163 - Car Seat Screening in Infants with Cyanotic Congenital Heart Disease

Poster Number: 163
Publication Number: 163.233

Emily Sangillo, University of Maryland Children's Hospital, Baltimore, MD, United States; Natalie L. Davis, University of Maryland School of Medicine, BALTIMORE, MD, United States

Background: Certain patient populations are at increased risk for cardiorespiratory instability when placed in the semi-upright car seat position, including premature and low birth weight infants, which led to the AAP recommendation for pre-discharge car seat tolerance screening (CSTS) in all infants born < 37 weeks gestation. In their most recent clinical report, the AAP acknowledged varied hospital practices for inclusion of other “at risk” infants, including those with congenital heart disease (CHD), though formal recommendations for testing these at-risk populations do not exist. Additional epidemiologic data on CSTS outcomes for CHD patients will help guide evidence-based recommendations.

Objective: To identify incidence and risk factors for CSTS failure in the cyanotic CHD population.

Design/Methods: We performed a retrospective medical record review of neonates with cyanotic CHD admitted to the University of Maryland neonatal intensive care unit (NICU), pediatric intensive care unit (PICU), or newborn nursery (NBN) between 2016-2020. Infants were excluded if they died prior to CSTS, were discharged in a car bed due to medical necessity, were discharged or transferred on positive pressure ventilation (PPV), or if parents declined CSTS. Bivariate analysis was used to identify predictors of CSTS failure using SAS 9.4.

Results: Fifty-three infants with cyanotic CHD met inclusion criteria, and of those, 5 (9.4%) failed initial CSTS with reasons for failure including: desaturation (Nf2), bradycardia (Nf1), both (Nf1), or other (Nf1). All infants passed a repeat CSTS. Subjects who failed CSTS had smaller birth head circumference, and were more likely exposed to stadol perinatally and caffeine postnatally. [Table 1] Other statistically significant factors associated with CSTS failure include aortic stenosis, seizures, hypotonia, and periventricular leukomalacia (PVL). The incidence of CSTS failure by cyanotic lesion [Table 2] was highest among infants with diagnoses of aortic stenosis (50%), total anomalous pulmonary venous return (TAPVR) (33%), pulmonary valve stenosis (25%), and hypoplastic left heart syndrome (HLHS) (17%).Conclusion(s): This is the largest study to date focusing on CSTS exclusively in cyanotic CHD and we identified a 9.4% CSTS failure rate. The incidence of CSTS failure was highest among infants with diagnoses of aortic stenosis, TAPVR, pulmonary valve stenosis, and HLHS. Those with neurologic abnormalities including seizures, hypotonia, and PVL were also more likely to fail a CSTS. More studies are needed, but these data can help guide recommendations for CSTS testing in this population.
Emily Sangillo CVES CV UMSOM.pdf
Table 2. CSTS Failure by Cyanotic Heart Lesion(a) One subject with failed CSTS had both aortic stenosis and HLHS.
(b) One subject with failed CSTS had DORV, TGA, and pulmonary valve stenosis.
Abbreviations: AVSD, Atrioventricular Septal Defect; TOF PA, Tetralogy of Fallot with pulmonary atresia; TOF PS, Tetralogy of Fallot with pulmonary stenosis; TGA, Transposition of the great arteries; TAPVR, Total anomalous pulmonary venous return; HLHS, Hypoplastic Left Heart Syndrome; DORV, Double outlet right ventricle