All preterm infants should be screened for cardiorespiratory stability before being allowed to be driven home from the hospital in a car seat. But late-preterm infants, born at 34 to 36 weeks' gestation, haven't been routinely screened for car seat tolerance because they're considered to be at a lower risk for respiratory problems than babies born before 34 weeks' gestation. However, recent research indicates that car seats may also place late-preterm babies at risk.

In the largest study to date, 4.6% of 918 late-preterm infants failed car seat tolerance screens (CSTSs)-performed after placing the infant in the semireclined position of a standard car seat. While in the car seat, they experienced potentially dangerous conditions such as apnea, bradycardia, and desaturation. Babies who spent time in both the nursery and the neonatal intensive care unit (NICU) had the highest risk (8.5%) of car seat breathing problems.

The goal of CSTSs is to ensure that preterm infants have stable cardiorespiratory status while riding in a car seat. Late-preterm births have increased recently in the United States; this combined with the research results underscores the need for CSTSs in this group.

The American Academy of Pediatrics recommends that all babies born prematurely undergo a CSTS. Yet 17% of Level II and Level III NICUs did not include late-preterm infants in the screening protocol, the researchers found. Nurses generally perform CSTSs at the time of discharge.

"Nurses should ensure that a CSTS policy is in place at their institution or create or strengthen their hospital's child passenger safety program," Natalie L. Davis, MD, assistant professor of pediatrics at the University of Maryland School of Medicine and a study coauthor, told AJN. "Hospitals need to adequately prepare nurses for performing safety tests by providing proper teaching modules and educational curricula. Some staff should also be trained as child passenger safety technicians to help troubleshoot car seat issues as they arise."-Carol Potera