Developing a Car Seat Challenge Program: Part of the Near-Term Infant Initiative

Developing a Car Seat Challenge Program:

Part of the Near-Term Infant Initiative

In 2005, the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) identified an opportunity to improve care to infants born between the ages of 34 and 36 6/7 weeks gestation, termed the near-term infant (AWHONN, 2005).

The National Center for Health Statistics data shows that the near-term infant comprised 8.5% of all births in the US in 2002 (AWHONN, 2006). In the same year the mortality rate for this group was 9.2 per 100,00 live births. When compared to the 2.5 per 100,00 live births in full term infants, born that same year, it is easy to see the increased potential for risk in this group (AWHONN, 2006). In 2006, 8% of all births at CCHS were to the near-term infant. This group is at increased risk for complications (AWHONN, 2005).

Recognizing the need for a review of the care of the near-term infant at CCHS, a team has been formed for the development of an evidence based practice guideline. One of the needs identified by this group was a car seat testing program that included all near-term infants being discharged from Women’s & Children’s Services.

AWHONN has developed a framework for care that employs the concepts of neonatal physiologic functional status, nursing care practices, care environment, and the role of family to optimize outcomes for the near-term infant (Medoff-Cooper, Bakewell-Sachs, et. al., 2005). A determination that the near-term infant can travel safely the distance from hospital to home prior to discharge is becoming a standard of care. It was identified that steps needed to be taken to ensure this is being done for all near-term infants from all discharge locations in the Women’s & Children’s Services Department.

The current practice has provided for car seat challenge testing for infants discharged from the NICU but inconsistent testing was provided for the near-term infant being discharged from the mother-baby units. The availability of staff to perform this additional testing was lacking and the short stay of many of these infants made success in providing this testing difficult. A core group of mother-baby nursing staff was identified. Education was provided for them, regarding proper placement of an infant in the car seat, the testing procedure, including use of the monitoring devices, and documentation of the outcome of the testing. A policy was developed for the testing procedure, including how to manage a failure to pass the exam. All necessary equipment has been purchased and the mother-baby nurses began providing car seat testing for all near-term infants, being discharged from units outside the NICU, in July 2007.