Information de reference pour ce titreAccession Number: | 00006455-200109000-00055.
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Author: | Merchant, Jennifer R. MD *++; Worwa, Cathy CRT *; Porter, Sharon RRT *; Coleman, J. M. MD *++; deRegnier, Raye-Ann O. MD *++
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Institution: | From the *Children's Hospital-St Paul, St Paul, and ++Division of Neonatology, University of Minnesota School of Medicine, Minneapolis, Minnesota.
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Title: | Respiratory Instability of Term and Near-Term Healthy Newborn Infants in Car Safety Seats.[Article]
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Source: | Pediatrics. 108(3):647-652, September 2001.
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Abstract: | Objective. Premature infants who are discharged from intensive care nurseries are known to be at increased risk for apnea, bradycardia, and oxygen desaturation while in the upright position. These small infants also do not fit securely in standard infant car seats. Because of these problems, the American Academy of Pediatrics recommends a period of observation in a car seat for all infants who are born at <37 weeks' gestation. It is not clear whether this recommendation should apply to the minimally preterm infants (born at 35-36 weeks' gestation) who are healthy at birth and are hospitalized in the normal newborn nursery. The objective of this study was to evaluate the respiratory stability and safety requirements of healthy, minimally preterm infants in car seats compared with term infants.
Methods. Fifty healthy, nonmonitored, preterm infants (mean gestational age: 35.8 +/- 0.6 weeks) and 50 term infants (mean gestational age: 39.5 +/- 1.4 weeks) were recruited from a level I newborn nursery in a community hospital. Appropriateness of car seat fit was documented for each infant. Heart rate, respiratory rate, and pulse oximetry were evaluated while infants were supine and in their car seats. Apneic and bradycardic events were recorded in addition to a continuous recording of oxygen saturation values.
Results. Twenty-four percent of preterm and 4% of term newborn infants did not fit securely into suitable car seats despite the use of blanket rolls. Mean oxygen saturation values declined significantly in both preterm and term infants from 97% in the supine position (range: 92%-100%) to 94% after 60 minutes in their car seats (range: 87%-100%). Seven infants (3 preterm and 4 term) had oxygen saturation values of <90% for longer than 20 minutes in their car seats. Twelve percent of the preterm infants (95% confidence interval: 4.5%-24.3%) but no term infants had apneic or bradycardic events in their car seats.
Conclusions. Our data support the current American Academy of Pediatrics recommendations that all infants who are born at <37 weeks' gestation, including those who are admitted to level I community hospitals, be observed for respiratory instability and secure fit in their car seats before hospital discharge. Because lowering of oxygen saturation values was seen uniformly in all newborn infants, car seats should be used only for travel, and travel should be minimized during the first months of life.
(C) American Academy of Pediatrics, 2001. All Rights Reserved.
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Author Keywords: | car seat; newborn; prematurity; apnea; bradycardia; oxygen desaturation.
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References: | 1.American Academy of Pediatrics, Committee on Injury and Poison Prevention and Committee on Fetus and Newborn. Safe transportation of premature and low birth weight infants. Pediatrics. 1996;97:758-760
2.American Academy of Pediatrics, Committee on Injury and Poison Prevention and Committee on Fetus and Newborn. Safe transportation of premature infants. Pediatrics. 1991;87:120-122
3.Willett LD, Leuschen P, Nelson LS, Nelson RM. Risk of hypoventilation in premature infants in car seats. J Pediatr. 1986;109:245-248
4.Willett LD, Leuschen P, Nelson LS, Nelson RM. Ventilatory changes in convalescent infants positioned in car seats. J Pediatr. 1989;15:451-455
5.Bass JL, Mehta KA, Camara J. Monitoring premature infants in car seats: implementing the American Academy of Pediatrics policy in a community hospital. Pediatrics. 1993;91:1137-1141
6.Ventura SJ, Martin JA, Curtin SC, Mathews TJ, Park MM. Births: Final data for 1998. Natl Vital Stat Rep. 2000;48:1-100.
7.Henderson-Smart DJ. The effect of gestational age on the incidence and duration of recurrent apnoea in newborn babies. Aust Paediatr J. 1981;17:273-276
8.Bull MJ, Stroup KB. Premature infants in car seats. Pediatrics. 1985;75:336-339
9.National Highway Traffic Safety Administration and Minnesota Child Passenger Safety Program. Buckle up Kids. Minneapolis, MN: National Highway Traffic Administration and Minnesota Child Passenger Safety Program; 1998:6-15
10.Nelson NM. Members of task force on prolonged apnea. Reports of the task force on prolonged apnea of the American Academy of Pediatrics. Pediatrics. 1978;61:651-652
11.Henderson-Smart DJ. Apnea of prematurity. In: Beckerman RC, Brouillette RT, Hunt CE, eds. Respiratory Control Disorders in Infants and Children. Baltimore, MD: Williams & Wilkins; 1992:161-177
12.Hodgman JE, Hoppenbrouwers T, Cabal LA. Episodes of bradycardia during early infancy in the term-born and preterm infant. Am J Dis Child. 1993;147:960-964
13.Stebbens VA, Poets CF, Alexander JR, Arrowsmith WA, Southall DP. Oxygen saturation and breathing patterns in infancy. 1: Full term infants in the second month of life. Arch Dis Child. 1991;66:569-573
14.Poets CF, Stebbens VA, Alexander JR, Arrowsmith WA, Salfield SW, Southall DP. Oxygen saturation and breathing patterns in infancy. 2: Preterm infants at discharge from special care. Arch Dis Child. 1991;66:574-578
15.Poets CF, Stebbens VA, Alexander JR, Arrowsmith WA, Salfield SW, Southall DP. Arterial oxygen saturation in preterm infants at discharge from the hospital and six weeks later. J Pediatr. 1992;120:447-454
16.Poets CF, Stebbens VA, Lang JA, O'Brien LM, Boon AW, Southall DP. Arterial oxygen saturation in healthy term neonates. Eur J Pediatr. 1996;155:219-223
17.Bass JL, Mehta KA. Oxygen desaturation of selected term infants in car seats. Pediatrics. 1995;96:288-290
18.American Academy of Pediatrics, Committee on Injury and Poison Prevention. Safe transportation of newborns at hospital discharge. Pediatrics. 1999;104:986-987
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Language: | English.
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Document Type: | Articles.
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Journal Subset: | Clinical Medicine.
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ISSN: | 0031-4005
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NLM Journal Code: | oxv, 0376422
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Annotation(s) | |
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