In the driver's seat: a pilot study evaluating the theoretical and practical aspects of a major study examining premature infants in car seats

Abstract

Premature and low birth weight infants are frequently discharged from New Zealand neonatal units weighing less than the minimum weight recommendation on most car seats. International research has demonstrated that a combination of immature physiological responses, poor head control and the design of some standard car seats increased forward head flexion exacerbating the risk of airway obstruction. Up to 60% of premature infants have experienced apnoea, bradycardia and oxygen desaturation while in a car seat (Boyd, 2002; Smith & Turner, 1990; Willett, Leuschen, Nelson & Nelson, 1986, Willett, Leuschen, Nelson & Nelson, 1989). The American Academy of Pediatrics (1991) recommends that all premature infants, born at less than 37 weeks gestation and weighing less than 2.5 kilograms, be assessed for cardiorespiratory stability in their car seat prior to discharge. There is no New Zealand research to confirm that the neonatal discharge population exhibit cardiorespiratory instability in the car seat models available in this country. Pre-discharge car seat testing is not routinely factored into the discharge management of New Zealand neonatal infants. This thesis is a descriptive account of a novice researcher's exploration of car seat use in the premature and low birth weight population. The journey starts with the recognition of a clinical practice concern and culminates in the development and completion of a pilot study examining the theoretical, practical and design elements of a major New Zealand pre-discharge car seat research investigation. The pilot study construct was based on research literature definitions of the role and scope of pilot work in the development of quality research. Each step of the pilot study preparation and design is described in relation to research literature and the major study. The car seat pilot study examined the practicability of the research setting, the documentation processes, booking procedures, the validity and reliability of the polysomnography and sleep state assessment instruments, aspects of the preliminary data and the analysis method in the actual setting, using the instruments and subjects proposed for a major study. The informed consent process was assessed from two perspectives, quantitative and qualitative, to establish if the procedural steps of the informed consent process were completed and if the process prepared the families for the lived research experience. The preliminary pilot study results supported previous research findings. The four infants experienced multiple short apnoea during quiet and active sleep, in both the cot and car seat. The mean length of the central apnoeas was similar to other studies (Barrington, Finer & Li, 1996; Lee, Caces, Kwiatkowski, Cates & Rigatto, 1987). The infants spent more time in active sleep than quiet sleep irrespective of sleeping position in the cot or car seat (Hertz, Aggarwal, Rosenfeld & Greensher, 1994). The pilot study confirmed the validity and reliability of the research instruments and the analysis method proposed for the major study. Procedural, logistical, environmental and informed consent issues were identified. Simple cost effective changes were recommended and implemented before the major study commenced.