A comparison of the infant car seat challenge and the polysomnogram at the time of hospital discharge

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The American Academy of Pediatrics recommends all infants born at <37 weeks gestation spend a period of observation in a car seat prior to hospital discharge to assess for apnoea, bradycardia or oxygen desaturation. The most recent Cochrane review suggested further studies to determine if the infant car seat challenge (ICSC) accurately predicts the risk of clinically adverse events. We reviewed our experience with the ICSC and the polysomnogram (PSG) to determine if the ICSC accurately predicts the risk of adverse events when compared with the PSG.

Study design

Retrospective chart review of all infants in our institution who had an ICSC and a PSG between January 2005 and December 2008.


785 infants had ICSCs. In addition, 313 infants (56.6%) had an abnormal PSG, even though the vast majority, 158 (88.3%), passed their ICSC. There were no significant differences in gestational age at birth, birth weight, chronological age at study or postmenstrual age at study between infants who either passed or failed the ICSC with those who passed or failed the PSG. The sensitivity of the ICSC was 0.11 and specificity was 0.96. The positive predictive value of the ICSC was 0.77 and the negative predictive value was 0.45.


The ICSC has a low negative predictive value (0.45) when compared with the PSG as a reference standard for identifying adverse cardiorespiratory events. Although less time consuming and cumbersome than extended polysomnography, the ICSC is not a reliable substitute.

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