Population-Level Changes in Infant Outcomes Associated With State "Eat Sleep Console" Initiative

Massachusetts implemented the "Eat, Sleep, Console" (ESC) initiative to manage neonatal abstinence syndrome (NAS) through its state Perinatal-Neonatal Quality Improvement Network (PNQIN) starting in 2017. This study examined the population-level changes in infant outcomes associated with the implementation of the initiative.

We used Massachusetts' Pregnancy to Early Life Longitudinal (PELL) Data System, a population-based data system linking live birth certificates and fetal death records to corresponding hospital discharge records for birthing women and infants over time. Our study included full-term, normal-weight singletons with NAS, based on recorded diagnosis codes, born in Massachusetts from 2012 to 2019. Interrupted time-series analysis assessed the changes in birth hospitalization length of stay (LOS) and costs, as well as monthly rates of 30-, 60- and 90-day infant readmissions before (2012-2016) and after (2018-2019) initiative implementation. Analyses were conducted in 2024.

We identified 5857 infants with NAS; the majority were non-Hispanic white (85.2%) and were covered by public insurance (89.7%). Implementation of the initiative was associated with decreased average total cost of birth hospitalizations (-$5763, 95% CI = -$9705, -$1820). Although not significantly associated with initiative implementation, there was a downward trend in LOS during both the pre-initiative and post-initiative periods. No significant difference was found in infant readmissions.

Implementation of the ESC initiative was associated with a population-level decrease in the average total cost of birth hospitalizations for infants with NAS. Future research may explore the drivers of cost reductions and assess differences by demographic subgroups.