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Neonatal-Perinatal Health Care Delivery: Practices and Procedures

Neonatal-Perinatal Health Care Delivery 3: Practices: Growth & Nutrition, Potpourri

773 - Car seat screening in infants with critical congenital heart disease

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 773
Publication Number: 773.247

Emily Sangillo, University of Maryland Children's Hospital, Baltimore, MD, United States; Natalie Davis, University of Maryland School of Medicine, BALTIMORE, MD, United States

Presenting Author(s)

Emily Sangillo, MD (she/her/hers)

Fellow
University of Maryland Children's Hospital
Baltimore, Maryland, United States

Background: Certain patient populations are at increased risk for cardiorespiratory instability when placed in the semi-upright car seat position, including premature and low birthweight infants, which led to the AAP recommendation for pre-discharge car seat tolerance screening (CSTS) in all infants born <37 weeks gestation. In their most recent clinical report, the AAP acknowledged varied hospital practices for inclusion of other “at risk” infants, including those with congenital heart disease (CHD), though formal recommendations for testing these at-risk populations do not exist. Additional epidemiologic data on CSTS outcomes for patients with CHD will help guide evidence-based recommendations.

Objective: To identify incidence and risk factors for CSTS failure in the critical congenital heart disease (CCHD) population.

Design/Methods: We performed a retrospective medical record review of neonates with CCHD born and admitted to the University of Maryland neonatal intensive care unit, pediatric intensive care unit, or newborn nursery between 2013-2020 to identify incidence and risk factors for CSTS failure in this population. Infants were excluded if they died prior to CSTS, were discharged in a car bed due to medical necessity, or if parents declined CSTS. Bivariate analysis and multivariable stepwise linear regression were used to identify predictors of CSTS failure using SAS 9.4.

Results: One-hundred and eighty-four infants with CCHD met inclusion criteria, of which, 132 underwent CSTS with 8 infants (6.1%) failing their initial CSTS. The incidence of CSTS failure was highest among infants with total anomalous pulmonary venous return (TAPVR) (12.5%) and transposition of the great arteries (TGA) (12.5%). Preterm infants and infants with periventricular leukomalacia (PVL) or seizures were more likely to fail their CSTS. P</span>rematurity and PVL remained significant predictors of CSTS failure on stepwise linear regression modeling. Preterm infants were 6.3 times more likely to fail their CSTS (95% confidence interval [CI]: 1.265-31.26) and those with PVL were 13.6 times more likely to fail (95% CI: 1.013-183.38).

Conclusion(s): This is the largest study to date focusing on CSTS exclusively in CCHD and we identified a 6.1% CSTS failure rate. Preterm infants, and infants with seizures or PVL were more likely to fail a CSTS; and prematurity and PVL remained significant predictors of CSTS failure on regression modeling. The incidence of CSTS failure was highest among infants with TAPVR and TGA. More studies are needed, but these data can help guide recommendations for CSTS testing in this population.