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Improving Care for Infants With Neonatal Abstinence Syndrome: A Multicenter, Community Hospital-Based Study

Joshua Parlaman1,2, Parimal Deodhar3,2, Virginia Sanders3,2

  • 1Seattle Children's Hospital, Seattle, Washington; and joshua.parlaman@seattlechildrens.org.

Hospital Pediatrics
|July 17, 2019
PubMed

Insights

Implementing an Eat, Sleep, Console (ESC) protocol for neonatal abstinence syndrome (NAS) in community hospitals significantly reduced hospital length of stay and morphine use. This nonpharmacologic approach improved infant care outcomes without compromising safety.

Area of Science:

  • Neonatal care
  • Pediatric pharmacology
  • Quality improvement in healthcare

Background:

  • Neonatal Abstinence Syndrome (NAS) treatment in children's hospitals often involves nonpharmacologic care, improving outcomes.
  • Community hospitals sought to enhance NAS care by implementing the Eat, Sleep, Console (ESC) protocol.

Purpose of the Study:

  • To improve NAS care in a community hospital setting.
  • To implement and evaluate the ESC protocol for infants with NAS.

Main Methods:

  • A multidisciplinary quality improvement approach was used to implement the ESC protocol in two community hospitals.
  • Key interventions included emphasizing nonpharmacologic care, initiating single-dose morphine, flexible weaning, and using ESC scoring.
  • Data were collected over two years (2017-2018) and analyzed using statistical process control.

Main Results:

  • Mean length of stay (LOS) for NAS infants decreased from 9.0 to 6.2 days post-intervention.
  • Scheduled morphine use decreased from 57% to 23% after protocol implementation.
  • No increase in transfers to higher care levels or 30-day readmissions was observed.

Conclusions:

  • The nonpharmacologic ESC protocol led to significant and sustained improvements in LOS and reduced morphine exposure for infants with NAS.
  • Evidence-based practices, like the ESC protocol, can be successfully implemented and sustained in community hospitals for NAS care.
Abstract

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