The car seat challenge - What makes sense

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The standard of care prior to discharge of a preterm infant is a test of cardiorespiratory stability in the car seat to be used for transporting the infant home. Some infants do have cardiorespiratory events when placed in car seats. The car bed, which allows the infant to be flat, is viewed as a good alternative for discharge. Salhab et al performed a high quality randomized-control trial comparing predischarge respiratory events for preterm infants placed in car seats or car beds. They found no differences in events. In an editorial, Greenberg points out that there is no evidence of the validity of the “car seat challenge,” even though the evaluation is endorsed by the American Academy of Pediatrics. Perhaps it is time to evaluate the utility of car seat assessments prior to discharge of preterms. It may be more effective to simply recommend limited automobile travel for preterms in car seats, along with continual observation during travel to protect the infant from cardiorespiratory events.