Is Eat, Sleep, Console the Key to Safer and Faster Discharge for Newborns with Neonatal Opioid Withdrawal Syndrome?

In 2023, a multicenter trial involving 26 units using “Eat, Sleep, and Console” (ESC) versus traditional care for babies exposed prenatally to opioids found the effectiveness of the ESC approach in reducing the length of stay in the hospital, decreased medication use, and enhanced family involvement in managing Neonatal Opioid Withdrawal Syndrome (NOWS).

Understanding Neonatal Opioid Withdrawal Syndrome (NOWS) or Neonatal Abstinence Syndrome (NAS)

NAS/NOWS occurs in newborns exposed to opioids during pregnancy, leading to withdrawal symptoms after birth. Traditional management often involves pharmacological interventions and extended hospital stays.

The “Eat, Sleep, Console” (ESC) Approach

The ESC method focuses on assessing three primary functions:

• Eating: The baby’s ability to feed effectively.
• Sleeping: The capacity to sleep undisturbed for at least an hour.
• Consoling: The ease with which the baby can be comforted when distressed.

By monitoring these behaviors, healthcare providers determine the necessity of medical interventions, emphasizing non-pharmacological care such as swaddling, skin-to-skin contact, and a quiet environment.

Benefits of the ESC Method

The study’s conclusions demonstrate the significant benefits of the ESC model:

• Reduced Hospital Stay: Infants in the ESC group had a 45% reduction in length of stay (LOS) compared to those assessed with the traditional Finnegan Neonatal Abstinence Scoring System (FNASS). The mean LOS for the ESC group was 8.2 days, compared to 14.9 days in the usual care group.
• Decreased Medication Use: The ESC approach led to a 30% reduction in opioid treatment initiation. In the ESC group, only 19.5% of infants required pharmacological intervention, compared to 52% in the usual care group.
• Comparable Safety Outcomes: The study found no increase in adverse outcomes among ESC-treated infants, with rates of safety events remaining comparable between the ESC and usual care groups (16.1% vs. 15.8%).
• Enhanced Family Involvement: The ESC model empowers parents to take an active role in their infant’s care, fostering bonding and confidence in managing their newborn’s needs.

Study Conclusion

The findings from this study indicate that the ESC approach significantly decreases the length of hospital stay and the need for pharmacological treatment without compromising infant safety. As healthcare continues to evolve, ESC highlights the importance of individualized, non-pharmacological care in neonatal medicine.

Citation

Young, Leslie W., et al. “Eat, Sleep, Console Approach or Usual Care for Neonatal Opioid Withdrawal.” New England Journal of Medicine, vol. 388, no. 25, 30 Apr. 2023, https://doi.org/10.1056/nejmoa2214470.