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Carseat trial for preterm infants

CARDIORESPIRATORY VARIABLES IN PRETERM INFANTS BEFORE AND DURING A CARSEAT TRIAL PRIOR TO DISCHARGE FROM THE NEONATAL NURSERY

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D Sheppard1,2, L Russell3, A Campbell2 D Elder1
(1) Department of Paediatrics, and (2) WellSleep, Department of Medicine, Wellington School of Medicine and Health Sciences, Wellington, New Zealand, (3) Neonatal Unit, Capital and Coast District Health Board, Wellington, New Zealand.

There are no national guidelines in NZ regarding the use of standard carseats for preterm infants. The mechanism of desaturations experienced by preterm infants when asleep in carseats provides a basis for guidelines for carseat use in this population. Methods: Eighteen infants born at less than 37 weeks gestation, healthy and ready for discharge were recruited. PSG data was recorded with the infants initially sleeping supine in their cot for up to 2 hours and then asleep in the carseat selected for transport home for up to 90 minutes. An extra oxygen sensor was attached during the carseat trial and the output monitored by a Home Discharge Planning Nurse (usual routine). Failure was defined as (a) persistent desaturation and or signs of respiratory distress noted by the nurse or (b) PSG revealing persistent baseline oxygen desaturation <90% not alleviated by repositioning, or >1 obstructive apnoea >20 seconds long and / or oxygen desaturation <80% noted by the sleep technician. Results: 53% (9 /17) of the infants failed the carseat trial. Three of these failures were common to both types of monitoring. Three failures occurred in Evenflo carseats (3/9 babies), 3 in Century carseats (3/3 babies), 2 in Britax carseats (2/4 babies) and 1 in a Bassimo carseat (1/1 baby). Conclusion: Preterm infants ready for discharge home from the neonatal nursery commonly show cardiorespiratory instability when asleep in carseats. Carseat design may be an important factor in these results.

Supported by: NZ Cot Death Association

Key Words: Preterm infants, Carseats, Sleep, Cardiorespiratory stability.

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