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

What can be learned when 26 hospitals move from using the Finnegan Neonatal Abstinence Scoring Tool, to assess the severity of neonatal opioid withdrawal, to a newer function-based approach — the Eat, Sleep, Console care approach?

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

Published in The New England Journal of Medicine, June 2023

Summary in plain English :

In the United States, a newborn is diagnosed with neonatal opioid withdrawal syndrome every 18 minutes due to exposure to opioids during pregnancy. This syndrome causes symptoms like stomach issues, fussiness, muscle stiffness, and seizures, leading to longer hospital stays. Current care for these babies varies because there's no standard approach, especially when it comes to using medications, which affects how long they stay in the hospital.

For nearly half a century, subjective scales have been used to assess the severity of this syndrome and decide when to use drugs. Despite concerns that this approach might lead to unnecessary treatment, it's still the main method because there hasn’t been a better alternative.

In 2014, a new approach called "Eat, Sleep, Console" was suggested for assessing these babies. More recently, this approach has gained popularity and is used alongside the Finnegan Neonatal Abstinence Scoring Tool. It focuses on evaluating the baby's ability to eat, sleep, and be comforted and promotes non-medical treatments first, like creating a calm environment, skin-to-skin contact, clustered care, and breastfeeding. Several quality-improvement programs have found this approach better than the old one, and it's being adopted in medical practice.

However, some people worry about its rapid adoption without solid evidence to support its safety and effectiveness across different situations and patient groups. There's concern that it might lead to undertreatment with medication and early discharge, putting babies at risk for readmission, harm, or even death.

To address these concerns, the Advancing Clinical Trials in Neonatal Opioid Withdrawal (ACT NOW) collaborative, part of the National Institutes of Health's Helping to End Addiction Long-term (HEAL) Initiative, was formed. They conducted a controlled trial called "Eating, Sleeping, Consoling for Neonatal Opioid Withdrawal (ESC-NOW)" to see how safe, effective, and applicable the "Eat, Sleep, Console" approach is compared to the usual approach with the Finnegan tool.

Primary Outcome:

On average, babies in the "Eat, Sleep, Console" group were ready to go home 8.2 days after they were born, while those in the usual-care group took longer, 14.9 days. This is a difference of almost a full week.

Secondary Outcomes:

In the usual-care group, 52.0% of babies received opioid treatment, whereas in the "Eat, Sleep, Console" group, only 19.5% did. This is a substantial difference of 32.5 percentage points.

When looking at the safety of the infants up to 3 months of age, both groups had similar rates of adverse outcomes, with 16.1% in the "Eat, Sleep, Console" group and 15.8% in the usual-care group.

Result:

In this study conducted across multiple medical centers, a randomized and controlled trial found that use of the Eat, Sleep, Console care approach significantly decreased the number of days until infants with neonatal opioid withdrawal syndrome were medically ready for discharge, compared to the usual-care approach, without increasing specified adverse outcomes

Many thanks to the authors of this article: Young LW et al.

The full report is accessible here: https://doi.org/10.1056/NEJMoa2214470