1. Infant Car Seat Challenge (ICSC)
Mary Stech, BSN, RN
Georgetown University Nurse Educator Student
Sibley Memorial Hospital

2. Learning Objectives
Describe the purpose of the Infant Car Seat Challenge (ICSC)
Identify the equipment needed for the ICSC
Explain the population of infants who qualify for the ICSC
Demonstrate understanding of the steps of the ICSC procedure
Demonstrate ability to correctly record the ICSC in the electronic medical record
Identify what constitutes a failed ICSC
Describe the proper course of action to take in the event an infant fails the ICSC

3. Why perform the ICSC?
All 50 states, including DC, require infants to be restrained in a car seat while riding in a car
Infants who are born premature, small, or with low tone are at risk of having poor respiratory effort while seated in a car seat
The car seat challenge allows us to determine if an infant seated in a car seat can maintain normal:
Respiratory Rate
Heart Rate
Oxygen saturations

4. What newborns require an ICSC?
Infants with a gestational age of 36 6/7 weeks or less *at birth*
Infants born weighing less than 2500 grams *at birth*
Any infant who who has an order for a car seat challenge from a physician

5. What equipment is needed for the ICSC?
Child safety car seat *manufactured within the past 5 years*
Pulse oximetry device
Reusable pulse oximetry cable
Single use neonatal pulse oximetry adhesive sensor
Blankets

6. The Car seat challenge procedure
1. Explain the ICSC to the infant’s parents
2. Position the car seat on a flat, firm surface
3. Apply the pulse oximetry sensor to the infant’s hand or foot
4. Place the infant securely in the car seat
5. Position the car seat retainer clip at the level of the infant’s chest
6. Position the seat at a 45 degree angle
7. Begin the ICSC by recording the date, time and the infant’s baseline vital signs (HR, RR, p.ox) in EPIC
8. Continue to monitor and record the infant’s HR, RR, and p.ox *every 15 minutes for a total of 90 minutes*

7. Important tips
The car seat used must be the car seat that the infant will be transported home with
The base of the car seat is not needed for the challenge
You may place a blanket on the floor with the car seat on top to avoid an injury from a fall
Blanket rolls may be used on the sides of the infant’s body to provide support (blankets must be used externally to the car seat straps)
Car seats with built-in levels must be placed so that the angle of the seat is in the “safe zone” as indicated on the level window

8. How do I know if the infant failed the ICSC?
The following vital signs count as a FAILED car seat challenge:
HR less than 30 beats below baseline for greater than or equal to 20 seconds
Apnea for greater than 20 seconds
Persistent labored breathing
Dusky colored skin accompanied by a SPO2 of less than or equal to 90% for 20 seconds or more

9. What do I do if an infant fails the ICSC?
*Notify the pediatrician or neonatologist*
The car seat challenge may be repeated within 3-4 hours or as ordered by the MD
An infant who continuously fails the challenge may need to be discharged home in a car bed as ordered by the MD

10. How do I document the ICSC in EPIC?
Remember, vital signs should be documented every 15 minutes for a total of 90 minutes
Infant’s pass or fail status should be documented
If an infant fails the challenge, notification of the pediatrician or neonatologist must be documented

11. References
Sibley Memorial Hospital Women’s and Infants’ Services. (2014). Infant car seat challenge procedure. Washington, DC.