Graduate School of Nursing Dissertations

Publication Date


Document Type

Dissertation, Doctoral


Graduate School of Nursing

Dissertation Committee Chair

Susan Sullivan-Bolyai


premature infants, car seats, oxygen desaturation

Subject Categories

Pediatric Nursing | Pediatrics


Research suggests that infants with poor neck and upper torso muscle tone experience lateral slouching and a compromised airway when placed in the semi-upright seating position. Studies reveal that 4-60% of premature infants (born at less than 3-7 weeks gestation) may experience oxygen desaturation events when in their child safety seats (CSS), potentially resulting in adverse neurodevelopmental outcomes. Therefore, the American Academy of Pediatrics recommends that premature infants be tested in their CSS prior to hospital discharge. However, neonatal healthcare providers are concerned that this method of testing might not be reliable. No formal studies have investigated the outcomes of repeat testing of premature infants, and little is known about the risk factors for oxygen desaturation events. Therefore, the purpose of this descriptive, non-experimental, observational study was to explore the stability of the one-point Infant Car Seat Challenge (ICSC) and risk factors that may be associated with oxygen desaturation events. A sample of 49 premature infants was used to explore the following variables: 1) pass/fail rates following two (ICSC) observation points, 2) oxygen saturation and desaturation patterns, sleep/wake activity, and a measure of head lag (using the pull-to-sit maneuver) during two ICSCs, and 3) the association between head lag, chronological age, time spent sleeping in the CSS and oxygen desaturation events. Data were analyzed by descriptive and nonparametric statistical tests. This study's findings indicated that 86% of premature infants had stable results, 8% passed rcsc 1 but not ICSC 2, and 6% failed ICSC l and passed ICSC 2. In addition the odds for oxygen desaturation events increased in infants that are born at a gestational age ≤ 34 weeks, were discharged home at a chronological age of > 7 days and had a corrected gestational age of ≤ 37 weeks. Neither head lag or sleep time influenced the ICSC outcomes. Furthermore the ICSC success rate for identifying at risk infants was equal to or better than that of other screening tests for newborn medical conditions. These findings will assist neonatal healthcare providers in making appropriate recommendations for safe travel.



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Creative Commons Attribution 4.0 License
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