The car seat: a challenge too far for preterm infants?

Physiological monitoring studies have shown that some preterm infants who are otherwise ready for hospital discharge experience episodes of oxygen desaturation, apnoea, or bradycardia when seated in standard car safety seats. The American Academy of Pediatrics recommends that all preterm infants are assessed for cardiorespiratory stability in their car seat before discharge: the "car seat challenge". This screening test has been incorporated into discharge assessments in most neonatal units in North America and is being increasingly used in the United Kingdom and elsewhere. The evidence base for the use of the car seat challenge in discharge assessment, the possible implications for infants, their families, and health services of adopting the practice, and the issues that may be resolved with further research are discussed.