Barriers to Maternal Presence at the Bedside of Infants With Neonatal Opioid Withdrawal Syndrome

Background Neonatal opioid withdrawal syndrome (NOWS) occurs in infants exposed to opioids during pregnancy. Caregiver presence is an important component of family-centered NOWS care. This study compared documented caregiver bedside presence and clinical outcomes before and after implementation of the Eat, Sleep, Console (ESC) approach and explored barriers to bedside presence reported by mothers in the ESC cohort. Methods We compared a retrospective non-ESC cohort of infants with NOWS admitted to an academic general pediatrics floor from August through December 2021 with a prospective ESC cohort admitted from May through August 2022. Clinical variables included length of stay (LOS), morphine receipt and duration, adjuvant pharmacologic therapy, and documented caregiver bedside presence. Mothers in the ESC cohort were invited to provide exploratory feedback regarding barriers to bedside presence. Results Fifty-four infants were included (41 non-ESC; 13 ESC). No statistically significant differences were observed in LOS, morphine receipt, morphine duration, adjuvant pharmacologic therapy, or documented caregiver bedside presence. Four of 13 mothers in the ESC cohort completed follow-up; two described concerns related to communication, shared decision-making, and perceived stigma. Conclusion Clinical outcomes and documented caregiver bedside presence did not differ significantly between cohorts. Maternal feedback was limited and should be considered exploratory, but it identified provider-family communication and support as potential areas for further study. Larger prospective studies with more precise measurement of caregiver presence and systematic assessment of family experiences are needed.