Continued Challenges of the Car Seat Tolerance Screen

Since 1991, the American Academy of Pediatrics has recommended all infants born <37 weeks gestation have a period of monitored observation in their car seat before discharge – the “car seat tolerance screen (CSTS)”¹ . This is based on evidence that infants in the inclined, semiupright position can experience cardiorespiratory instability. Although widely implemented, the CSTS has been a controversial topic among physicians who provide newborn care.²  Historically this was due, in part, to a variation in screening parameters, including what constitutes a “pass” or a “fail,” questions regarding the clinical significance of the cardiorespiratory instability, and lack of clear guidance about how to respond to CSTS failures.³  Indeed, citing lack of sufficient evidence to support the practice, the Canadian Pediatric Society discontinued their recommendation for routine CSTS for preterm infants in 2016.⁴  The literature seeking to address concerns around the practice of screening is unfortunately...