Preemie carseat test HELP!!!!

So I had twin girls the 10th of August and they sent my first born homw with the angel bed carseat since she was only 4 lbs. Well I had to go yesterday to have her tested for a regular carseat seeing as how now shes 7lbs 10oz she failed the regular one and they tested her in the car one for whatever reason and she passed but shes too big for it. She barely failed the regular one it was at the very end of the 90 minute test and they didnt have it reclined at a 45 degree angle or anything which i didnt even think about till now. My issue is I know shes fine and ready for the regular carseat and she is too big for the bed one anyways so they were talking about admitting her to a hospital 3 hours away if she fails again tomorrow and thats not ok with me when i know shes perfectly fine. She never had any issues after she was born she was perfectly healthy. I dont agree with this test in the first place since she doesnt fit in the other one and she perfectly healthy so im wondering if legally i have to do this test... If i thought there was any problem with her breathing I would have no issue but the fact there is nothing wrong with her and they know it I just dont want her admitted and getting poked and proded for no reason!! Any help would be great I cant seem to find any information on this legally wise..

1) As a parent, I'm pretty sure you have the right to refuse "treatment" for your child. What I don't know is how big a stink the medical staff will put up? [If they feel strongly, I suppose they could get social services involved .]

I can't imagine your insurance company paying for a child to be admitted w/o a medical reason.

2) Ask for the testing procedures for this facility (I know there are variations).

3) Who exactly is doing the test and why? Why are they insisting on doing a car seat test for an infant (even a preemie) w/o respiratory or other health concerns?

Best of Luck! I hope all goes well on the 2nd test.

What car seat are you testing her in? Does she fit properly?

Car seat tests are to determine if a child can breathe when at a 45 degree angle (standard angle desired for rear facing a newborn) for a set amount of time. They are not done to determine if the child fits or not. She will have a better chance passing the test if she is in a well fitted seat.

Are the harness straps "at or below" her shoulders? Is there a head support pillow in the seat (if allowed by the manufacturer - remove it, as they can often push a small infants head too far forward and block the airway).

My twins were born at 36w6d. They were (baby A) 6lb 11oz & 18.25" and (baby b) 5lb 15oz & 17.5". I had a Graco Snugride 22 and Snugride 32 for them. Neither of them fit in the seat because the shoulder straps were well above their shoulders. The nurses wouldn't even conduct the test (some do even with a poor fit) until we had seats with a lower bottom slot.

Assuming her seat fits well... do they have any reason behind her not passing the test? Does she have any other medical concerns?

I am confused about why they would want to re-admit her solely because she failed the car seat test. How is having her lying flat in a hospital 3 hours away better than having her lying flat at home in her crib? I suggest you talk to the nurses again to sort out what is really going on. Perhaps they are concerned about an underlying apnea or other breathing issue that would best be dealt with in the hospital?

I would see if there is a CPST at the hospital, and if not, ask for the hospital's policy and procedures book, and ask the charge nurse to personally retest the baby.

Am I reading aright that:

-she was originally discharged in a car bed
-she has now outgrown the car bed
-she failed the angle tolerance test, but was not actually at a 45 degree angle
and
-now they want to admit her to evaluate for positional apnea and see if there are associated problems, even though she's not shown other symptoms or signs of trouble?

If so, I'd first ask that she be retested with the car seat at a correct, 45 degree angle. Also, if you don't live 90 minutes from the hospital there's no reason she'd need to tolerate the angle for that long. Have them test for the actual amount of time that she'd be in the car at that angle, OR 90 minutes, whichever is shorter (every 60-90 minutes you would probably be stopping to attend to the babies' needs anyway.) If she passes that, and does not sit inclined at home, and has no underlying or other issues, I'd ask them exactly why they want to admit her for a condition that never occurs at home.

It's probably their hospital policy to test for 90 minutes (I believe the AAP changed their recommendations early this year, and as a result our policy changed from <7 pounds or <37 weeks for 60 minutes to <5.5 pounds or <37 weeks for 90 minutes).

But even if it's hospital policy, if the child won't BE at that angle for 90 minutes, I see no reason they couldn't test for the time she'd actually be at that angle, even a little longer, with a buffer. Replicating circumstances that will never occur outside the hospital just doesn't make sense.

Right, but the hospital would be held liable if there was an issue of her losing her oxygenation status outside the hospital, if they did not test the infant correctly according to their standards. As with many hospital policies, they are CYA and don't make much (if any) sense. We do 90 minute angle tolerance tests on babies who will never even ride in a carseat, except on the 15 minute taxi ride to the airport. Does it make sense? No, not in the slightest. But if the chart were to be audited, and that discrepancy would be found, it would be a big fiasco.

So it's just a liability thing. Gotcha.

I still don't see why they'd want to admit based on that if there's no chance of the situation recurring.

I'd probably, personally, just refuse treatment at that point, as a parent.

I think here babies are always retested if they failed the original test and went home in a car bed. Our tests are done by pulmonary diagnostics dept, not by NICU nurses.

Do make sure they retest in a properly fitted seat and at the 45 degree angle. Then see if there are any issues. If baby is desaturating, I guess I'd want to know why. They likely should test in a lying position as well, if baby is not passing the reclined position, to be sure there are no other issues. An observation period might actually be a good idea if the baby is found to be desaturation reclined and flat.

Make sure the seat is at a true 45 degree angle... and another thought is if you're using a seat with head support that may be pushing the babies head out and causing issues? Maybe try taking that out and using rolled receiving blankets on the sides? I would talk to them too... if they're really going to admit for not doing well in a carseat test but having no other issues that seems like insurance would have some issues with that.