P0603 - Parent Reported Impact of Hospitalization for Infants with Bronchiolitis on High Flow Nasal Cannula Therapy

Background:
Many therapies are used to support infants hospitalized with bronchiolitis, with a recent rise in utilization of high flow nasal cannula (HFNC) therapy. The short-term data suggest that there is minimal risk to high flow nasal cannula therapy; however, there are currently few studies looking at the impact of the therapy on parent experience or breastfeeding.

Methods:
A 30-item previously validated survey, the Impact of Bronchiolitis Hospitalization Questionnaire, was administered to caregivers of children hospitalized for bronchiolitis after discharge. The survey was available in English and Spanish. The survey contained 13 questions that asked parents to rank if and to what extent the hospitalization interfered with specific topics (ex: patient appetite, breastfeeding, caregiver sleep etc.) In addition to the survey, a retrospective chart review extracted clinical data related to the child’s hospitalization (HFNC therapy, the length of the therapy and the max flow rate). We examined whether several measures of impact on the parent-child dyad (breastfeeding, bonding, stress) were associated with HFNC therapy using descriptive statistics.

Results:
Over a two-season period, 63 caregivers of children hospitalized for bronchiolitis completed the survey. Caregivers were predominantly parents and the majority identified as the patient’s mother, selected white as their race and had a mean age of 33 years (SD 7.5). Median length of stay for patients on HFNC therapy was 5 days and 2 days for patients not on HFNC therapy (p <0.001). Of the 13 questions mentioned above, severity of interrupted breastfeeding and home financial problems were more profound in the HFNC therapy group vs the no HFNC therapy group. 100% of breastfeeding caregivers of children on HFNC therapy reported that breastfeeding was interrupted to some degree (somewhat, very much, extremely); compared to 55% of breastfeeding caregivers of children not on HFNC therapy (p=0.006). Survey comments on the barriers to breastfeeding noted medical equipment (tubes, cords, oxygen support) and a focus on bottle feeding as oppose to breastfeeding as common barriers. In addition, 56% of caregivers of patients on HFNC therapy reported home financial problems after discharge; compared to 21% of caregivers of patients not on HFNC therapy (p=0.01).

Conclusion:
Caregivers of infants hospitalized for bronchiolitis on HFNC therapy report a higher frequency of breastfeeding interruption and home financial problems after discharge when compared to caregivers of infants hospitalized for bronchiolitis not on HFNC therapy. While severity of illness associated with HFNC may partially explain this finding, the qualitative data also suggest some modifiable factors within the hospital that can be changed to better support breastfeeding.