Citation

Elder DE, Russell L, Sheppard D, Purdie GL, Campbell AJ. Arch. Dis. Child. Fetal Neonatal Ed. 2007; 92(6): F468-72.

Affiliation

Department of Paediatrics, WSMHS, PO Box 7343, Wellington, New Zealand. dawn.elder@otago.ac.nz

Copyright

(Copyright © 2007, BMJ Publishing Group)

DOI

10.1136/adc.2006.109488

PMID

17412748

PMCID

PMC2675396

Abstract

OBJECTIVES: To monitor preterm infants in a cot and a car seat and compare an observed car seat trial with polysomnography (PSG). DESIGN: Non-randomised controlled trial. SETTING: Regional neonatal unit. PATIENTS: Preterm infants before discharge. INTERVENTIONS: Nap PSG respiratory and sleep variables were measured including gastro-oesophageal pH. Nurse observations included respiratory distress, apnoea measured by apnoea alarm, oxygen saturation and heart rate. Infants were studied supine in a cot and then in a car seat. Nursing observations were compared with PSG during the car seat trial only. Criteria for failure of the PSG and observed tests were predefined. MAIN OUTCOME MEASURES: Difference in respiratory instability between cot and car seat. Concurrence regarding failure of the car seat trial between nurse-observed data and PSG. RESULTS: 20 infants (median gestation 33 weeks (range 28-35 weeks; median postmenstrual age (PMA) at study 36.5 weeks (range 35-38 weeks)) were studied. There were sufficient car seat data on 18 infants for comparison. There were fewer central apnoeas and arousals in the cot than the car seat (p = 0.047 and p = 0.024, respectively). Airway obstruction was not more common in the car seat. Younger PMA at time of study predicted failure in both car seat (p = 0.022) and cot (p = 0.022). The nurse-observed test had low sensitivity for predicting PSG failure but more accurately predicted airway obstruction on PSG. CONCLUSIONS: Immature infants exhibit respiratory instability in cots and car seats. A car seat test does not accurately detect all adverse events during sleep in the seat.

Language: en