Car safety seats are meant to keep children safe given that the car seat fits the child and it is used correctly each and every car ride.
However, near term infants (born before 37 weeks gestation) may be at risk for potential respiratory difficulties when placed in a semi-upright position in a car safety seat. The Nebraska Medical Center is the first hospital in Omaha to expand its car safety seat screening program to all near term infants.
“The most recent recommendations of the American Academy of Pediatrics extend the population of babies who need to be screened to include the near term infants,” said David Bolam, M.D., associate professor of pediatrics at UNMC and medical director of the Newborn Intensive Care Unit at The Nebraska Medical Center.
“We wanted to set the community standard and to be the first Omaha hospital to implement the AAP recommendations for car seat safety screening in all near term infants who are not admitted to the NICU,” said Susan Adams, director of Women’s and Infants’ Services at The Nebraska Medical Center.
Previously, the car seat screening had only been performed for all premature and at-risk infants admitted to the NICU, however not all near term infants need to receive care in the NICU. Some of these near term infants are healthy enough to begin life in the newborn nursery units.
“Research has indicated that near term infants due to their lower birth weights and neurological immaturity are at greater risk of respiratory difficulty when placed in a semi-upright position in a car seat,” NICU case manager Denise Lynes said.
Lynes is also a Certified Child Passenger Safety Technician with the National Highway Traffic Safety Administration.
Before heading home from The Nebraska Medical Center, infants born before 37 weeks gestation or who have a birth weight of less than 5 pounds 8 ounces will be observed in a car safety seat to monitor for apnea (no breathing), bradycardia (slow heart rate) or desaturation (decreased oxygen level in the blood). During the car seat safety screening, the baby is placed in the car seat and attached to an oximeter that monitors the heart rate and oxygen levels while the breathing pattern is observed by the nurse.
“If the infant is observed to have any problems, the nurse will attempt to re-adjust the baby in the car seat and continue to evaluate. If the infant shows continued respiratory problems the screening is stopped and a respiratory care practitioner will do a further evaluation of the infant and re-screen,” Lynes said.
Timing of the screening procedure is a key factor.
“The best time to test infants is about thirty minutes after they have eaten, after their diapers have been changed and when they are ready for some sleep time,” Lynes said.
Tyrell and Tyreshia Fuller were the first babies to be monitored under the new program.
“The nurses showed me how to properly secure my infants using blanket rolls on each side of their heads to help keep their airways open,” said Candace Fuller, the twins’ mother. The twins do not have the muscle control required to keep their heads upright or to move their heads if they had trouble breathing.
“When you’re a new mom, there’s so much to learn. I was so glad that the nurses took this extra time to teach me about monitoring my babies in their car seats,” Fuller said.
Nurses Nancy Rasmussen and Debra Crabbe screened the twins. The screening offered the parents reassurance that their twins’ first ride in their car seat would be a safe ride, Rasmussen and Crabbe said.
The nurses also advised the twins’ parents to minimize the amount of time the infants spend in semi-upright positioning devices like car seats during the first months of life.
The parents were encouraged to travel with another person who would be able to observe the infants and their breathing in the car seats.
Paula Miller, clinical nurse specialist for obstetrics and newborn services, coordinated the staff training and program implementation.