New Care Approach Lowers Opioid Use and Hospital Stay in Infants with opioid Withdrawal Syndrome: Study

A recent study published in the Journal of American Medical Association demonstrated that a novel care method, the eat, sleep, console (ESC) approach, substantially lowers opioid exposure and the length of hospital stays for infants with neonatal opioid withdrawal syndrome (NOWS) when compared to the traditional care practices.

The study was conducted from September 2020 to March 2022 and included a total of 463 infants across 26 U.S. hospitals as part of the ESC-NOW clinical trial. These infants were born at 36 weeks of gestation or later with evidence of antenatal opioid exposure and were pharmacologically treated for NOWS under two different care protocols, which is the ESC care approach and the usual care using the Finnegan scoring tool.

The results revealed that infants managed with the ESC care approach had significantly lower total opioid exposure, with a mean difference of 4.1 morphine milligram equivalents per kilogram (MME/kg) when compared to the individuals who receive usual care. Also, infants in the ESC group received an average of 4.8 MME/kg, whereas the infants in the usual care group received 8.9 MME/kg.

This study found that initiation of pharmacologic treatment was delayed by an average of 22.4 hours in the ESC group that allowed more time for non-pharmacological interventions and assessments. Also, there was no significant increase in the peak opioid dose required by suggesting that the ESC approach does not compromise the efficacy of the treatment when pharmacological intervention is necessary.

One of the most significant findings was the reduction in both the length of opioid treatment and total length of hospital stay. Infants in the ESC care group completed their treatment 6.3 days earlier than the infants in the usual care group and were discharged from the hospital an average of 6.2 days earlier. This not only suggests better outcomes for the infants but also indicates potential cost savings and more efficient use of hospital resources. Overall, the ESC method offers a more compassionate and sustainable option for treating vulnerable newborns exposed to opioids in utero by focusing on supportive care measures that allow for natural parental involvement and less reliance on medications.

Source:

Devlin, L. A., Hu, Z., Merhar, S. L., Ounpraseuth, S. T., Simon, A. E., Lee, J. Y., Das, A., Crawford, M. M., Greenberg, R. G., Smith, P. B., Higgins, R. D., Walsh, M. C., Rice, W., Paul, D. A., Maxwell, J. R., Fung, C. M., Wright, T., Ross, J., … McAllister, J. M. (2024). Influence of Eat, Sleep, and Console on Infants Pharmacologically Treated for Opioid Withdrawal. In JAMA Pediatrics. American Medical Association (AMA). https://doi.org/10.1001/jamapediatrics.2024.0544