The Science Journal of the American Association for Respiratory Care

2007 OPEN FORUM Abstracts

CAR SAFETY SEATS: THE IMPLEMENTATION OF TESTING FOR PREMATURE AND HIGH-RISK INFANTS PRIOR TO HOSPITAL DISCHARGE

D. O'Brien-Genrich1

Background: Premature and high-risk (history of respiratory complications) term infants have been tested for cardiorespiratory complications in a car safety seat (CSS) prior to hospital discharge at The Nebraska Medical Center in Omaha, Nebraska since 1986. However, CSS testing is selective among the ordering physicians. The American Academy of Pediatrics (AAP) recommends that each infant born at less than 37 weeks gestation should have a period of observation in a CSS before hospital discharge in order to monitor for possible apnea, bradycardia, or desaturation (1996). The concern is if a standard criterion recommended by the AAP is not utilized, will it pose a serious risk? The Neonatal Intensive Care Unit (NICU) Performance Improvement Team determined that the implementation of the AAP recommendations is necessary to provide consistent CSS testing of infants prior to hospital discharge.

Method: Collected secondary data from CSS test results six months prior to and after implementation of the AAP recommendations. The study includes only infants admitted to the NICU from July 2004 through June 2005. Two samples were identified. The first sample is selected to include only tests that were performed based on the discretion of the physician (pre AAP group). The second sample is selected to include only those infants who fell within the guidelines of the revised policy (post AAP group). A quasi-experimental design is utilized to evaluate the CSS testing results.

Conclusion: The implementation of the AAP guidelines established a consistent process without a significant increase in CSS testing for infants discharged from the NICU. It was found that the number of failed tests post implementation were all infants less than 37 weeks gestation compared to the pre AAP testing group. Based on this analysis with the small sample size, the recommendation would be to continue to test all NICU infants in a CSS prior to discharge.

Results
 Pre AAP Group Post AAP Group
Total Admissions to the NICU 170 140
CSS Tests Performed 53% (n=90) 52% (n=73)
Premature infants tested 72% 82%
High-risk term infants tested 28%18%
Passed CSS Test90%93%
Failed CSS Test5.6%6.8%
Premature infants failed CSS Test 40% 100%
Infants discharged with supplemental oxygen 8.9% 4.1%



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