infant car seat challenge...car seat facts: car seats reduce risk of injury by 71 to 82% 28%...
TRANSCRIPT
INFANT CAR SEAT CHALLENGE
Barb Downs RNC-NIC & Andrea Davis RNC-NIC
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)
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.
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.
TIME FRAME FOR CAR SEAT CHALLENGE OBSERVATION TIME FRAME: 90 - 120 minute
minimum or length of travel time to infant’s home.
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
UTILIZE CORRECT POSITIONING
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)
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
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
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
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
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
CAR BED OPTION
Car Bed: Document all car seat challenge attempts & results.
Notify Physician of “failed” screening in infant car seat.
Infant may require additional observation in level II nursery to rule out medical issues.
If unable to tolerate upright position, on a rare occurrence, may need to utilize car bed.
Car seat challenge must be performed in car bed prior to discharge.
AAP(2009, reaffirmed 2013)
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..
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)
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)
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
THANK YOU!!!
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)*