Car seat tests for newborn babies

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[Text on screen: Jenna Holcomb, RN
Postpartum Nurse
Ohio State Wexner Medical Center]

Jenna Holcomb, RN: The car seat test is something that we perform on infants that are at increased risk for having airway or breathing problems. We would perform this test in the nursery, but we use your home car seat that you bring with you that you're going to take the baby home in, and we hook the baby up to a cardiac monitor, a pulse ox, and we watch their respirations, their oxygen level, and their heart rate for either 90 minutes or up to two hours if you have a longer drive than 90 minutes home.

[Text on screen: Babies who need car seat tests.
- Late-preterm (35 weeks to 36 weeks and 6 days)
- Born at less than 2500 grams, or 5.5 pounds
- Experiencing low oxygen saturation or other breathing problems]

Infants that are born late preterm, which is anywhere from 35 weeks to 36 weeks and six days, infants that are born small for gestational size, which would be less than 2,500 grams is our policy, or any infant that shows us that maybe they're having oxygenation problems or have had any low saturations throughout their stay, we might do a car seat test on them.

[Text on screen: Car seat tests measure:
- heart rate
- respirations
- oxygenation]

A car seat test measures a baby's heart rate, their respirations and their oxygenation while they're in that semi-inclined position of the car seat. So if your baby has an indication for a car seat test, when it's convenient, when the baby has fed and after they've turned 24 hours old, we'll take the infant for anywhere from 90 minutes up to 120 minutes if you have a longer than 90 minute drive home. We're going to take the infant to the nursery where we can monitor them for that entire time. We're going to put a cardiac monitor on them. We're going to put a pulse ox on them, and we're going to have them attached to a monitor up in the nursery where we can visualize them the entire time. We're going to watch them for any desaturations, any low heart rate, or any times that maybe they stop breathing for a period of time.

Those are concerns that we want to address and make sure we watch out for. So we're going to watch them for that whole time. If they have any of those problems or concerns while they're in the car seat, we'll remove them from the car seat, we'll monitor their vitals, make sure that they're stable, and then we can possibly repeat the test within 12 or 24 hours. If an infant doesn't pass their car seat test, that would look like them having a lower than normal heart rate, a oxygenation that drops below 90% for a sustained amount of time or if their respiration's dropped too low.

The infant is allowed up to three times being tested for their car seat test. If they don't pass the first time, we allow them 12 or 24 hours. If at the third time the infant is still not passing the car seat test, that would constitute a transfer of care to the NICU for further workup to make sure that there's nothing happening with their airway or breathing to make sure that we're not missing anything.

When coming to the hospital to deliver your baby, we want you to have your car seat already installed in the car. What that means is that we still want you to bring the car seat into the room, but the base can stay installed in the car. So after the baby is born, we'd like you to bring the car seat with any of the inserts that come with the car seat that's purchased that way. It can come into the room in case we are indicated to do a car seat test for your infant. So if your infant does indicate that they need a car seat test, even if they have passed this test, we do still recommend that a parent or support person watches them whenever they're in a semi-inclined position. So that could be a swing, a car seat, a bouncer, or anything like that.

If an infant has been indicated to have a car seat test, it is recommended that the parent or support person sits in the back of the car with them during their ride to just to monitor for any color change or breathing problems even if they have passed the car seat test. An infant shouldn't be in a semi-inclined position for more than two hours. So if your drive is long, we do recommend that you stop and take a break.

[Text on screen: The Ohio State University Wexner Medical Center
For more information, visit wexnermedical.osu.edu/maternity-center]

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