This study showed that the hospitalization of an infant for bronchiolitis has a multidimensional impact on its parents as well as on the whole family: emotional and physical impact, impact on daily life organization and parenting role, and impact on siblings. Among the various studied aspects, only the financial impact and to a lesser extent parent’s perception on the physical reaction of the hospitalized infant revealed lower levels of impact. Unsurprisingly, the impact at hospital discharge was consistently stronger than the impact 3 months later; however, the impact 3 months after hospital discharge remained notable for many aspects (especially for emotional consequences, parenting roles, and reactions of siblings).
One of the main challenges of this study was to interpret the IBHQ results, as this is the first study using the IBHQ, and no control group can be defined to compare the specific impact of hospitalization for bronchiolitis with the impact of hospitalization for other reasons since the IBHQ is a specific questionnaire that is not suitable for other populations / pathologies than parents of children hospitalized for bronchiolitis. Given the absence of clear rules for the interpretation of scores, it had to rely largely on the content of the questions. For example, to obtain a value of 40 for the mean guilt score at hospital discharge, parents would have answered “very much” or “extremely” to at least one of the three questions of the dimension (i.e. feeling guilty for leaving the infant in hospital, feeling guilty because of the infant’s bronchiolitis, and feeling lonely). In light of this kind of considerations, it clearly appeared that the observed mean scores, which ranged between 40 and 60 for almost all scores, are indicative of a non-trivial impact.
The impact on parents of the hospitalization of their child was often investigated in the context of severe diseases, in a PICU context
[6–10, 16]. A literature review revealed the great emotional and physical impact on the parents of hospitalized critically ill children
; moreover, these hospitalizations were shown to have important consequences on the whole family. To our knowledge, a single previous study specifically explored the impact on parents of their infant’s hospitalization for bronchiolitis in a small sample (N = 46) of infants hospitalized with RSV-bronchiolitis
; this work showed a clear impact on emotional aspects and parenting role that persisted several weeks after hospital discharge. The present study confirmed these key findings in a much larger sample, since most of the results were based on more than 300 infants. Moreover, our results provide a broader spectrum of this impact, by adding physical and daily life organization consequences to the picture as well as by outlining the distressful impact on the siblings of the hospitalized infant.
We also analyzed the impact in different subgroups of parents of infants at high-risk of hospitalization for bronchiolitis, i.e. preterm and CHD infants. The few differences found depending on gestational age were small and did not appear meaningful. As for parents of infants with CHD, unexpectedly, they seemed overall less affected by the bronchiolitis hospitalization. This could indicate a different perception of the bronchiolitis hospitalization in these parents whose infants had already experienced more serious hospitalizations; their reaction to the bronchiolitis hospitalization may be mitigated by their previous difficult experiences, and they may have already created strategies to cope with the burden of their infant’s hospitalization. Nevertheless, these findings should be interpreted with caution given the small observed impact differences as well as the limited number of CHD infants included in the analyses.
We also evaluated the main drivers of the impact of bronchiolitis hospitalizations on parents: none of the factors considered in these analyses consistently affected all the dimensions of the impact. Nonetheless two factors were associated to a higher impact on several aspects: duration of hospitalization and parents’ educational level. Hospital length of stay can be considered as a surrogate marker of the severity of the hospitalization, which has already been shown as a key driver of impact on parents of the hospitalization of their infant in previous studies
[4, 5, 7]. Parents’ level of education equally had a significant effect on many aspects of the impact of hospitalization: worries and distress, fear for future, guilt, and impact on daily organization. However, no clear, consistent pattern was observed; the impact of bronchiolitis hospitalization is obviously dependent on the parents’ level of education, but this relationship is not straightforward. Further research specifically focusing on this issue is warranted in order to get a better understanding of how hospitalizations for bronchiolitis affect parents with different educational levels.
Despite, the population of the present study seemed to be similar to the population of infants generally hospitalized for bronchiolitis, and the in-ward management was consistent with the current medical practice, the representativeness of the study sample could not be formally supported, in the absence of French reference data. The stratified enrolment procedure, which initially imposed the inclusion of preterm and CHD infants, increased the percentage of these cases in our study, and therefore our sample may be slightly different from the general population of infants hospitalized for bronchiolitis. The longer hospital stays observed in this study as compared to those retrieved from the 2005–2006 French National Hospitalizations Database (Programme de Médicalisation des Systèmes d’Information; PMSI) could be explained by these differences: the mean length of hospitalization in our study was of 6.6 days while the mean length of hospital stay for bronchiolitis in infants younger than one year was of 4.7 days in the PMSI database.
Some other specific features should also be taken into account when interpreting the results of the present study. The parent who completed the questionnaire was in most of the cases the mother (92%). The parent’s gender doubtlessly generates certain differences in the impact of the hospitalization
 but the paucity of data collected from fathers in this study does not allow reliable conclusions on the impact on fathers of their infant’s bronchiolitis hospitalization. Also, parents with low educational level might be underrepresented in this study sample because an inclusion criterion required the responding parent to be able to complete the questionnaire alone; this aspect could be particularly important since low educational level of the mother has been shown to be a risk factor for infant’s hospitalization for bronchiolitis
. In addition, among the children whose parents accepted to participate in the study, those whose parents eventually completed the discharge questionnaire had less often CHD, had shorter hospitalizations, and less often admitted in intensive care units than children whose parents did not complete the discharge questionnaire, suggesting that they may have presented a less severe level of bronchiolitis. However, even for those parents, the bronchiolitis hospitalization of their children showed a clear impact, which demonstrates that, regardless of the severity of the disease, the hospitalization of the child is not of no consequence for the parents. Also, we could not take into account the potential impact on the follow-up assessment of additional family events that could have occurred in the three month period since discharge. Finally, this study was conducted in France and, even if most of the results are probably applicable to other Western European countries, certain cultural peculiarities might not be replicated in other cultures. In particular, the low financial impact of bronchiolitis hospitalization may be somewhat specific to France, where the costs of hospitalization are fully reimbursed by the social security system.