Pre-discharge "car seat challenge" for preventing morbidity and mortality in preterm infants

  • Review
  • Intervention

Authors

  • Elizabeth Pilley,

    1. Royal Free Hospital, Department of Paediatrics, Glasgow, Scotland, UK
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  • William McGuire

    Corresponding author
    1. Australian National University Medical School, Department of Paediatrics and Child Health, Canberra, ACT 2606, Australia
    • William McGuire, Department of Paediatrics and Child Health, Australian National University Medical School, Canberra Hospital Campus, Canberra, ACT 2606, Australia. william.mcguire@act.gov.au.

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Abstract

Background

Physiological monitoring studies indicate that some preterm infants 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 should be assessed for cardiorespiratory stability in their car seat prior to discharge - the "car seat challenge". We aimed to assess the evidence to support this practice, specifically to determine whether the use of the car seat challenge prevents morbidity and mortality in preterm infants.

Objectives

To assess the available evidence from randomised controlled trials that pre-discharge cardiorespiratory monitoring in a car safety seat prevents morbidity and mortality in preterm infants.

Search methods

We used the standard search strategy of the Cochrane Neonatal Review Group. This included searches of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 3, 2005), MEDLINE (1966 - September 2005), EMBASE (1980 - September 2005), CINAHL (1982 - September 2005), conference proceedings, and previous reviews.

Selection criteria

Randomised or quasi-randomised controlled trials that compared pre-discharge cardiorespiratory monitoring in a car seat versus no monitoring in preterm infants in the week prior to planned discharge from hospital.

Data collection and analysis

The standard methods of the Cochrane Neonatal Review Group, with separate evaluation of trial quality and data extraction by two review authors, and synthesis of data using relative risk, risk difference and weighted mean difference.

Main results

We did not find any randomised controlled trials that fulfilled the eligibility criteria.

Authors' conclusions

It is unclear whether undertaking a pre-discharge car seat challenge is beneficial or harmful to preterm infants. Further studies are needed to determine whether the car seat challenge accurately predicts the risk of clinically significant adverse events in preterm infants travelling in car seats. If this is shown to be the case then a large randomised controlled trial is needed to provide an unbiased assessment of its utility in pre-discharge assessment.

摘要

背景

用於預防早產兒罹病及死亡之出院前「汽車座椅挑戰」

生理監測實驗指出,部分之早產兒於坐在標準之汽車安全座椅中時,會發生血氧失飽和、窒息、或心律不整之情形。美國小兒科學會 (The American Academy of Pediatrics) 建議,所有之早產兒都應於出院之前,在其汽車安全座椅上接受心肺穩定性之評估,亦即所謂之「汽車座椅挑戰」。我們的目標在於評估支持此種做法之證據,特別是要判定使用汽車座椅挑戰是否可預防早產兒之罹病及死亡。

目標

取自隨機對照試驗之證據,評估在汽車安全座椅上進行出院前之心肺監測是否可預防早產兒之罹病及死亡。

搜尋策略

我們使用 Cochrane Neonatal Review Group標準搜尋策略。搜尋Cochrane Central Register of Controlled Trials (CENTRAL, Cochrane Library, Issue 3, 2005) 、 MEDLINE (1966年2005年9月) 、 EMBASE (1980年2005年9月) 、 CINAHL (1982年2005年9月) 、研討會手冊,以及之前的文獻回顧。

選擇標準

找出隨機或半隨機對照試驗,於計畫出院前一週,讓早產兒在汽車座椅中進行出院前之心肺監測,與無監測的早產兒做比較。

資料收集與分析

Cochrane Neonatal Review Group之標準方法,由2位回顧作者分別評估試驗品質及摘錄數據,並使用相對風險、風險差及加權平均差合成數據。.

主要結論

我們並未發現任何符合標準之隨機對照試驗。

作者結論

目前仍不清楚接受出院前之汽車座椅挑戰對早產兒而言為有益或是有害。仍需要進一步之實驗,以判定汽車座椅挑戰是否可精確預測早產兒在乘坐汽車座椅移動時會產生的臨床上有意義之不良作用風險。如的確如此,則需要進行大型之隨機對照試驗,以提供有關其在出院前評估中之用途的無偏差評估。

翻譯人

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

NA

Plain language summary

Pre-discharge "car seat challenge" for preventing morbidity and mortality in preterm infants

There is no evidence that undertaking a pre-discharge "car seat challenge" benefits preterm infants. The "car seat challenge" assesses whether preterm infants who are ready for discharge home are prone to episodes of apnoea (stopping breathing), bradycardia (slow heart rate), or desaturation (low oxygen levels) when seated in their car seat. However, it is not clear whether the level of oxygen desaturation, apnoea, or bradycardia detected in the car seat challenge is actually harmful for preterm infants. Additionally there is concern that the use of the car seat challenge may cause undue parental anxiety about the safety of transporting their infant in a car seat. Despite these uncertainties, and despite the widespread use of the test, we have not identified any randomised controlled trials that assessed whether undertaking a car seat challenge is beneficial or harmful to preterm infants.