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INFANT CAR SEAT CHALLENGE Barb Downs RNC-NIC & Andrea Davis RNC-NIC

INFANT CAR SEAT CHALLENGE...CAR SEAT FACTS: Car seats reduce risk of injury by 71 to 82% 28% reduction in death No lower weight limits for infant car seats have been established by

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Page 1: INFANT CAR SEAT CHALLENGE...CAR SEAT FACTS: Car seats reduce risk of injury by 71 to 82% 28% reduction in death No lower weight limits for infant car seats have been established by

INFANT CAR SEAT CHALLENGE

Barb Downs RNC-NIC & Andrea Davis RNC-NIC

Page 2: INFANT CAR SEAT CHALLENGE...CAR SEAT FACTS: Car seats reduce risk of injury by 71 to 82% 28% reduction in death No lower weight limits for infant car seats have been established by

AMERICAN ACADEMY OF PEDIATRICS CAR SEAT FACTS: Car seats reduce risk of injury by 71 to

82% 28% reduction in death No lower weight limits for infant car

seats have been established by Federal Motor Vehicle Safety Standards No car seats available for infants <

3.3 pounds AAP promotes Car seat

challenges/Car Seat Tolerance screening for premature & at risk infants

Reference: Durbin (2011)

Page 3: INFANT CAR SEAT CHALLENGE...CAR SEAT FACTS: Car seats reduce risk of injury by 71 to 82% 28% reduction in death No lower weight limits for infant car seats have been established by

WHAT IS THE GOAL OF A CAR SEAT CHALLENGE???

Evaluate the premature or at risk infants ability to ride safely in an infant car seat, while positioned in a semi-reclined position.

Page 4: INFANT CAR SEAT CHALLENGE...CAR SEAT FACTS: Car seats reduce risk of injury by 71 to 82% 28% reduction in death No lower weight limits for infant car seats have been established by

CRITERIA FOR SCREENING

Infant weight less than or equal to 2,500 grams @ birth

Gestational age < 37 weeks Chronic lung disease, airway or facial anomalies Going home on oxygen or monitors Congenital heart disease Discharging on respiratory stimulant medications As ordered per Physician due to medical history

Reference AAP, (2009, reaffirmed 2013)

The AAP supports that each facility may develop additional criteria for screening infants other than prematurity & age < 37 weeks. These additional guidelines identified were established by NICU medical team @ IBMC in the NICU.

Page 5: INFANT CAR SEAT CHALLENGE...CAR SEAT FACTS: Car seats reduce risk of injury by 71 to 82% 28% reduction in death No lower weight limits for infant car seats have been established by

TIME FRAME FOR CAR SEAT CHALLENGE OBSERVATION TIME FRAME: 90 - 120 minute

minimum or length of travel time to infant’s home.

Page 6: INFANT CAR SEAT CHALLENGE...CAR SEAT FACTS: Car seats reduce risk of injury by 71 to 82% 28% reduction in death No lower weight limits for infant car seats have been established by

INFANT CAR SEAT Screen infant in the car seat

they are going home in Parents to provide car seat

with a base: Rear facing car seat

Weight guidelines: < 5 pounds use a car seat designated for 4-5 lb. infant

Ensure car seat not expired or involved in a wreck

Page 7: INFANT CAR SEAT CHALLENGE...CAR SEAT FACTS: Car seats reduce risk of injury by 71 to 82% 28% reduction in death No lower weight limits for infant car seats have been established by

UTILIZE CORRECT POSITIONING

Page 8: INFANT CAR SEAT CHALLENGE...CAR SEAT FACTS: Car seats reduce risk of injury by 71 to 82% 28% reduction in death No lower weight limits for infant car seats have been established by

PREPARING FOR CAR SEAT CHALLENGE

Correct Placement in car seat: Avoid heavy clothing for secure fit

Shoulder strap insertion point just below shoulder

Avoid twisting of straps

Retainer clip center of chest, level @ armpits

Adjust straps to a snug position

References: AAP (2009, reaffirmed 2013)

Page 9: INFANT CAR SEAT CHALLENGE...CAR SEAT FACTS: Car seats reduce risk of injury by 71 to 82% 28% reduction in death No lower weight limits for infant car seats have been established by

PREPARING FOR CAR SEAT CHALLENGE

Position car seat securely in base on flat surface when available: 45 degree angle or as instructed by car seat manufacturer

Utilize angle indicator & angle adjuster if present on car seat to assure proper position

Assure you can see baby throughout the observation

Page 10: INFANT CAR SEAT CHALLENGE...CAR SEAT FACTS: Car seats reduce risk of injury by 71 to 82% 28% reduction in death No lower weight limits for infant car seats have been established by

CAR SEAT CHALLENGE SCREENING

Infant placed on C/R monitor & Pulse oximeter

• Evaluate breathing, heart rate and oxygen saturation.

Observe infant for time identified as appropriate

• Observation period 90 -120 minute minimum or greater • If travel time exceeds minimum than observe for length of time to infant’s

home.

