Nurses Babywearing Neonates with Neonatal Abstinence Syndrome in the Neonatal Intensive Care Unit

Background and Purpose: The opioid epidemic in the United States has resulted in an increase of infants born and diagnosed with Neonatal Abstinence Syndrome (NAS). Infants diagnosed with NAS often spend several weeks in a Neonatal Intensive Care Unit (NICU) and have difficulty with being consoled. Infant carriers may be used to help with irritability, while allowing the adult user to be more mobile, through the practice of babywearing (facilitated holding of an infant using a soft cloth that is worn on the body). The purpose is to examine the experience of babywearing infants diagnosed with NAS while admitted in the NICU from the perspective of the nurses who treat them.

Methods: Nurses (N=18, Mage=35.44 years, SD= 9.45) were recruited and interviewed using a semi-structured interview method from a 36-bed NICU in the Southwestern United States that includes a Family Centered approach to care for infants diagnosed with NAS (FC-NAS program). While family members are encouraged to room in with the infants on a daily basis, nurses provide ongoing bedside care, respite care, and support the primary concepts of the FC-NAS program through physical care and educational support to the caregivers. Families were provided with an infant carrier as part of the program and nurses had the option of using the carriers. Nurses were asked a series of open-ended questions such as, “What has your experience with using infant carriers been like?”

Results: A qualitative thematic content analyses using an open coding scheme yielded six themes which fell into two categories: 1) Benefits of babywearing infants with NAS in the NICU: Infant Consoling (“they aren’t crying all the time”), Adult Multi-Tasking (“you are able to hold the infant and still be able to do other stuff, like charting”), Caregiver-Infant Trust (“our patients need the feeling of closeness to somebody, especially if they don’t have the parent readily available”); and 2) Suggestions of how babywearing in the NICU can be more effective: Infection Control (“you can’t just throw one on you and then care for other babies”), Reoccurring Infant Carrier Education (“it’s a newer practice for some people”), Reduced Patient Load (“lower nurse to patient ratios so that we can focus a little more on the baby and the parents”).

Conclusions and Implications: Many NICUs incorporate kangaroo care as a treatment option; however, NICU staff, social workers, and other hospital volunteers, cannot participate in kangaroo care. Babywearing is a safe and feasible addition to the variety of non-pharmacologic treatment options available to infants with NAS, and is a practical alternative for support staff. The nurses described infants with NAS as having higher discomfort levels; the carriers provided the comfort demanded of them. Additionally, babywearing resulted in stronger patient-nurse relationships, which resulted in improved perceived quality of patient care. This is the first study to evaluate the impact of babywearing on the infant-adult relationship in non-parental samples and has implications for physically supporting mothers with substance use disorders in the work of caregiving.