Pediatrician Hospices Civils de Lyon Bron, Rhone-Alpes, France
Background: To manage bronchiolitis with nutritional impairment when no bed is available, a short-term enteral nutrition protocol (STENP) was implemented in our pediatric emergency room (PER). Objective: The primary objective was to describe the ability of STENP to avoid immediate hospitalization. Design/Methods: A cohort study was conducted during the 22-23/23-24 RSV-epidemic seasons in a French tertiary teaching hospital PER. STENP was proposed to parents of infants with nutritional impairment of a bronchiolitis. Infant with indication criteria (Figure 1) was proposed to receive the STENP as an attempt to get discharged after the care. Infants then underwent a 6h-enteral nutrition; events were hourly monitored (Figure 1). Data were collected from the emergency room visit to day 28 (D28) to document outcomes (Table 1). The study was approved by the institutional review board. STROBE reporting guideline were followed. Results: Ninety infants with an indication of STENP (Table 1) had an NGT-placement with initiation of enteral nutrition (100%). Eleven of them (12%), all being further hospitalized, required premature slow-down regimen or stop due to appearance of respiratory distress or vomiting. A total of 56 infants (62%) returned home after the STENP. Fifty infants (57%) had not been admitted at D28. The 14 AEs (16%) consisted of pulling-out the NGT, and 40 SAEs consisted of hospitalization, all being related to disease progression. The clinical success of avoiding hospitalization was 56% in the total population, but in the in the subgroup of infants remaining with only nutritional impairment, the success rate was 91% (50/55).
Conclusion(s): STENP was both feasible and safe as AEs involved usual management of NGT placement and SAEs were related to the natural course of the disease. STENP allowed home returns for 6 out of 10 STENP (and for 9 of 10 patients with only nutritional impairment) and unveiled respiratory insufficiencies. Although the STENP was initiated for hospital benefit to manage the deficit of available beds, it proved promising in creating a new care trajectory that strengthens hospitalization indications, make the care starting as soon as the PER, and save beds; STENP is more in line with parents' expectations; the STENP could be beneficial, not only from the hospital's point of view, but also from that of the parents, the team of HCPs, and society. Further research is needed to show how STENP can empower both parents and pediatric teams in this new care paradigm, as returns at-home bring benefits for both families, HCP-teams and hospital, and society.
Figure 1: Summary of the short-term enteral nutrition protocol (STENP) as displayed in the PER.
Table 1: Population characteristics and summary of outcomes
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