WIP 104 - Examining the Incidence and Factors Influencing the Infant Car Seat Tolerance Screening Failure in Neonates with Hypoxic Ischemic Encephalopathy
Categorical Pediatric Resident University of Maryland Children's Hospital, Maryland, United States
Background: The American Academy of Pediatrics (AAP) recommends routine pre-discharge car seat tolerance screening (CSTS) for premature infants but also notes that hospitals should develop protocols to include CSTS for infants at risk of obstructive apnea, bradycardia, or oxygen desaturation other than those born prematurely. Several reviews have suggested that muscle tone abnormalities may impact an infant’s tolerance to car seats due to potential airway obstruction. Given that infants affected by hypoxic-ischemic encephalopathy (HIE) may experience alterations in tone, it is reasonable to anticipate an elevated risk of cardiorespiratory instability when placed in a semi-upright car seat position. While previous studies have demonstrated that many NICUs will screen infants with neurologic issues such as HIE and seizures, there is a notable absence of published research specifically focused on this high-risk population. Objective: This study adopts a comprehensive approach to investigate the incidence and predictors of CSTS failure in a large cohort of infants with HIE to inform national recommendations for or against this testing. Design/Methods: We conducted a retrospective medical record review of neonates born between 2013 – 2021 who were admitted to the University of Maryland for therapeutic hypothermia (TH) treatment with concern for HIE. Our study aimed to ascertain the frequency of CSTS testing in this population and its failure rates. We collected data on antenatal and clinical factors during admission while also accounting for potential confounding variables that might impact outcomes. We performed Bivariate analyses and multivariable stepwise linear regression to identify clinical and demographic differences between infants who did vs. did not undergo CSTS, and between those who passed vs. failed initial CSTS.
