Premature Infants in Car Seats

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Premature

Infants

in Car Seats

Marilyn

J. Bull, MD,

and Karen

Bruner

Stroup,

MA

From the Automotive Safety for Children Program, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis

ABSTRACT.

Advancements in health care have made it possible for many premature infants weighing less than 2.2 kg (5 lb) to be discharged from the hospital. Medical

professionals, however, have no information available from which to make recommendations on which child safety seats are most appropriate for safely transporting

the low-birth-weight infant. Current federal safety

stand-ards do not specify the minimum weight of an infant for which a seat is appropriate. The suitability of various types of infant car safety seats for premature infants was documented by placing 2.0-kg (4 lb 8 oz) babies in a

representative sample of seat models. Ease and ability of

the seat to fit the size of the infant and allow for proper positioning of the baby was noted. Each seat was mea-sured from the seat back to crotch strap and shoulder strap to seat bottom to provide a basis for comparison of

various seat models. Convertible seats with seat back to crotch strap height of 14 cm (5#{189}in) or less provided relatively good support for the infant. Seats with longer seat back to crotch strap distances allowed the infant to slouch. Seats with lap pads or shields were uniformly

unacceptable. Pediatrics 1985;75:336-339; premature in-fants, child safety seats.

The dramatic improvement in survival rates and tendency toward early discharge of premature in-fants has resulted in an increasing frequency of infants weighing less than 2.2 kg (5 lb) being dis-charged from the hospital. The problem of safe transportation for these infants is of concern to parents and health professionals responsible for their care. Many models and styles of infant safety seats have been developed which meet specific fed-era! safety standards and, when used properly, these seats have been shown to reduce the frequency of death and serious injury from automobile accidents

Received for publication May 29, 1984; accepted Aug 2, 1984.

Reprint requests to (M.J.B.) Automotive Safety for Children

Program, James Whitcomb Riley Hospital for Children, Room P-121, Indiana University School of Medicine, 702 Barnhill Drive, Indianapolis, IN 46223.

by 70% to 9#{216}%#{149}12The federal standards, however,

do not specify minimum size or weight of the infant for which a seat is appropriate’; thus relevant ques-tions have been raised about the safe.transportation of infants weighing less than 2.2 kg (5 lb). The

purpose

of this study was to evaluate the appropri-ateness of various models of infant safety seats for babies weighing less than 2.2 kg (5 ib). The sugges-tions provided in this article are necessary for sat-isfactory positioning of preterm infants in car safety seats; these suggestions are also applicable for positioning full-term infants.

METHODS

AND

RESULTS

Documentation of the suitability of various types of infant car safety seats for premature infants was undertaken by placing approximately 2.0-kg (4 lb 8

oz) babies

in a representative

sample

of seat models.

The ease and ability of the seat to securely and comfortably position the small infant were noted. Each seat was measured from the seat back to crotch strap and from the shoulder strap to seat bottom to provide a basis for comparison for various seat models (Table).

Several seats were found to be appropriate for the very small infant with minimal modification. The Questor Dyn-o-mite and Cosco-Peterson First Ride seats were infant-only seats which could be used with only blanket rolls added on each side of the infant to support the head and trunk (Fig 1). The Century Infant Love Seat, however, also re-quired the addition of a large blanket roll in the crotch to prevent slouching of the very small infant (Fig 2). Care should be taken to ensure close

ap-proximation

of shoulder

straps

with

the addition

of

a retainer strap if necessary (Fig 2).

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Fig 1. Infant weighing 2.1 kg (4 lb 11 oz) in infant-only

seat which requires addition only of blanket rolls to

support head and trunk.

TABLE.

Guide for Selecting Safety Seats for the Premature Infant

ARTICLES

337

Seat Type Measurements

Seat Bottom to Seat Back to Lowest Shoulder Crotch Strap

Strap (cm) (cm)

Infant only seats

Century Infant Love Seat 15.2 (6 in) 27.9 (11 in)

Cosco-Peterson First Ride 22.9 (9 in) 10.2 (4 in)

Questor Dyn-o-mite 24.1 (9#{189}in) 11.1 (4#{189}in)

Convertible seats with internal harness

Questor Bobby Mac Champion 20.3 (8 in) 16.5 (6#{189}in)

Century 100 or 300 24.1 (9#{189}in) 11.1 (4#{189}in)

Cosco-Peterson Safe-T-Seat 21.6 (8#{189}in) 17.8 (7 in)

Pride Trimble Pride Ride 27.9 (11 in) 15.9 (6/4 in)

Strolee Wee Care 27.9 (11 in) 13.3 (5’/4 in)

Teddy Tot Astroseat 25.4 (10 in) 14 (5#{189}in)

Convertible seats with lap pad or shield

Century 200 24.1 (9#{189}in) 11.1 (4#{189}in)

Kantwet One Step 26.7 (10#{189}in) 11.1 (4#{189}in)

Kolcraft Redi-Rider 26.7 (10#{189}in) 15.9 (6/4 in)

Seats with longer seat back to crotch strap dis-tances such as the Cosco-Peterson Safe-T-Seat, Pride Trimble Pride Ride, and Questor Bobby Mac

Champion

tended

to allow

the infant

to slouch

and

resulted in suboptimal positioning. Addition of a small rolled diaper between the crotch strap and

the infant prevented the slouching and maintained the infant in a more satisfactory position (Fig 3).

