Car seat insert reduces hypoxia in term infants

A simple car seat insert that maintains a baby’s head in a neutral position without its chin touching its chest reduces the severity of hypoxic events while the infant is in the car seat, but does not reduce the overall number of hypoxic events, a new study finds.

Researchers from New Zealand conducted a randomized, controlled trial involving 78 healthy, full-term infants. Using continuous polysomnographic recordings and sleep video at a mean age of 8 days, they evaluated approximately half the infants using the insert and the other half without.

The insert, which is commercially available, consisted of a simple piece of foam plastic placed behind the infant’s back with a slot that allows the infant’s head to rest behind the spinal line in a neutral plane. The design prevents flexion of the head on the body, which can lead to significant narrowing of the upper airway.

The investigators noted that brief and mild-to-moderate (≤95%) desaturation events were common, particularly during active sleep, and that use of the insert had no effect on these. They did find, however, that the insert significantly reduced the number of obstructive apneic events, the severity of desaturation events, and the length of time the infants spent with oxygen saturation below 85%.

The researchers concluded that because car seat use, even with an insert, is associated with an increase in desaturation events, caregivers should not use car seats to sleep infants outside of the car. They also should not keep infants in car seats for any longer than absolutely necessary and should always attend to them while they are in the devices.

For more information on car seat sleeping, see the American Academy of Pediatrics’ latest technical report on sudden infant death syndrome. 

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