Maternal Mental Health Issues Correlate with Maternal Visits and NAS Infant Distress

Background and Purpose: Rates of Neonatal Abstinence Syndrome (NAS) have increased due to rising rates of opioid use in the United States, making NAS a leading cause of medical and developmental problems in newborns. Social Workers intervene in many arenas with these infants and their families (including their mothers) in the hospital, through Child Protection Services and foster care, among others. Women who struggle with opioid abuse often have co-occurring mental health (MH) issues, as well as histories of trauma. These conditions can influence their ability to function in relationships and as parents. Poverty and rural residence often limit access to behavioral health treatment. As a mother’s health and functioning are integral to her infant’s well-being, if a mother’s MH needs aren’t being met this will influence her ability to be present and comfort her infant during the trauma of withdrawals and hospitalization. Real and perceived stigma further discourages a mother’s presence in the NICU. We hypothesize that NAS infants whose mothers have identified MH issues and histories of trauma will have higher Finnegan scores (a measure of infant withdrawal distress) related to being visited less frequently by their mothers than the average for this sample.

Methods: We collected electronic data from institutional archives from a regional children’s hospital in Appalachia. Participants included all infants diagnosed with NAS born in 2015 who were admitted to the NICU at East Tennessee Children’s Hospital. We particularly noted any mention of MH diagnoses or medication, as well as trauma, in NICU discharge summaries and/or social work records. Family visits documented family visits, length of stay came from discharge summaries, and nursing notes provided Finnegan Scores.

Results: Mediation analyses were conducted using the PROCESS macro developed by Hayes to investigate the hypothesis that the relationship between maternal MH and NAS infant Finnegan scores would be mediated by maternal contact, measured through the frequency of maternal feedings.  The mediation model showed that approximately 19.5% of the variance in Finnegan scores was accounted for by the predictors, F(2, 65) = 7.87, p < .001.  The bootstrapped indirect effect was significant b = 2.14, SE = 1.18, 95% CI [.34, 4.08].  The Johnson-Neyman probe revealed that when the mean of maternal feedings was less than 18.93, maternal mental health had a significant negative effect on Finnegan scores, representing 25% of total infant feedings, while when maternal feedings exceeded 18.93, maternal MH no longer had any significant negative effects on Finnegan scores. 

Conclusions: Findings highlight the relationship between maternal contact and infant well-being, and indicate that, even when the mother is experiencing MH issues, when mothers provide at least 25% of NICU feedings the relationship between maternal MH and NAS severity is mitigated. Hospital Social Workers can play a significant role in challenging societal prejudice against these mothers that may contribute to reduced maternal contact and related infant distress.