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Is it time to study routine car seat tolerance screening in a randomized controlled trial? An international survey of current practice and clinician equipoise

Journal of Perinatology volume 42, pages 507–509 (2022)Cite this article

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Preterm infants can develop transient cardiorespiratory abnormalities when positioned semi-upright in an infant car safety seat [1]. For this reason, the American Academy of Pediatrics has recommended for nearly 30 years that all preterm infants be monitored for apnea, bradycardia, and hypoxemia in a car seat prior to hospital discharge [2]. However, since 2016 the Canadian Paediatric Society has not recommended routine pre-discharge car seat tolerance screening (CSTS), citing a lack of evidence that it prevents morbidity or mortality in preterm infants [3]. Importantly, no randomized trial has evaluated whether routine CSTS is beneficial or harmful [3, 4]. We surveyed attendees at the 2018 Hot Topics in Neonatology conference to assess opinions regarding CSTS and equipoise to study CSTS in a randomized trial.

Hot Topics in Neonatology is a large, annual conference held in the United States (US), attended by an international audience of neonatal healthcare providers. Attendees present on December 4, 2018 were asked to complete an anonymous “paper and pencil” survey that collected data on respondent demographics, current use and opinions regarding CSTS in preterm infants, and equipoise to conduct 2 hypothetical randomized trials. Both trials proposed enrolling infants born <37 weeks’ gestation who were breathing in room air and otherwise considered medically ready for discharge to home. Trial #1 randomized infants to either be discharged home without CSTS or to undergo CSTS with discharge contingent upon passing a CSTS according to investigator agreed upon failure criteria (specific criteria were not provided). In trial #2, all infants underwent CSTS but were randomized to either permissive/liberal or restrictive/conservative failure criteria. Respondents were asked to assume that the primary outcome for both trials was one they believed best assessed the utility of CSTS. Data on preferred CSTS failure criteria, post-failure management, and the primary trial outcome were obtained. A sample survey and details of administration are available online. Data were summarized using Stata/SE 15.1 (College Station, Texas). The Institutional Review Board at the Children’s Hospital of Philadelphia approved this study.

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Fig. 1: Survey results.

References

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Acknowledgements

Prior presentation: the results of this study were presented in abstract form at the 2019 Pediatric Academic Societies annual meeting.

Funding

EAJ received research support from the NICHD through an administrative supplement to grant UG1 HD068244. The NICHD had no role in the design and conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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Authors and 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, USA

    Erik A. Jensen, Eric C. Eichenwald, Sara B. DeMauro & Kevin Dysart

  2. Division of Neonatology, Nemours/Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA

    Jay S. Greenspan, Zubair H. Aghai & David L. Carola

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  1. Erik A. Jensen
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  2. Jay S. Greenspan
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  3. Zubair H. Aghai
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  4. David L. Carola
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  5. Eric C. Eichenwald
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  6. Sara B. DeMauro
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  7. Kevin Dysart
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Correspondence to Erik A. Jensen.

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Jensen, E.A., Greenspan, J.S., Aghai, Z.H. et al. Is it time to study routine car seat tolerance screening in a randomized controlled trial? An international survey of current practice and clinician equipoise. J Perinatol 42, 507–509 (2022). https://doi.org/10.1038/s41372-021-01167-7

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