0%; P = .03); however, the difference was not significant after confounder adjustment (OR, 0.38; 95% CI, 0.11-1.31).

CONCLUSION: CSTS failure was associated with longer post-test hospitalization but no difference in the risk-adjusted odds for 30-day mortality or hospital readmission. Whether CSTS failure unnecessarily prolongs hospitalization or results in appropriate care that prevents adverse postdischarge outcomes is unknown. Further research is needed to address this knowledge gap.

Copyright © 2017 Elsevier Inc. All rights reserved.

Keywords: car seat tolerance screening; infant car seat challenge; premature infant

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