The function of shoulder straps on a rear-facing seat is to retain the infant in the seat on rebound or in a rear-end crash. The shoulder straps on seats with the greatest seat bottom to shoulder strap distance (25 cm) see the Table) may cross the infant’s ears and fit loosely. The addition of a retainer strap will maintain the shoulder straps in close approximation and may minimize the risk of ejection of the infant from the seat on impact.

Seats with lap pads or shields (Fig 4) were uni-formly unacceptable as, in most instances, the pad or shield device directly contacted the neck or face of the infant.

DISCUSSION

Test dummies weighing less than

7.7 kg

(17 ib) are not currently available for testing in dynamic crash situations the safety margins of seats for the low-birth-weight infant. Available information, however, does document that the infant held in the mother’s arms is at greatest risk of serious injury and that the youngest infants are the most vulner-able.4 Thus, health professionals should encourage parents of all newborns and even very low-weight infants to use car safety seats beginning with hos-pital discharge and should provide parents with suggestions for any necessary modification of the seat.

The head and trunk support of both preterm and full-term infants is improved by the addition of a blanket roll on both sides of the infant inside the seat.5 All safety seats in the infant position should be rear-facing when placed in the automobile in either the front or rear seat. The infant should ride facing the rear of the car as long as possible since

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Fig

2. Premature baby in infant-only seat which allows slouch (left) and with blanket roll in crotch to prevent slouch (right).

::.

Fig 3. Premature infant slouched in convertible seat (left) and with diaper roll added to prevent slouch (right).

on front impact the entire head, neck, and back of the infant are pressed into the impact-absorbing shell of the seat. Parents can be encouraged to sit beside the infant to allow optimal observation of respirations and color. This suggestion is particu-larly helpful to parents of the very low-birth-weight infant because these parents perceive the infant as vulnerable to apnea, choking, and other complica-tions of prematurity and they might otherwise elect to hold the infant in their arms.

The use of a seat already available to the family is preferred whenever possible. The minor

modifi-cations described above may be helpful to ensure

that

the seat

will better

meet

the needs

of the very

low-birth-weight

infant.

The

special

care

nursery,

however,

may

find it beneficial

to have

a few seats

available

for short-term

loan to families

who cannot

acquire

a suitable

and safe model.

It should

be noted

that models with a lap pad or shield are not

adapt-able

to the

infant

who

weighs

less than

2.2 kg (5

lb).

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,/ /

,,_‘

/ I 4

Fig 4. Premature infant in convertible seat with lap pad hitting face.

ARTICLES

339 seats for low-weight infants. Until such testing has

been

performed

and

actual

world

crash

experience

has been reported, however, the restraint capabili-ties of currently available seats cannot be estab-lished. Although the very small infant may not fit perfectly into a car safety seat, it is imperative for health care professionals to emphasize that it is always safer for the baby to travel correctly re-strained in an approved safety seat than in an infant carrier or a parent’s arms.

ACKNOWLEDGMENT

This project was funded by section 402 of the National Highway Traffic Safety Administration State and Com-munity Highway Safety Program.

REFERENCES

1. Scherz RG: Restraint systems for the prevention of injury to children in automobile accidents. Am J Pub Hea!th

1976;66:451-456

2. Nichols JL: Effectiveness and Efficiency of Safety Belt and Child Restraint Usage Programs: The Safety Potential of Safety Belts, Child Restraints, and Programs to Promote

Their Use. US Dept of Transportation, National Highway

Traffic Safety Administration, 1982, p 15

3. Child Restraint Systems. Federal Register 1979;44:72147-72159, 1980;45:29045-29048, 67095-67096, 82264-82265

4. Baker SP: Motor vehicle occupant deaths in young children.

Pediatrics 1979;64:860-861

5. Don’t Risk Your Child’s Life, ed 14. Irvington, NJ, Physi-cians for Automotive Safety, 1980

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1985;75;336

Pediatrics

Marilyn J. Bull and Karen Bruner Stroup

Premature Infants in Car Seats

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