Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Matern Child Health J. 2021 Nov;25(11):1707-1716. doi: 10.1007/s10995-021-03220-5. Epub 2021 Aug 17.
To assess whether adherence to institutional car seat tolerance screening (CSTS) guidelines differed for infants born preterm (PTM), term low birth weight (T-LBW), or both preterm and low birth weight (P-LBW), and to examine the association between CSTS adherence and patient characteristics.
Within two large academic and community hospitals, we retrospectively reviewed all infants meeting institutional criteria (< 37 weeks' gestation and/or < 2.27 kg) for CSTS from 2014 to 2018. Multivariable logistic regression evaluated the association of patient characteristics with institutional CSTS guideline adherence.
4374 eligible infants were born PTM (50.9%), T-LBW (6.5%), or P-LBW (42.6%). Adherence rates were 92.7% in the neonatal intensive care unit (NICU) and 95.2% in the well-baby nursery with initial CSTS failure rates of 6.1% and 9.9%, respectively. Adherence was lowest among T-LBW (80.7%) compared to PTM (95.1%) or P-LBW (92.2%) infants in the NICU (p < 0.001) and well-baby nursery (81.6%, 96.7% and 97.1%, respectively, p < 0.001). In bivariate analyses, gestational age, birth weight, insurance, race, hospital type, discharge year, and preferred language were associated with adherence. In fully-adjusted models, adherence was positively associated with lower gestational age, higher birth weight, non-Medicaid insurance, and later discharge year (NICU) and lower gestational age and later discharge year (well-baby nursery).
Adherence was lower for T-LBW than PTM or P-LBW infants, despite similar CSTS failure rates. Disparities in adherence among Medicaid-insured patients in the NICU warrant further study. Future studies are needed to clarify the benefit of CSTS and increase adherence in high-risk populations.
评估机构汽车座椅耐受筛查（CSTS）指南的遵循情况是否因早产儿（PTM）、足月低体重儿（T-LBW）或两者均为早产儿和低体重儿（P-LBW）而有所不同，并检查 CSTS 遵循情况与患者特征之间的关联。
在两家大型学术和社区医院中，我们回顾性审查了 2014 年至 2018 年期间符合机构 CSTS 标准的所有婴儿（<37 周妊娠和/或<2.27 公斤）。多变量逻辑回归评估了患者特征与机构 CSTS 指南遵循情况的关联。
4374 名符合条件的婴儿为 PTM（50.9%）、T-LBW（6.5%）或 P-LBW（42.6%）。在新生儿重症监护病房（NICU）和婴儿保健病房中，初始 CSTS 失败率分别为 6.1%和 9.9%，遵循率分别为 92.7%和 95.2%。在 NICU 中，T-LBW（80.7%）的依从率最低，低于 PTM（95.1%）或 P-LBW（92.2%）婴儿（p<0.001），在婴儿保健病房中，T-LBW（81.6%、96.7%和 97.1%）的依从率也较低，分别为 96.7%和 97.1%（均为 p<0.001）。在单变量分析中，胎龄、出生体重、保险、种族、医院类型、出院年份和首选语言与依从性相关。在完全调整的模型中，依从性与较低的胎龄、较高的出生体重、非医疗补助保险和较晚的出院年份（NICU）以及较低的胎龄和较晚的出院年份（婴儿保健病房）呈正相关。
尽管 CSTS 失败率相似，但 T-LBW 婴儿的依从性低于 PTM 或 P-LBW 婴儿。NICU 中 Medicaid 保险患者的依从性差异值得进一步研究。需要进一步研究阐明 CSTS 的益处并提高高危人群的依从性。
