The American Academy of Pediatrics (AAP) has released the updated clinical report, “Safe Transportation of Preterm and Low Birth Weight Infants at Hospital Discharge.” The report is the result of a lengthy and thorough analysis and review process headed by Marilyn J. Bull, MD, and William A. Engle, MD. The new clinical report replaces the policy statement on this subject that had been in effect since 1996. The AAP added the clinical report classification sometime after the prior policy statement was issued. With this update, it was determined that the document better suited the definition of a clinical report (“guidance for the clinician in rendering pediatric care”), so it was reclassified.
Main Points in the Updated AAP Publication
Chief among the subjects covered in this publication is the need for a “period of observation” in a CR before a preemie or low birth weight infant is discharged from the hospital. It is noteworthy that the AAP does not give a name to this process, thereby opting to not give a nod to any of the various terms used in practice, such as Angle Tolerance Test or Car Seat Challenge.
It does make some new recommendations regarding the period of observation. The duration of the observation period is specified as 90-120 minutes or the length of travel home, whichever is longer. Specific parameters for test failure are not given, leaving that decision to each hospital. Interventions are, however, suggested in cases where the infant fails the parameters set by the hospital. These include use of a car bed, supplemental oxygen, continued hospitalization, and further medical assessment. It states that infants leaving the hospital in a car bed should be observed in that type of device, and another test should be given when transitioning from the car bed to a traditional rear-facing CR.
The report identifies the hospital tester as someone trained both in proper CR use and testing procedures, and it also states that medical staff should train parents regarding CR use for the infant. The previous policy was more vague in describing the tester as an “appropriate” staff member.
The report also lays out a strong case for taking the recommended precautions when transporting a preemie or low birth weight infant, outlining the possible cardio-respiratory events that can occur in transport and why it is important to both the long- and short-term health of the infant to avoid these events. It also lists seven “Research Implications” as suggestions for areas where improvements in care options can be made.