Examining how many nurseries do car seat tolerance screenings

July 9, 2020

Newborn nurseries are supposed to run a car seat tolerance screening before discharging any infant born prematurely. An investigation examines how well nurseries follow this recommendation.

Running a car seat tolerance screening is recommended for every infant born prematurely, but data on the implementation of the screening is limited. An investigation published in Pediatrics looks at implementation and any variations.1

Investigators used the Better Outcomes through Research for Newborns network to reach out to newborn nurseries in 35 states. The staff at the nurseries were asked whether they performed car seat tolerance screenings, inclusion and failure criteria, provider attitudes toward car seat tolerance screenings, performance characteristics, and the follow-up of failed car seat tolerance screenings.

A total of 84 newborn nurseries responded. Roughly 90% of the nurseries did predischarge car seat tolerance screenings. Most common failure criteria included apnea >20 seconds, bradycardia <80 beats per minute, saturation 90%. Over 55% of the nurseries said that hypotonia was an additional inclusion criterion for testing and >34% said they tested any infant who had ever needed supplemental oxygen. Following an initial failed car seat tolerance screening, >93% of the nurseries would retest the car seat at some time in the future and only ~1% would automatically discharge an infant in a car bed. Survey respondents recommended that infants with hypotonia (83%), airway malformations (78%), hemodynamically significant congenital heart disease (63%), and prematurity (61%) as indications for receiving the screening when they were asked who should be given predischarge car seat tolerance screenings.

The researchers said that due to the large variability in implementing predischarge car seat tolerance screenings further guidelines for screening practices could improve the practice.


1. Davis NL, Hoffman BD, Eichenwald EC. Variation in car seat tolerance screen performance in newborn nurseries. Pediatrics. 2020:146(1):e20193593. doi:10.1542/peds.2019-3593