Infant Feeding and Weight Trajectories in the Eat, Sleep, Console Trial: A Secondary Analysis of a Randomized
Stephanie L Merhar1,2, Zhuopei Hu3, Lori A Devlin4
1Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Insights
The Eat, Sleep, Console (ESC) approach for neonatal opioid withdrawal syndrome (NOWS) improved breastfeeding initiation and continuation. Infants in the ESC group showed no significant difference in weight loss compared to standard care.
Area of Science:
- Neonatal care
- Pediatric pharmacology
- Public health
Background:
- Neonatal opioid withdrawal syndrome (NOWS) affects infants exposed to opioids in utero.
- The Eat, Sleep, Console (ESC) approach is a non-pharmacologic care strategy for NOWS.
- Previous studies show ESC reduces pharmacologic treatment and hospital stays, but its effect on infant feeding and weight is unclear.
Purpose of the Study:
- To compare feeding practices and weight trajectories in infants with NOWS managed with the ESC approach versus standard care.
- To evaluate the impact of ESC on breastfeeding initiation, exclusivity, and continuation.
- To assess weight loss patterns in infants managed with ESC compared to standard care.
Main Methods:
- A cluster randomized trial (ESC-NOW) involving 26 US hospitals and 1305 infants with NOWS.
- Infants were managed with either usual care (Finnegan Neonatal Abstinence Scoring Tool) or the ESC intervention.
- Feeding and weight outcomes were assessed at hospital discharge, with growth analyzed using z scores.
Main Results:
- A higher proportion of infants in the ESC group initiated breastfeeding (52.7% vs 41.7%) and received exclusive or any breast milk.
- Direct breastfeeding at discharge was significantly higher in the ESC group (35.2% vs 19.5%).
- No significant differences were observed in the proportion of infants experiencing weight loss greater than 10% or in maximum percentage weight loss between groups.
Conclusions:
- The ESC approach is associated with improved breastfeeding outcomes for infants with NOWS.
- These improvements may be linked to reduced pharmacologic treatment and enhanced non-pharmacologic care within the ESC model.
- ESC care demonstrates potential benefits for infant feeding without compromising weight management.
Importance:
Infants with neonatal opioid withdrawal syndrome (NOWS) cared for with the Eat, Sleep, Console (ESC) care approach receive less pharmacologic treatment and have shorter hospital stays compared to usual care with the Finnegan Neonatal Abstinence Scoring Tool, but the effects of these approaches on feeding and weight are unknown.
Objective:
To evaluate feeding practices and weight trajectories in infants cared for with ESC vs usual care.
Design, Setting, And Participants:
ESC-NOW is a cluster randomized trial of infants with NOWS born at 36 weeks' gestation or later at 26 US hospitals from September 2020 to March 2022. Each site transitioned from usual care to ESC (the study intervention) at a randomized time. Feeding was per site practice and not specified by the intervention. Feeding and weight outcomes were assessed at hospital discharge.
Intervention:
ESC vs usual care.
Main Outcomes And Measures:
Outcomes include prospectively identified secondary end points related to feeding and weight. z Scores were used for growth to account for corrected gestational age at the time of measurement. All analyses were intention to treat and adjusted for study design. Maternal/infant characteristics were included in adjusted models.
Results:
The analyses included 1305 infants (702 in usual care and 603 in ESC; mean [SD] gestational age, 38.6 [1.3] weeks; 655 [50.2%] male and 650 [49.8%] female). Baseline demographic characteristics were similar between groups. The proportion of breastfed infants was higher in the ESC group (52.7% vs 41.7%; absolute difference, 11%; 95% CI, 1.0-20.9). A higher proportion of infants cared for with ESC received exclusive breast milk (15.1% vs 6.7%; absolute difference, 8.4%; 95% CI, 0.9-5.8) or any breast milk (38.8% vs 27.4%; absolute difference, 11.4%; 95% CI, 0.2-23.1) and were directly breastfeeding at discharge (35.2% vs 19.5%; absolute difference, 15.7%; 95% CI, 4.1-27.3). There was no difference in proportion of infants with weight loss greater than 10% or maximum percentage weight loss, although infants cared for with ESC had a lower weight z score on day of life 3 (-1.08 vs -1.01; absolute difference, 0.07; 95% CI, 0.02-0.12). When pharmacologic treatment was added into the model, no breastfeeding outcomes were statistically significant.
Conclusions And Relevance:
In this study, infants cared for with ESC were more likely to initiate and continue breastfeeding and had no difference in percentage weight loss. The improvement in breastfeeding with ESC may be driven by reduction in pharmacologic treatment and provision of effective nonpharmacologic care.
Trial Registration:
ClinicalTrials.gov Identifier: NCT04057820.
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