147 - Characteristics Associated with Failed Car Seat Screening Tests: A Multicenter Study

Poster Number: 147
Publication Number: 147.1141

Background: Car seat tolerance screening (CSTS) is widely implemented across US nurseries. However, significant variation exists in: (1) population of infants that are screened and (2) specific cardiorespiratory thresholds used to determine failure.

Objective: To examine, across multiple level 1 nurseries with varying CSTS guidelines, the association between CSTS implementation and CSTS results.

Design/Methods: This was an observational study using retrospective electronic health record (EHR) data on infants discharged from level 1 newborn nurseries (NBNs) over a 6-year period (Jan 2015- Dec 2020) in 12 sites across the Academic Pediatric Association’s Better Outcomes for Research through Newborns (BORN) Network. Infants discharged from the neonatal intensive care unit were excluded. Bivariate statistics examined the association of infant characteristics with receipt of CSTS and CSTS outcomes. A cross-sectional survey obtained the CSTS criteria and NBN characteristics of each site. We developed index scores for each hospital based on its reported screening and failure criteria (Figure 1). A mixed Poisson regression model examined cumulative incidence rates of initial CSTS failure after adjusting for hospital level covariates (screening index score and failure index score) and the infant-level covariates shown in Table 2.

Results: Of 13,202 infants undergoing a CSTS across 12 institutions, 5.1% failed an initial CSTS (range 0.2%-13.0%). As shown in Table 1, CSTS failure was associated with increased length of stay and was more common among infants born with the following characteristics: cesarean delivery, public insurance, Hispanic ethnicity, Trisomy 21, and oxygen use. In the Poisson regression model, for every 1 unit increase in the failure or screening index score, there was a 1.167- or 1.45-times greater incidence rate of initial CSTS failure, respectively (Table 2).

Conclusion(s): Both infant characteristics and hospital-level screening criteria impact CSTS screening failure rates. Given the variation in hospital-level screening criteria, it may be beneficial to determine the optimal criteria for selection of infants for screening and standardization of CSTS failure.