{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T13:12:00Z","timestamp":1783689120160,"version":"3.55.0"},"reference-count":33,"publisher":"American Academy of Pediatrics (AAP)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,8,1]]},"abstract":"<jats:sec>\n                  <jats:title\/>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>BACKGROUND:<\/jats:title>\n                  <jats:p>Currently, car seat tolerance screens (CSTSs) are recommended for all infants born prematurely in the United States. Although many late-preterm infants are cared for exclusively in newborn nurseries (NBNs), data on implementation of CSTS in nurseries are limited. Our objective for this study was to determine management strategies and potential variation in practice of CSTS in NBNs across the nation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS:<\/jats:title>\n                  <jats:p>We surveyed NBNs across 35 states using the Better Outcomes through Research for Newborns (BORN) network to determine what percentage perform CSTSs, inclusion and failure criteria, performance characteristics, follow-up of failed CSTSs including use of car beds, and provider attitudes toward CSTS.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS:<\/jats:title>\n                  <jats:p>Of the 84 NBNs surveyed, 90.5% performed predischarge CSTSs. The most common failure criteria were saturation &amp;lt;90%, bradycardia &amp;lt;80 beats per minute, and apnea &amp;gt;20 seconds. More than 55% noted hypotonia as an additional inclusion criterion for testing, and &amp;gt;34% tested any infant who had ever required supplemental oxygen. After an initial failed CSTS, &amp;gt;93% of NBNs retested in a car seat at a future time point, whereas only \u223c1% automatically discharged infants in a car bed. When asked which infants should undergo predischarge CSTS, the most common recommendations by survey respondents included infants with hypotonia (83%), airway malformations (78%), hemodynamically significant congenital heart disease (63%), and prematurity (61%).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS:<\/jats:title>\n                  <jats:p>There is a large degree of variability in implementation of CSTS in NBNs across the United States. Further guidance on screening practices and failure criteria is needed to inform future practice and policy.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1542\/peds.2019-3593","type":"journal-article","created":{"date-parts":[[2020,7,8]],"date-time":"2020-07-08T12:25:04Z","timestamp":1594211104000},"source":"Crossref","is-referenced-by-count":11,"title":["Variation in Car Seat Tolerance Screen Performance in Newborn Nurseries"],"prefix":"10.1542","volume":"146","author":[{"given":"Natalie L.","family":"Davis","sequence":"first","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin D.","family":"Hoffman","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Oregon Health and Science University School of Medicine, Doernbecher Children\u2019s Hospital, Portland, Oregon; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric C.","family":"Eichenwald","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2020,8,1]]},"reference":[{"key":"2021120914553358500_B1","volume-title":"Traffic Safety Facts 2012 Data","author":"National Highway Traffic Safety Administration","year":"2014"},{"issue":"3","key":"2021120914553358500_B2","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1016\/S0022-3476(89)80854-6","article-title":"Ventilatory changes in convalescent infants positioned in car seats","volume":"115","author":"Willett","year":"1989","journal-title":"J Pediatr"},{"issue":"2","key":"2021120914553358500_B3","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/S0022-3476(86)80379-1","article-title":"Risk of hypoventilation in premature infants in car seats","volume":"109","author":"Willett","year":"1986","journal-title":"J Pediatr"},{"issue":"1","key":"2021120914553358500_B4","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1542\/peds.2014-3527","article-title":"Car seat screening for low birth weight term neonates","volume":"136","author":"Davis","year":"2015","journal-title":"Pediatrics"},{"issue":"3","key":"2021120914553358500_B5","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1542\/peds.108.3.647","article-title":"Respiratory instability of term and near-term healthy newborn infants in car safety