Proper selection and use of car safety seats or car beds are important for ensuring that preterm and low birth-weight infants are transported as safely as possible. Relative hypotonia and risk for airway obstruction can lead to cardiorespiratory events (and potential adverse neurodevelopmental outcomes) when these infants are secured in the semireclining position of a car safety seat.

The American Academy of Pediatrics' Committees on Injury, Violence, and Poison Prevention and Fetus and Newborn recently issued a clinical report on "Safe Transportation of Preterm and Low Birth Weight Infants at Hospital Discharge."1 The report suggests that preterm infants should have a period of observation of 90 to 120 minutes (or longer, if the time for travel to home will exceed this duration) in a car safety seat before hospital discharge. Educating parents about the proper positioning of preterm and low birth-weight infants in car safety seats is important for minimizing the risk of respiratory compromise. The time the infant is seated in a car safety seat should be minimized, and parents should be advised that car safety seats should be used only for travel. Infants at risk for respiratory compromise in car safety seats may also be at risk with use of other upright equipment, including infant swings, infant seats, backpacks, slings, and infant carriers. Consideration should be given to limiting the use of these devices until the child's respiratory status in a semireclined position is stable.

The authors also noted that equipment (apnea monitors, oxygen tanks, portable ventilators, and suction machines) used to monitor or treat infants after discharge could cause injury if these heavy items were to hit the child or another vehicle occupant in the event of a sudden stop or crash. Although there are no commercially available securement systems for portable medical equipment, it is recommended that these objects be restrained or wedged on the floor or under the car's seat.

The report also discusses the use of car beds (including transitioning an infant from a car bed to a standard upright car seat), proper positioning of preterm and low birth-weight infants (including use of supplemental head supports), and ways to deal with a sloping car seat that causes the infant's head to drop forward.

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