Infant Feeding and Weight Trajectories in the Eat, Sleep, Console Trial
Authors: Stephanie L. Merhar, Zhuopei Hu, Lori A. Devlin, Songthip T. Ounpraseuth, Alan E. Simon, P. Brian Smith, Michele C. Walsh, Jeannette Y. Lee, Abhik Das, Rosemary D. Higgins, Margaret M. Crawford, Ward Rice, David A. Paul, Jessie R. Maxwell, Sucheta D. Telang, Camille M. Fung, Tanner Wright, Anne-Marie Reynolds, Devon Hahn, Julie Ross, Jennifer M. McAllister, Moira Crowley, Sophie K. Shaikh, Lori Christ, Jaime Brown, Julie Riccio, Kara Wong Ramsey, Erica F. Braswell, Lauren Tucker, Karen McAlmon, Krishna Dummula, Julie Weiner, Jessica R. White, Meghan P. Howell, Sarah Newman, Jessica N. Snowden, Leslie W. Young, De Ann Hubberd, Kathy Edwards, Bonny L. Whalen, Kate MacMillan, Adrienne Pahl, Farrah Sheehan Desselle, Katie White, Anna Marie Hibbs, Leslie Clarke, Kathy Serio, Maria Kertesz, Ashley Rodriguez, Sarah Driscoll, Kim Hammond, Deborah Hines, Patricia Kish, Taylor Schmidt, Jennifer Stepp, Jodi Jackson, Allie Scott, Rochelle Brown, Kari Smith, My Rieper, Carrie Miner, Lynne Ray, Karen Kowel, Victoria Reynolds, Diana Castellone, Amy Mackley, Kurt Schibler, Traci Beiersdorfer, Cathy Grisby, Kristin Kirker, Katherine McKeown, M. Katherine Loudermilk, Amy Carnohan, Patti Froese, April Haddix, Virginia Summe, Clara Chlon, Rita Kunk, Jen Hamilton, Sadie Moore, Angela Ziegelmeyer, Lucy Rolfes, Erica Schomaker, Holly Strike, Sharon Harvey, Paula Richards, Ashley Simon, David Russell, Christine A. Gleason, Marilee C. Allen, Robert J. Boyle, Traci Clemons, Mary E. D’Alton, Robin Steinhorn, Steven J. Weiner, Carol J. Blaisdell, Stephanie Wilson Archer, Annette Amiotte, Moara Santos, Jill Taosaka, Charles Neal, Andrew M. Atz, Andrea Summer, Michelle Amaya, Mary Freeman, Madison Johnson, Layla Al Sarraf, Rosemary Ros-Demarize, Pablo J. Sánchez, Jonathan L. Slaughter, Kristen Benninger, Patricia Luzader, Laura Marzec, Brittany DeSantis, Kristi Small, Julia Newton, Jessica Purnell, Rachel Reedy, Cory Hanlon, Tanvi Naik, Jordan Knox, Aishwarya Tallikar, Chelsea Cobe, Megan Resetar, Jacqueline McCool, Erin Frailey, Stephanie Jones, Stacy Williams, Taise Staton, Jacqueline N. Palmer, Jana L. Erner, Jason B. Kovalcik, Erin L. Keels, Teri McCarty, Katherine Harris, Meagan DeSpain, Jackie Boyd, Sara Watson, Jan Sullivan, Timothy Walsh, Brianna Anderson, Devon Hahn, Christi Madden, Anne Nascimbeni, Shannon Wilson, Theresa Gibson, John Karlin, Carla M. Bann, Jeanette O’Donnell Auman, Eugene Turner, Emily Smith, Lauren Bradley, Lillian Trochinski, Jenna Gabrio, David Leblond, James Pickett, Jamie E. Newman, Kristin M. Zaterka-Baxter, Michelle L. Baack, Laurie A. Hogden, Chelsey Elenkiwich, Megan M. Henning, Sarah Van Muyden, Anna-Lisa Martino, Allison Lutz, Jeralyn Nelson, Bette Schumacher, Aimee Brodkorb, Deborah Pritchett, Kristen Ford, Darla Howard, Ryan Orland, Monique Diles, Kay L. Shuttleworth, DeAnn E. Hubberd, Kathy D. Edwards, Sherry L. Lloyd, Catrice Banks-Johnson, Patrina Robinson, Melissa Griffith, Amie Slaughter, Teresa Kilkenny, Kristina Foster, Morgan Cross, Jessica Gier, Natalie Roberts, Jessica Wadman, Kathy Cathey, Jenna Todd, Emily Fratesi, Lacy Malloch, Radha Alur, Joseph Marc Majure, Courtney Walker, Catherine Powers, Robert D. Annett, Rachel Wellman, Kerry Miller, Ann Anderson-Berry, Hengameh Raissy, Alberta Kong, Kate McCalmont, Sandra Sundquist Beauman, Sarah Sanders, Eric C. Eichenwald, Toni Mancini, Kristina Ziolkowski, Megan Dhawan, Mary Kay Gambacorta, Allie Pulsifer, Marisa Brant, Aida Schumacher, Sydney Gocial, Kristen Azuma, Elizabeth Quigley, Whitney Zachritz, Nicole Pastore, Jessica Barber, Abby McDowell, Alissa Ferri, Joanna Parga-Belinkie, Ronnie Guillet, Rosemary L. Jensen, Alison Kent, Ann Marie Scorsone, Satyan Lakshminrusimha, Michelle E. Hartley-McAndrews, Emily Li, Jennifer Donato, