NurtureMax Infant Car Seat

U.S. NICU based CPST here- My favorite seat for small babies is the Evenflo Litemax, specifically [this one](https://www.evenflo.com/products/pivot-xpand-travel-system-litemax-infant-car-seat) due to the supportive insert. It has harness adjustments that make it fit small babies *beautifully.* I would personally suggest making the hip and crotch buckle adjustments for a 3-6lb baby yourself prior to bringing the car seat in, because not all nurses (or even CPSTs) realize that these adjustments exist. But when done correctly I don’t think there’s anything else that fits a small baby so well. Some other really great options for 4lb babies at different price points: - Evenflo NurtureMax (also has small baby adjustments I suggest doing yourself- this one is almost as great as the Litemax!) - Chicco Keyfit 22/30/Max - Britax Willow (also has small baby adjustments I suggest doing yourself) - Clek Liing - Nuna Pipa Urbn Seats I’d personally avoid for a 4lb baby: - Graco Litemax line (often fits poorly before 7-8 lbs- it’s fixable with certain techniques but I’d rather have a seat that just fits as designed without all that) - baby trend (some will work well with adjustments but some won’t and they’re all hard to adjust) - Uppababy Mesa (huge headrest + awkward insert = poor head position)

NICU based car seat tech here. I agree baby’s positioning isn’t great in this seat. Unfortunately that’s extremely common with the Mesa v2. It’s… not a good seat for preemies. It’s the single hardest seat I deal with for getting babies to pass their car seat tests and one of the only seats that I sometimes just truly *can’t make work* when the baby is otherwise stable and fine - in those cases, I typically recommend parents to get a different seat that I recommend if possible, and I’ve never been wrong about the baby subsequently passing the car seat test in the new seat (I have a short list of recs that I personalize with parent input when acting in my professional role). Did baby pass a car seat test before discharge? If so, you don’t need to *panic* right now - the car seat test serves to show that baby can tolerate the car seat positioning, so that would be reassuring. You may be able to raise the headrest by one click and have the straps still correctly positioned just below shoulder level- that may help slightly. You can alternatively try to remove the insert (you’ll also have to move the headrest/harness down so the straps come out of the car seat just below baby’s shoulder level) and see how that looks - but unfortunately the harness probably will not tighten enough around such a small baby without the insert in. Occasionally I’ve had it work out okay, though, so it’s worth checking. The burp cloth thing is not safe from a crash performance perspective (may increase risk of ejection in a crash) so if that’s the only way you can achieve acceptable positioning then it’s time for a new seat. I’d also check your base install. The Mesa base has a really wide range of “green” on the recline indicator, but they don’t specify or recommend that the base be as reclined as allowed for a newborn. If you haven’t already extended the recline foot, reinstall the base with the recline foot fully extended (lowered) and see if the indicators are fully green. If so, great, if there is any red then retract the recline foot by one click and try again - rinse and repeat until the seat is at the maximum reclined angle that doesn’t show any red. While the main problem with this seat is the shape of the seat itself, ensuring maximum recline can help slightly (and it’s what you want for a newborn regardless, for improved airway protection). If you do prefer to get another seat, and you need something compatible with an Uppababy stroller, then your main options are the Chicco Keyfit 30 or Keyfit Max (I slightly prefer the Max and recommend removing the extra head insert it comes with; but both are excellent), any Nuna Pipa model (The Pipa Urbn is one of the single best car seats out there for babies this size, though unfortunately it only comes with a Nuna stroller so that may be redundant) or the Clek Liing (another fave of mine with an excellent preemie fit; this is what one of my 27 week twins used at NICU discharge in 2020, before the Urbn existed). If UB stroller compatibility isn’t a concern, I would consider the Evenflo NurtureMax (a very bare bones, basic seat that I personally consulted on with Evenflo to ensure an ideal fit for preemies); the Evenflo Litemax (I prefer [this one](https://www.evenflo.com/products/pivot-modular-car-seats-and-stroller-travel-systems?_pos=7&_fid=6df9cb69c&_ss=c) because it has my favorite insert style; it’s only available with the travel system but the standalone options also work well); or the higher end Graco seats (the ones with headrests that look like [this](https://www.gracobaby.com/shop/car-seats/infant-car-seats/snugride-snugfit-dlx-infant-car-seat/SAP_2156211.html)- there are a few different “trim levels” of this headrest style but the seats themselves are all the same and work better for small newborns than Graco’s lower end seats with smaller headrests and less supportive inserts).