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Eat, Sleep, Console Approach or Usual Care for Neonatal Opioid Withdrawal.

Leslie W Young1, Songthip T Ounpraseuth1, Stephanie L Merhar1

  • 1From the Larner College of Medicine, University of Vermont, Burlington (L.W.Y.); the Departments of Biostatistics (S.T.O., Z.H., J.Y.L.) and Pediatrics (J.N.S.), University of Arkansas for Medical Sciences, Little Rock; the University of Cincinnati College of Medicine and Perinatal Institute and the Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati (S.L.M., W.R., J.M.M.), the Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland (M.C.), and the Department of Pediatrics, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus (E.F.B.); the Institutional Development Awards Program of the States Pediatric Clinical Trials Network, Environmental Influences on Child Health Outcomes (ECHO) Program, National Institutes of Health, Rockville (A.E.S.), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda (A.A.B., R.D.H., M.C.W.) - both in Maryland; the Social, Statistical, and Environmental Sciences Unit, RTI International, Research Triangle Park (A.D., M.M.C.), and the Duke Clinical Research Institute, Duke University School of Medicine (R.G.G., P.B.S.), and the Department of Pediatrics, Duke University (S.K.S.), Durham - all in North Carolina; Emory University School of Medicine, Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta (B.B.P.); the Office of Research and Sponsored Programs, Florida Gulf Coast University, Fort Myers (R.D.H.), and the Department of Pediatrics, University of South Florida, Tampa (T.W.); St. Elizabeth Healthcare, Edgewood (W.R.), and the Department of Pediatrics, University of Louisville, Louisville (S.T., L.A.D.) - both in Kentucky; the Division of Neonatology, Department of Pediatrics, ChristianaCare, Newark, DE (D.A.P.); the University of New Mexico School of Medicine, Albuquerque (J.R.M.); the Department of Pediatrics, Division of Neonatology, University of Utah School of Medicine, Salt Lake City (C.M.F.); the Department of Pediatrics, University at Buffalo, Buffalo (A.M.R.), and the University of Rochester School of Medicine and Dentistry, Rochester (J. Riccio) - both in New York; the Oklahoma University Health Sciences Center, Oklahoma City (D.W.H.); the Medical University of South Carolina, Health Shawn Jenkins Children's Hospital, Charleston (J. Ross), and the Department of Pediatrics, Spartanburg Regional Medical Center, Spartanburg (J.B.) - both in South Carolina; the Section on Newborn Medicine, Pennsylvania Hospital (K.M.P.), and the Hospital of the University of Pennsylvania (L.C.), Philadelphia; the Kapiolani Medical Center for Women and Children, Honolulu (K.W.R., A.); the Department of Pediatrics, University of Mississippi Medical Center, Jackson (L.T.); Winchester Hospital, Winchester, MA (K.R.M.); the Department of Pediatrics, University of Kansas Medical Center (K.D.), and Children's Mercy Hospital (J.W.) - both in Kansas City, MO; Sanford Health, Sioux Falls, SD (J.R.W.); Tulane University School of Medicine, New Orleans (M.P.H.); and the University of Nebraska Medical Center, Omaha (S.N.).

The New England Journal of Medicine
|May 1, 2023
PubMed
Summary

The Eat, Sleep, Console approach significantly reduced hospital stay for infants with neonatal opioid withdrawal syndrome. This new method safely decreased time to discharge readiness without increasing adverse outcomes.

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Area of Science:

  • Neonatology
  • Pediatric Pharmacology
  • Public Health

Background:

  • The Finnegan Neonatal Abstinence Scoring Tool is traditionally used for neonatal opioid withdrawal.
  • The Eat, Sleep, Console (ESC) care approach is a newer, function-based alternative gaining traction.
  • The safety and efficacy of the ESC approach across diverse clinical settings remain under investigation.

Purpose of the Study:

  • To evaluate if the Eat, Sleep, Console care approach can safely shorten the time to medical readiness for discharge in infants with neonatal opioid withdrawal syndrome.
  • To compare the ESC approach with traditional Finnegan tool-based care in a multi-site trial.

Main Methods:

  • A cluster-randomized controlled trial involving 26 U.S. hospitals.
  • Infants born at 36 weeks' gestation or more with neonatal opioid withdrawal syndrome were enrolled.
  • Hospitals transitioned from usual care to the ESC approach, with staff training provided.

Main Results:

  • The study enrolled 1305 infants; 837 met the readiness for discharge criteria.
  • Infants in the ESC group were ready for discharge in a mean of 8.2 days, compared to 14.9 days in the usual care group (adjusted mean difference, 6.7 days).
  • The incidence of adverse outcomes was comparable between the ESC and usual care groups.

Conclusions:

  • The Eat, Sleep, Console care approach significantly reduced the time to medical readiness for hospital discharge for infants with neonatal opioid withdrawal syndrome.
  • This approach demonstrated similar safety outcomes compared to traditional care, suggesting it can be broadly applied.
  • The findings support the wider adoption of the ESC approach in clinical practice.