Home Care for Bronchiolitis: A Systematic Review

Abstract

CONTEXT: Bronchiolitis is the leading cause of pediatric hospital admissions. Hospital-at-Home (HAH) delivers hospital-level care at home, relieving pressure on the hospital system. OBJECTIVES: We aimed to review the feasibility, acceptability, and safety of HAH for bronchiolitis, and assess the cost-impact to hospitals and society. DATA SOURCES: Ovid Medline, Embase, Pubmed, Cochrane Library, CINAHL, and Web of Science. STUDY SELECTION: Studies (randomized control trials, retrospective audits, prospective observational trials) of infants with bronchiolitis receiving HAH (oxygen, nasogastric feeding, remote monitoring). Studies were limited to English language since 2000. DATA EXTRACTION: We reviewed all studies in duplicate for inclusion, data extraction, and risk of bias. RESULTS: Ten studies met inclusion criteria, all for home oxygen therapy (HOT). One abstract on nasogastric feeding did not meet full inclusion criteria. No studies on remote monitoring were found. HOT appears feasible in terms of uptake (70%–82%) and successful completion, both at altitude and sea-level. Caregiver acceptability was reported in 2 qualitative studies. There were 7 reported adverse events (0.6%) with 0 mortality in 1257 patients. Cost studies showed evidence of savings, although included costs to hospitals only. LIMITATIONS: Small number of studies with heterogenous study design and quality. No adequately powered randomized control studies. CONCLUSIONS: Evidence exists to support HOT as feasible, acceptable, and safe. Evidence of cost-effectiveness remains limited. Further research is needed to understand the relevant impact of HAH versus alternative interventions to reduce oxygen prescribing. Other models of care looking at nasogastric feeding support and remote monitoring should be explored.

Contribution of Infant Rhinovirus Bronchiolitis to Hospital Bed and Ventilation Use

“…As nirsevimab will certainly reduce the burden due to bronchiolitis and therefore reduce care cancellation, hospital transfers, and other substantial quality of care impairments, our findings do not undermine its implementation; however, they draw attention to challenges regarding bronchiolitis management, especially non-RSV infections. To protect hospital and nonhospital pediatric settings from the devastating effects of multipathogen winter epidemics, efforts must be made to include HRV in the development of multipathogen vaccines and to continue to optimize patient management by developing tailored protocols for home enteral nutrition and home oxygen therapy for infants with moderately severe bronchiolitis . Until then, adherence to universal preventive hygiene measures remains particularly critical …”

“…To protect hospital and nonhospital pediatric settings from the devastating effects of multipathogen winter epidemics, efforts must be made to include HRV in the development of multipathogen vaccines 4 and to continue to optimize patient management by developing tailored protocols for home enteral nutrition and home oxygen therapy for infants with moderately severe bronchiolitis. 5 Until then, adherence to universal preventive hygiene measures remains particularly critical. 6 …”