Most NICUs have adopted some form of car seat challenge prior to discharge of very low birth-weight (VLBW) infants. Protocols for car seat challenges are not standardized, and criteria for passing or failing the test vary widely among institutions.1 The options for an infant who has "failed" the car seat challenge seem to be (1) retest until the infant passes, (2) wait a few days and retest, or (3) discharge in a car bed instead of a car seat.1 The third option, use of a car bed, is based on the assumption that infants who have cardiorespiratory compromise (apnea, bradycardia, oxygen desaturation) in a car seat will not experience these events in a car bed.1
A study in the Journal of Pediatrics compares the incidence of apnea, bradycardia, or desaturation in preterm, VLBW infants (<= 1500 g) in car seats with that in car beds during a car seat challenge.2 One hundred fifty-one infants were studied for 2 hours in both a car seat and a car bed, while apnea (>20 seconds), bradycardia (<80/min for >5 seconds), desaturation (SpO2 < 88% for >10 seconds), and nasal air flow were monitored. Investigators found no evidence that an event is less likely to occur in a car bed than a car seat: 23 infants (15%) had >=1 event in the car seat, compared with 29 (19%) in the car bed (P = .4) The length of time until the first event occurred was similar in the car seat and car bed (mean 54 to 55 minutes).2
It is important to advise parents that, regardless of car safety device used, VLBW infants require close observation during travel.2 Furthermore, long trips should be discouraged; if unavoidable, they should be interrupted with frequent rest stops.1
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