seats","volume":"108","author":"Merchant","year":"2001","journal-title":"Pediatrics"},{"issue":"1","key":"2021120914553358500_B6","first-page":"16","article-title":"Factors associated with car seat test failure in late preterm infants: a retrospective chart review","volume":"21","author":"Smith","year":"2016","journal-title":"Paediatr Child Health"},{"key":"2021120914553358500_B7","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/j.jpeds.2016.09.072","article-title":"Clinical outcomes associated with a failed infant car seat challenge","volume":"180","author":"Shah","year":"2017","journal-title":"J Pediatr"},{"key":"2021120914553358500_B8","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1186\/1471-2431-5-28","article-title":"Risk of cardio-respiratory abnormalities in preterm infants placed in car seats: a cross-sectional study","volume":"5","author":"Ojadi","year":"2005","journal-title":"BMC Pediatr"},{"issue":"5","key":"2021120914553358500_B9","doi-asserted-by":"crossref","first-page":"1424","DOI":"10.1542\/peds.2009-0559","article-title":"Safe transportation of preterm and low birth weight infants at hospital discharge","volume":"123","author":"Bull","year":"2009","journal-title":"Pediatrics"},{"issue":"1","key":"2021120914553358500_B10","first-page":"CD005386","article-title":"Pre-discharge \u201ccar seat challenge\u201d for preventing morbidity and mortality in preterm infants","author":"Pilley","year":"2006","journal-title":"Cochrane Database Syst Rev"},{"issue":"3","key":"2021120914553358500_B11","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1016\/j.acap.2013.01.009","article-title":"Car seat safety for preterm neonates: implementation and testing parameters of the infant car seat challenge","volume":"13","author":"Davis","year":"2013","journal-title":"Acad Pediatr"},{"key":"2021120914553358500_B12","article-title":"A national survey of car seat tolerance screening protocols in neonatal intensive care units [published online ahead of print February 7, 2020]","author":"Davis","journal-title":"Acad Pediatr"},{"issue":"3","key":"2021120914553358500_B13","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1093\/pch\/21.3.155","article-title":"Assessment of cardiorespiratory stability using the infant car seat challenge before discharge in preterm infants (&lt;37 weeks\u2019 gestational age)","volume":"21","author":"Narvey","year":"2016","journal-title":"Paediatr Child Health"},{"issue":"2","key":"2021120914553358500_B14","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1097\/00005237-200304000-00008","article-title":"Car seat challenges: where are we in implementation of these programs?","volume":"17","author":"Williams","year":"2003","journal-title":"J Perinat Neonatal Nurs"},{"key":"2021120914553358500_B15","doi-asserted-by":"crossref","first-page":"103208","DOI":"10.1016\/j.jbi.2019.103208","article-title":"The REDCap consortium: building an international community of software platform partners","volume":"95","author":"Harris","year":"2019","journal-title":"J Biomed Inform"},{"issue":"2","key":"2021120914553358500_B16","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research electronic data capture (REDCap)\u2013a metadata-driven methodology and workflow process for providing translational research informatics support","volume":"42","author":"Harris","year":"2009","journal-title":"J Biomed Inform"},{"issue":"4","key":"2021120914553358500_B17","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1542\/peds.2011-1419","article-title":"Risk factor changes for sudden infant death syndrome after initiation of Back-to-Sleep campaign","volume":"129","author":"Trachtenberg","year":"2012","journal-title":"Pediatrics"},{"issue":"1","key":"2021120914553358500_B18","doi-asserted-by":"crossref","first-page":"e20182576","DOI":"10.1542\/peds.2018-2576","article-title":"Infant deaths in sitting devices","volume":"144","author":"Liaw","year":"2019","journal-title":"Pediatrics"},{"key":"2021120914553358500_B19","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.jpeds.2017.11.010","article-title":"Car seat tolerance screening in the neonatal intensive care unit: failure rates, risk factors, and adverse outcomes","volume":"194","author":"Jensen","year":"2018","journal-title":"J Pediatr"},{"issue":"1","key":"2021120914553358500_B20","doi-asserted-by":"crossref","first-page":"e20191703","DOI":"10.1542\/peds.2019-1703","article-title":"Car seat tolerance screening for late-preterm infants","volume":"145","author":"Magnarelli","year":"2020","journal-title":"Pediatrics"},{"key":"2021120914553358500_B21","volume-title":"Guidelines