Car seat challenges: where are we in implementation of these programs?

Premature infants and infants with special needs are being discharged home at smaller weights and earlier postconceptional ages. This presents a challenge to safely transporting these infants in car seats. Car seat technology has not kept abreast of advances experienced in neonatal medical technology. Several studies have demonstrated that preterm infants are at risk for apnea, bradycardia, and oxygen desaturations while being transported in traditional car seats. The American Academy of Pediatrics issued policy statements recommending that all infants less than 37 weeks of gestational age be monitored in a car seat safety test prior to discharge. This article reviews current literature on implementing car seat safety testing in hospitals and the results of a research survey of newborn nursery and neonatal intensive care units across the United States to evaluate the status of these facilities in implementing car seat safety testing programs. The results show that many level II and level III units have begun to implement car seat safety programs despite the lack of literature and guidelines available on how to develop a program. Although most programs monitored the same criteria, there were variations in length of testing, which infants were tested, and recommendations for the infants who failed the testing.