References: AAP (2009, reaffirmed 2013) & Pediatrics and Child Health

Page 11: INFANT CAR SEAT CHALLENGE...CAR SEAT FACTS: Car seats reduce risk of injury by 71 to 82% 28% reduction in death No lower weight limits for infant car seats have been established by

Reducing Barriers to Promote Success Proper placement in weight appropriate car seat:

Infants buttocks and back flat against seat back Blanket rolls for small babies

position on sides of infant for head, neck & trunk support

Small rolled cloth placed between crotch strap & infant

Avoid the use of additional “head support” systems that did not come with the car seat Position head to maintain airway

AAP Guidelines 2009, reaffirmed 2013

March of Dimes 2017

Page 12: INFANT CAR SEAT CHALLENGE...CAR SEAT FACTS: Car seats reduce risk of injury by 71 to 82% 28% reduction in death No lower weight limits for infant car seats have been established by

REDUCING BARRIERS

Utilize the car seat base on a flat

surface to maintain appropriate angle

Completion of Car seat challenge

Once screening complete remove

infant from car seat

Minimize time in car seat to avoid

cardiorespiratory compromise

Page 13: INFANT CAR SEAT CHALLENGE...CAR SEAT FACTS: Car seats reduce risk of injury by 71 to 82% 28% reduction in death No lower weight limits for infant car seats have been established by

RESULTS OF OBSERVATION

“Passing:” No episodes observed

“Failed:” episode noted during screening

Bradycardia

Apnea > 20 seconds

Desaturation per pulse oximeter

Verify “real” desaturation & not movement

Documentation in EMR

Record pass or fail: note reason for failure

Notify Physician

Repeat screening as indicated

Avoid back to back screening

Page 15: INFANT CAR SEAT CHALLENGE...CAR SEAT FACTS: Car seats reduce risk of injury by 71 to 82% 28% reduction in death No lower weight limits for infant car seats have been established by

EDUCATION

Nursing Staff: Instruct parents to read car seat manual & be

familiar with their car seat prior to discharge.

Trained hospital staff to educate parents about correct positioning in car seat.

Educate family prior to car seat challenge about rationale of observation & significance of results.

Limit time in car seat to observation period & travel time

Preterm and low birth weight infants at risk for cardiorespiratory compromise may not be tolerant of other semi-upright equipment: swings, infant carriers, etc..

Page 16: INFANT CAR SEAT CHALLENGE...CAR SEAT FACTS: Car seats reduce risk of injury by 71 to 82% 28% reduction in death No lower weight limits for infant car seats have been established by

PARENT’S ROLE

Provide infant car seat appropriate for infants weight.

Parents secure infant in car seat after staff education & place in vehicle when being discharged.

Avoid leaving infant unattended in infant car seat

Parents may opt to have additional adult to ride next to infant while traveling home.

Remove infant from car seat when arriving at destination.

Utilize car seats for travel only

Utilize community resources for car seat safety checks

Davis (2015)

Page 17: INFANT CAR SEAT CHALLENGE...CAR SEAT FACTS: Car seats reduce risk of injury by 71 to 82% 28% reduction in death No lower weight limits for infant car seats have been established by

INFANT CAR SEAT TIPS

Multiple types of car seat designs are utilized by parents

Additional car seat features supporting appropriate angle & reducing cardiorespiratory compromise:• Angle indicator & angle adjuster to assure correct position

• Adjust accordingly to assure proper angle

A rear-facing infant car seat should be utilized. The back seat is the safest place for all children to travel.

Vehicles without rear seating positions, disarm the front air bag due to risk of harm or death.

AAP (2009, reaffirmed 2013)

Page 18: INFANT CAR SEAT CHALLENGE...CAR SEAT FACTS: Car seats reduce risk of injury by 71 to 82% 28% reduction in death No lower weight limits for infant car seats have been established by

ADDITIONAL RESOURCES Mosby’s: “Car Seat Tolerance

Screening” module Federal Motor Vehicle Safety Standards-

NHTSA American Academy of Pediatrics March of Dimes Oklahoma Safe Kids Coalition Dynamic Health

Page 19: INFANT CAR SEAT CHALLENGE...CAR SEAT FACTS: Car seats reduce risk of injury by 71 to 82% 28% reduction in death No lower weight limits for infant car seats have been established by

THANK YOU!!!

Page 20: INFANT CAR SEAT CHALLENGE...CAR SEAT FACTS: Car seats reduce risk of injury by 71 to 82% 28% reduction in death No lower weight limits for infant car seats have been established by

REFERENCES

Bull, M.J., Engle, W.A., American Academy of Pediatrics (AAP) Committee on Injury, Violence, and Poison Prevention and Committee on Fetus and Newborn. (2009, reaffirmed 2013). Safe transportation of preterm and low birth weight infants at hospital discharge. Pediatrics, 123(5), 1424-1429. doi:10.1542/peds.2009-0559

Davis, N.L. (2015). Car seat screening for low birth weight term neonates. Pediatrics, 136(1), 89-96. doi:10.1542/peds.2014-3527

Davis, N.L. (2015). Screening for cardiopulmonary events in neonates: a review of the infant care seat challenge. Journal of Perinatology35(4),235-240. doi:10.1038/jp.2015.1

Durbin, D.R., American Academy of Pediatrics (AAP) Committee on Injury, Violence, and Poison Prevention. (2011, reaffirmed 2014). Policy statement: Child passenger safety. Pediatrics, 127(4), 788-793. doi:10.1542/peds.2011-0213

Mosby’s (2017) Newborn Car Seat Safety Module

National Highway Traffic Safety Administration (NHTSA), U.S. Department of Transportation. (2011). Car seat recommendations for children. Retrieved October 15, 2017, from https://www.nhtsa.gov/sites/nhtsa.dot.gov/files/nhtsacarseatrecommendations.pdf (classic reference)*