Which Infants Fail the Predischarge Infant Car Seat Challenge?

The American Academy of Pediatrics recommends that all infants born before 37 weeks' gestation undergo an infant car seat challenge prior to discharge. Annually, about 500,000 infants undergo these labor-intensive and costly tests (requiring >90 minutes of observation). Researchers retrospectively reviewed car seat test results for 1036 premature infants to identify predictors of failure. Infants weighing <5 pounds in a standard car seat and <4 pounds in a premature car seat were excluded.

The overall failure rate was 4.3%. Although investigators hypothesized that more-premature infants and those with more-severe clinical illness would be most likely to fail, they found the opposite outcome: infants who failed had significantly higher gestat…