Effect of Babywearing on Acute Reactivity of Cortisol and Oxytocin in Infants with Neonatal Abstinence Syndrome: A Feasibility Study

Abstract

Purpose: The purpose of this study was to examine feasibility and test the study protocol for a babywearing intervention aimed at reducing withdrawal symptoms in infants with Neonatal Abstinence Syndrome (NAS) through mechanisms of comfort and connection. Background: NAS continues to affect thousands of infants every year. Nonpharmacological treatment options are the first line of therapy for NAS, and babywearing is one nonpharmacological intervention that has been shown to decrease heart rate in infant withdrawal. Methods: A prospective cohort feasibility study design was used to compare three interventions (babywearing, Skin-to-Skin Care or SSC, and walking with a stroller) in two groups (infants with NAS and infants without NAS). A convenience sample of infants was taken from an active parent study examining outcomes in mothers. The infants participated in a 20-minute reactivity lab at baseline (~ 2 weeks of age) and at 3 months to assess the acute reactivity of cortisol and oxytocin in relation to the intervention. Results: Twenty-five (n=25) infants were enrolled, and eighteen (n=18) completed participation to three months, translating to a 72% retention rate. The groups differed in that the NAS group was more often born by c-section and admitted to the Neonatal Intensive Care Unit (NICU) more often (71% vs. 11%; t-value=2.94, df=14, p = 0.01). Feasibility results included a low intervention compliance (8 – 33%) among both groups and all three interventions. Saliva samples successfully collected with ≥ 1 mL at baseline was 6.8% and at Post-partum month 3 (PPM3) was 51.4%. Exploratory results for cortisol changes from baseline to PPM3 by intervention included a decrease of 0.206 μg/dL (SD 0.28) for babywearing, a decrease of 0.272 μg/dL (SD 0.46) for SSC, and an increase of 0.163 μg/dL (SD 0.38) for the stroller-walking group. Exploratory results for oxytocin changes from baseline to PPM3 included decreases in all three interventions: babywearing by 20.99 pg/mL (SD 23.26), SSC by 83.79 pg/mL (SD 48.96), and stroller-walking by 237.35 pg/mL (SD 303.62). Implications to Practice: Babywearing may be effective at decreasing cortisol and minimizing the decrease in oxytocin in infants with NAS, but further research is needed with improvements in intervention compliance and methods for adequate saliva collection.