Paternal Bottle Feedings Moderate the Relationship between Finnegan Scores and Length of Stay for Infants with Neonatal Abstinence Syndrome

Background & Purpose:

During the opioid epidemic rates of infants born with Neonatal Abstinence Syndrome/Neonatal Opioid Withdrawal Syndrome (NAS/NOWS) have increased five-fold. NAS is a withdrawal syndrome that frequently occurs post-opioid exposure in utero that necessitates treatment in a neonatal intensive care unit (NICU), often for 2-6 weeks. Previous research has examined the significant role that maternal involvement can play in reducing the length of time needed for such intensive treatment, but there is a paucity of research on paternal involvement/contact. There is therefore a pressing need to explore whether supportive/caregiving maternal interventions (i.e. rooming-in, swaddling, skin-to-skin contact), shown to mitigate NAS infants’ distress, can also be effectively delivered by fathers.

Our Research Hypothesis:

We hypothesize that paternal bottle feedings will moderate the relationship between Finnegan Scores and length of stay for NAS infants.

Methods:

We conducted a retrospective chart review. Data was gathered for calendar year 2015 from Electronic Medical Records (EMR) for a regional children’s hospital in Appalachia. Participants included all infants diagnosed with NAS who were born in 2015 and admitted to the hospital’s NICU. We examined Finnegan Scores (commonly used to measure infants’ withdrawal symptoms/distress), paternal bottle feedings (frequency of bottle feedings given by the infant’s father), and length of stay.

Results:

Zero-order correlations revealed a strong positive correlation between Finnegan scores and the length of NICU stays, r(241) = .63, p < .001, a small negative correlation between maternal feedings and NICU length of stay r(318) = -.27, p < .001, and a small negative correlation between paternal bottle feedings and NICU length of stay r(319) = -.14, p = .01.

To examine the hypothesis that paternal bottle feedings would moderate the relationship between severity of NAS symptoms, as measured by Finnegan scores, and the length of infant NICU stay (even while controlling for maternal feedings), moderation analysis was conducted with Hayes PROCESS macro.

The overall model was significant, R² = .44, F(4, 236) = 46.62, p < .001.  While the R² change was small (ΔR² = .04), both Finnegan scores (β = .38, p < .001) and paternal feedings (β = -.13, p < .05) remained significant in the final model.

We further probed this interaction effect using the Johnson-Neyman statistical approach, which showed that when the frequency of paternal bottle feedings was more than 20.4, or 25.5% of feedings, Finnegan scores were no longer predictive of the length of infant NICU stay.

Conclusions and Implications:

Our findings suggest paternal involvement/contact positively contributes to NAS infant well-being and impacts treatment course/length. Potentially fathers’ presence could be leveraged when mothers are in active addiction or have serious mental health issues that impede active participation on the NICU. Future research should examine the contributions of grandparents, and other extended family members, presence and activity on the NICU.