Clinical Research

Presentation Title (IN ALL CAPS)

The Impact of Skin-To-Skin Holding on Stress and Attachment in Opioid Dependent Mothers and Infants with Neonatal Abstinence Syndrome

Departmental Affiliation and City, State, Zip for All Authors

Assistant Professor, The University of Texas Health Science Center at San Antonio, School of Nursing, Department of Family & Community Health Systems; Assistant Professor, Molecular Biology and Immunology, Assistant Dean Recruitment & Minority Affairs, The University of North Texas Health Science Center; Associate Professor-Department of Family Medicine, Associate Director, Primary Care Research Institute, Interim Executive Director of NorTex, The University of North Texas Health Science Center

Classification

Non-UNTHSC Faculty

Research Presentation Category

Clinical Research

Brief Narrative or Summary

National rates of neonatal abstinence syndrome (NAS) have tripled since 2000 resulting in one child being born every hour with NAS. NAS is a withdrawal syndrome experienced by infants who are prenatally exposed to addicting substances and is associated with preterm birth, respiratory distress, inconsolable crying, seizures, and in rare cases, death. The rising rates of NAS have followed the nationwide trend toward an increased prescribing and misuse of opioid pain relievers. Infants with NAS require extensive care resulting in a lengthy hospital stay typically in a neonatal intensive care unit (NICU). No universally agreed upon standard of care exists for infants with NAS. Treatment is generally focused on symptom management through the use of medications and soothing techniques. Medications may alleviate some NAS symptoms; however, evidence shows that the use of medications prolongs an infant’s length and cost of hospital stay. While soothing techniques may potentially reduce the need for medications, evidence showing that these techniques are beneficial is mostly anecdotal. Maternal-infant skin-to-skin (STS) holding is an intervention that has been shown to improve outcomes in preterm and other high-risk infants and is often recommended for infants with NAS; however, no scientific evidence exists to demonstrate the impact of STS on the care of opioid dependent mothers and infants with NAS. Therefore, the purpose of this study is to address the following specific aims: 1) Determine if STS reduces stress in opioid dependent mothers and their infants with NAS. 2) Determine if STS increases maternal attachment scores in opioid dependent mothers who have infants with NAS. 3) Determine if STS reduces neonatal withdrawal symptoms, need for medication, and length and cost of hospital stay. An explanatory baseline, response-paired design, with all individuals acting as their own controls before, during, and after STS across two time points is being used for this investigation. A convenience sample of 30 mother-infant dyads (N=60) is being recruited from a community methadone program for pregnant women. Upon enrollment, mothers are receiving a prenatal, educational, intervention focused on the importance of STS and proper technique. Following birth, maternal and infant heart rate as well as salivary biomarkers of stress (cortisol) are being collected immediately prior to, 20 minutes into, and 20 minutes following two STS sessions (1st and 4th). Comparisons of biomarkers will be made between data collection time points, STS sessions and between and within dyads. The Maternal Attachment Inventory and the Parenting Stress Index are being administered at baseline and again following the 4th STS session. The following maternal/Infant baseline and demographic data are being collected: health and birth history, birth weight, gestational age, scores on the Modified Finnegan Neonatal Abstinence Scoring Tool (M-FNAST), need for medication and dosages, rate of weight gain, and length of hospital stay. The findings of this study will make a significant contribution to the care of substance exposed mother-infant dyads. We believe that the use of STS will reduce stress and improve maternal attachment supporting the use of this intervention as standard of care for this population.

Scientific Abstract

Purpose: Determine the impact of mother-infant, skin-to-skin (STS) holding on stress and attachment in opioid dependent mothers and infants with neonatal abstinence syndrome (NAS). The following specific aims are being addressed: 1) Determine if STS reduces stress in opioid dependent mothers and their infants with NAS. 2) Determine if STS increases maternal attachment scores in opioid dependent mothers who have infants with NAS. 3) Determine if STS reduces neonatal withdrawal symptoms, need for medication, and length and cost of hospital stay. Design: An explanatory, baseline, response-paired design is being used with all individuals acting as their own controls before, during, and after STS across two time points (1st and 4th). Method: Thirty mother-infant dyads (N=60) are being recruited. Mothers are receiving a prenatal, educational intervention on the importance of and proper technique for STS. Maternal and infant heart rates and salivary samples (for cortisol) are being collected immediately prior to, 20 minutes into, and 20 minutes following STS sessions. Biomarker correlations will be assessed for each mother-infant dyad at each data collection time point and between STS sessions. The Maternal Attachment Inventory and Parental Sources of Stress: Neonatal Intensive Care Unit (PSS: NICU) are being administered at baseline and following the 4th STS. Maternal/Infant baseline and demographic data are also being collected. Results: Data collection is on-going with results pending.

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The Impact of Skin-To-Skin Holding on Stress and Attachment in Opioid Dependent Mothers and Infants with Neonatal Abstinence Syndrome

Purpose: Determine the impact of mother-infant, skin-to-skin (STS) holding on stress and attachment in opioid dependent mothers and infants with neonatal abstinence syndrome (NAS). The following specific aims are being addressed: 1) Determine if STS reduces stress in opioid dependent mothers and their infants with NAS. 2) Determine if STS increases maternal attachment scores in opioid dependent mothers who have infants with NAS. 3) Determine if STS reduces neonatal withdrawal symptoms, need for medication, and length and cost of hospital stay. Design: An explanatory, baseline, response-paired design is being used with all individuals acting as their own controls before, during, and after STS across two time points (1st and 4th). Method: Thirty mother-infant dyads (N=60) are being recruited. Mothers are receiving a prenatal, educational intervention on the importance of and proper technique for STS. Maternal and infant heart rates and salivary samples (for cortisol) are being collected immediately prior to, 20 minutes into, and 20 minutes following STS sessions. Biomarker correlations will be assessed for each mother-infant dyad at each data collection time point and between STS sessions. The Maternal Attachment Inventory and Parental Sources of Stress: Neonatal Intensive Care Unit (PSS: NICU) are being administered at baseline and following the 4th STS. Maternal/Infant baseline and demographic data are also being collected. Results: Data collection is on-going with results pending.