Work

Predischarge Car Seat Tolerance Screening in Preterm and At-Risk Full-Term Infants

Year: 2026

Type: article

Study designs: Systematic Review, Meta-Analysis

Abstract: Importance: Predischarge car seat tolerance screening (CSTS) has been recommended by the American Academy of Pediatrics since 1991 for preterm and at-risk full-term-born infants. However, it remains unclear whether routine CSTS prevents adverse outcomes after discharge. Objective: To estimate the frequency of failed CSTS and its association with adverse postdischarge outcomes. Data Sources: PubMed, Embase, and Web of Science were searched for English-language studies published before June 2025. Study Selection: Randomized trials, nonrandomized intervention studies (utilizing a comparison group discharged without CSTS), and single-group observational studies were eligible. Data Extraction and Synthesis: Data were extracted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline by 2 reviewers. Study quality was assessed using the Risk of Bias in Nonrandomized Studies tool. Main Outcomes and Measures: Outcomes were 30-day readmission, mortality, and predischarge length of stay for intervention studies, and first and subsequent CSTS failure rates for single-group studies. Random-effects models were used to pool data, and generalized linear mixed models were used to estimate pooled treatment effects from 2-group studies and CSTS failure event rates from all included studies. Results: A total of 21 studies were included. No randomized trials were identified. Three nonrandomized intervention studies (54 358 participants; 27 786 participants without CSTS) reported postdischarge outcomes. There was no difference in 30-day mortality (2 studies; not pooled due to 0 events), 30-day readmissions (odds ratio, 1.05; 95% CI, 0.86-1.28; 3 studies; 54 559 participants), or combined 30-day mortality or readmission (odds ratio, 1.17; 95% CI, 0.95-1.43; 2 studies; 49 420 participants) among infants receiving predischarge CSTS compared with those that did not. Pooled analysis estimated 8.62 (95% CI, 6.42-11.47) first-test failures per 100 patients (21 studies; 39 052 participants) and 24.40 (95% CI, 6.44-34.64) repeat-test failures per 100 patients (11 studies; 912 participants). Conclusions and Relevance: In this systematic review and meta-analysis of predischarge CSTS for preterm and at-risk full-term-born infants, CSTS was not associated with a reduction in postdischarge readmission or mortality. These findings call into question whether routine CSTS before discharge improves outcomes in preterm or at-risk full-term infants.

Source: JAMA Network Open

DOI: 10.1001/jamanetworkopen.2025.58197

Authors: Brian C. King, Nisha Dalvie, Susanne Hay, Erik A. Jensen, John A. F. Zupancic

Institutions: Beth Israel Deaconess Medical Center, Harvard University, Boston Children's Hospital, Lucile Packard Children's Hospital, Stanford University

Language: English

Topic: Infant Development and Preterm Care

Subfield: Pediatrics, Perinatology and Child Health

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,000