Safely transporting a preterm or low birth weight infant

Apr 27 2009

New guidelines from the American Academy of Pediatrics should eliminate one of the many stresses of bringing a preterm or low birth weight infant home from the hospital.

The new AAP clinical report, "Safe Transportation of Preterm and Low Birth Weight Infants at Hospital Discharge," co-authored by Marilyn J. Bull, M.D., and William A. Engle, M.D., of Indiana University School of Medicine and Riley Hospital for Children, provides guidelines for secure transport and also advises parents that car safety seats should only be used for travel.

Developed jointly by the AAP Committee on Injury, Violence and Poison Prevention and the AAP Committee on Fetus and Newborn, the report offers guidance about car safety seats to pediatricians and other caregivers who counsel parents of preterm and low birth weight infants at hospital discharge. It appears in the May issue of the journal Pediatrics.

"These guidelines are an update of a policy first published in 1999 and report updates in research and new resources available for ensuring the safest transportation possible for our most vulnerable babies. Selection of the best seat for the infant, guidelines for positioning the baby and the assessment of the baby in the seat prior to discharge are emphasized," said Dr. Bull.

The weight, length, neurologic maturation and associated medical conditions of the newborn determine whether to bring the baby home in a car safety seat or a car bed. The AAP report recommends that preterm and low birth weight infants at risk for adverse cardio-respiratory events or episodes of stopped breathing be placed in a car safety seat and observed by a trained hospital staff for as long as the trip home or up to two hours, whichever is greater, before hospital discharge.

While rear-facing car safety seats are the transport method of choice for infants who can maintain cardio-respiratory stability when seated, car beds are appropriate for some infants with breathing difficulties, slow heart beats or blood levels low in oxygen when seated in a semi-reclining position, according to the AAP report.

"It is important to place car seats or car beds in the rear seat of the car to avoid the potential injury associated with air bags in small individuals. An adult sitting in the rear seat of the vehicle next to the child also provides an additional measure of safety," said Dr. Engle.

According to the guidelines, rolled blankets can be placed on both sides of a newborn to provide support of the head or body when riding in the car safety seat. A small rolled diaper or blanket may be added if necessary between the crotch strap and the baby to prevent the child from slipping down in the seat.

These new guidelines are important for infants that are small or born preterm but also can enhance the safety of transportation of all infants as they grow and mature, noted Dr. Bull and Dr. Engle.

Correctly used car safety seats are 71 percent effective in preventing fatalities to infants in a passenger car crash according to the National Highway Traffic Administration.

Dr. Bull, a developmental pediatrician, is the Morris Green Professor of Pediatrics. Dr. Engle, a neonatologist, is the Eric T. Ragan Professor of Pediatrics and medical director of the neonatal intensive care unit at Riley Hospital. The clinical report is co-authored by the AAP's Committee on Injury, Violence, and Poison Prevention and its Committee on Fetus and Newborn.