Home visits following hospital discharge for families with preterm and low-birthweight infants

Abstract

RATIONALE: Home visiting programmes are widely used to support families of preterm and low-birthweight (LBW) infants after hospital discharge, yet evidence on their effectiveness is limited and of variable quality, particularly in low- and middle-income countries (LMICs). A comprehensive, up-to-date review was needed to inform healthcare decisions. OBJECTIVES: To assess the effectiveness of home visits following hospital discharge compared to standard of care or no home visits, for families/caregivers of preterm or LBW infants to reduce morbidity and mortality and enhance health and well-being. SEARCH METHODS: We searched CENTRAL, MEDLINE, CINAHL, Scopus, Web of Science, ClinicalTrials.gov, and the WHO ICTRP, together with reference checking, to identify eligible studies. The latest search date was April 2026. ELIGIBILITY CRITERIA: We included randomised controlled trials (RCTs) of preterm and LBW infants and their caregivers comparing home visits after discharge from hospital with no home visits or standard of care including home visits. There were no restrictions on language or publication status. OUTCOMES: Our critical outcomes included all-cause mortality, neurodevelopment, morbidity, growth, breastfeeding rates, exclusive breastfeeding, and emergency hospital visits. Important outcomes were hospital readmission rates, maternal/parental emotional well-being, and maternal-infant interaction. RISK OF BIAS: We used Cochrane's RoB 2 tool to assess the risk of bias. SYNTHESIS METHODS: We synthesised results for each outcome in meta-analysis where possible, using random-effects models to calculate risk ratios (RRs) for dichotomous outcomes, mean differences (MDs) or standardised mean differences (SMDs) for continuous outcomes, and hazard ratios (HRs) for time-to-event outcomes, along with 95% confidence intervals (CIs). We used GRADE to assess the certainty of evidence for each outcome. INCLUDED STUDIES: We included 35 RCTs, of which 28 (12,021 infants and 10,056 mothers/caregivers) contributed data to our prespecified outcomes. Most studies were from high-income countries; however, approximately 70% of participants were from a large study in India contributing data to comparison 2. The content, timing, duration, and frequency of home visits varied widely. Twenty-one studies contributed data to meta-analyses. SYNTHESIS OF RESULTS: Home visits versus no home visits The effects of home visits on all-cause mortality at one year are very uncertain (RR 3.08, 95% CI 0.13 to 73.27; 1 study, 79 participants). Home visits may have little to no effect on cognitive development (SMD 0.06, 95% CI -0.17 to 0.29; 3 studies, 287 participants), and likely have little to no effect on motor development (SMD -0.02, 95% CI -0.36 to 0.33; 1 study, 127 participants). The effect on morbidity, specifically on diarrhoea at six months, is very uncertain (RR 0.71, 95% CI 0.42 to 1.19; 1 study, 179 participants). Home visits likely have little to no effect on growth, specifically weight-for-age z-scores (WAZ) at six months (MD -0.09, 95% CI -0.36 to 0.18; 1 study, 179 participants). Home visits likely increase the proportion of infants breastfeeding at six months (RR 1.26, 95% CI 1.16 to 1.37; I² = 0%; 4 studies, 1217 participants) and may result in a large increase in exclusive breastfeeding at six months (RR 2.31, 95% CI 0.85 to 6.29; 3 studies, 1129 participants). The certainty of the evidence ranged from moderate to very low due to risk of bias and imprecision. More intensive home visits versus less intensive home visits (part of standard of care) Home visits with community-initiated kangaroo mother care likely reduce all-cause mortality at 6 months (HR 0.75, 95% CI 0.60 to 0.93; 1 study, 8402 participants), likely have little to no effect on cognitive (MD 0.21, 95% CI -1.77 to 2.19; 1 study, 552 participants) or motor development (MD -0.85 95% CI -2.59 to 0.89; 1 trial, 552 participants) at 12 months, and likely reduce morbidity, specifically rates of diarrhoea slightly at 3 months (RR 0.94, 95% CI 0.85 to 1.04; 1 study, 7654 participants) and the risk of possible serious bacterial infections slightly at 28 days (RR 0.89, 95% CI 0.82 to 0.97; 1 study, 8384 participants). They likely have little to no effect on WAZ at six months (MD -0.01, 95% CI -0.06 to 0.04; 1 study, 7086 participants) and likely reduce the proportion of infants who are severely underweight at six months slightly (RR 0.95, 95% CI 0.87 to 1.04; 1 study, 6641 participants). More intensive home visits may have little to no effect on breastfeeding at six months (RR 1.18, 95% CI 0.88 to 1.59; 1 study, 308 participants), and their effect on exclusive breastfeeding at six months is very uncertain (RR 1.97, 95% CI 0.19 to 20.62; I² = 84%; 3 studies, 7091 participants). The certainty of the evidence was moderate for all outcomes except for breastfeeding and exclusive breastfeeding, for which it was low and very low, respectively. The certainty of evidence was downgraded for risk of bias, imprecision, and indirectness. No study in either comparison reported on emergency hospital visits. AUTHORS' CONCLUSIONS: Home visits likely improve breastfeeding and may improve exclusive breastfeeding compared to no home visits. They may have little to no effect on cognitive development, and likely have little to no effect on motor development or growth. The effects on mortality or diarrhoea are very uncertain. In places where home visits are already implemented, enhancing them so that they are more intensive than the standard of care (i.e. more frequent, longer, delivered by specialised personnel, with kangaroo mother care, etc.) likely reduces mortality, morbidity, and the risk of underweight. However, they likely have little to no effect on cognitive and motor development or WAZ, and may have little to no effect on breastfeeding rates. The effects on exclusive breastfeeding are very uncertain. Better-quality studies are needed, particularly in LMICs. There is a need for studies reporting on the critical outcome of emergency hospital visits, and to standardise outcome measures reported in this area of research, particularly for mental health and neurodevelopment outcomes. FUNDING: This review was conducted for the GELA project (africa.cochrane.org/projects/GELA) which is funded as part of the EDCTP2 programme (grant number RIA2020S-3303-GELA) supported by the European Union. REGISTRATION: Protocol: CRD42024496298 registered on 15 January 2024 (PROSPERO), available at https://www.crd.york.ac.uk/PROSPERO/view/CRD42024496298.