Car seat safety for premature and/or high risk infants

What measures does your NICU take to assure the safe and proper use of car seats at discharge of premie or high-risk infants?
Does your unit recommend an individualized car seat evaluation for all premie and high risk infants?
Does your unit have an checklist for parental education on car seat safety?
Does your unit educate parents by use of videotapes, pamphlets, or referring them to websites?

For all of us who work in the Neonatal ICU, car seat safety is of paramount importance since we are discharging smaller and smaller premature and high risk infants. Some of these babies are going home with monitors and oxygen. These infants are susceptible to episodes of apnea, bradycardia and desaturation especially if they are not properly fitted and fastened in to their car seats.
The American Academy of Pediatrics has issued the following guidelines and recommendations regarding the transportation of infants at possible risk of respiratory problems:
1. Current information suggests that each preterm infant born at less than 37 weeks' gestation should have a period of observation in a car safety seat before hospital discharge to monitor for possible apnea, bradycardia, or oxygen desaturation. An appropriate hospital staff person should conduct the observation. Hospitals should develop policies to include this evaluation in their discharge planning process. An Academy endorsed video " Special Delivery: Safe Transportation of Premature and Small Infants, " contains additional information on this topic.
2. Families should minimize travel for infants at risk of respiratory compromise.
3. Infants with documented desaturation, apnea or bradycardia in a semiupright position should travel in a supine or prone position in an alternative safety device. The use of other upright equipment, including infant swings, infant seats, and infant carriers, should be avoided.
Alternative child restraint devices are available for infants who must travel in a prone, supine, or semiupright position. Specific information regarding currently available restraint systems can be obtained from the American Academy of Pediatrics brochure, "Family Shopping Guide to Car Seats."
If a semiupright position can be maintained safely by the infant, a conventional car safety seat that allows for proper positioning of the low birth weight infant should be selected. Better observation of the infant is possible when the child is in a rear- facing car safety seat adjacent to an adult rather than in a car bed.
4. Infants for whom home cardiac and apnea monitors are prescribed should use this monitoring equipment during travel and have portable, self-contained power available for twice the duration of the expected transport time.
5. Because commercially available securement systems for all portable medical equipment such as monitors and oxygen tanks are limited and not designed for use in motor vehicles, such equipment should be wedged on the floor or under the vehicle seat to prevent it from becoming a dangerous projectile in the event of a crash or sudden stop.
This information was retrieved from:
http://aappolicy.aappublications.org/cgi/reprint/pediatrics;97/5/758.pdf
Please review this article for the complete recommendations on this topic.
Also review the article titled "Car Seat Safety for High-Risk Infants" by Kimberly D. Howard-Salsman in the March/April 2006 issue of Neonatal Network. Visit Neonatal Network on the web:
http://www.neonatalnetwork.com