for Perinatal Care","author":"AAP Committee on Fetus and Newborn","year":"2017","edition":"8th ed"},{"issue":"5","key":"2021120914553358500_B22","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1542\/peds.2008-2174","article-title":"Hospital discharge of the high-risk neonate","volume":"122","author":"American Academy of Pediatrics Committee on Fetus and Newborn","year":"2008","journal-title":"Pediatrics"},{"issue":"3","key":"2021120914553358500_B24","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1542\/peds.2009-3344","article-title":"The infant car seat challenge: determining and managing an \u201cabnormal\u201d result","volume":"125","author":"Bass","year":"2010","journal-title":"Pediatrics"},{"issue":"4","key":"2021120914553358500_B25","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1038\/jp.2015.1","article-title":"Screening for cardiopulmonary events in neonates: a review of the infant car seat challenge","volume":"35","author":"Davis","year":"2015","journal-title":"J Perinatol"},{"issue":"4","key":"2021120914553358500_B26","first-page":"CD011190","article-title":"Effects of targeting lower versus higher arterial oxygen saturations on death or disability in preterm infants","author":"Askie","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"issue":"5","key":"2021120914553358500_B27","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2011-1317","article-title":"Strategies for implementing screening for critical congenital heart disease","volume":"128","author":"Kemper","year":"2011","journal-title":"Pediatrics"},{"issue":"3","key":"2021120914553358500_B28","first-page":"1","article-title":"Crash protection for child passengers: a review of best practice","volume":"31","author":"Weber","year":"2000","journal-title":"UMTRI Research Review"},{"issue":"3","key":"2021120914553358500_B29","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2009-0160","article-title":"A comparison of respiratory patterns in healthy term infants placed in car safety seats and beds","volume":"124","author":"Kornhauser Cerar","year":"2009","journal-title":"Pediatrics"},{"issue":"2","key":"2021120914553358500_B30","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1542\/peds.2005-2712","article-title":"Comparison of respiratory physiologic features when infants are placed in car safety seats or car beds","volume":"118","author":"Kinane","year":"2006","journal-title":"Pediatrics"},{"issue":"3","key":"2021120914553358500_B31","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1016\/j.jpeds.2006.10.068","article-title":"Car seat or car bed for very low birth weight infants at discharge home","volume":"150","author":"Salhab","year":"2007","journal-title":"J Pediatr"},{"issue":"10","key":"2021120914553358500_B32","doi-asserted-by":"crossref","first-page":"1287","DOI":"10.1038\/s41372-018-0195-7","article-title":"Use of car beds for infant travel: a review of the literature","volume":"38","author":"Davis","year":"2018","journal-title":"J Perinatol"},{"issue":"8","key":"2021120914553358500_B33","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1055\/s-0033-1356925","article-title":"Newborn car bed testing in a community hospital: implementing the American Academy of Pediatrics recommendations","volume":"31","author":"Wilker","year":"2014","journal-title":"Am J Perinatol"},{"key":"2021120914553358500_B34","volume-title":"Hospital Discharge Recommendations for Safe Transportation of Children: Best Practice Recommendations Developed By an Expert Working Group Convened by the National Highway Traffic Safety Administration","author":"National Highway Traffic Safety Administration","year":"2015"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2019-3593\/1079447\/peds_20193593.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2019-3593\/1079447\/peds_20193593.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,10]],"date-time":"2021-12-10T03:58:09Z","timestamp":1639108689000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/146\/2\/e20193593\/77008\/Variation-in-Car-Seat-Tolerance-Screen-Performance"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,8,1]]},"references-count":33,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2020,8,1]]},"published-print":{"date-parts":[[2020,8,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2019-3593","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,8,1]]},"article-number":"e20193593"}}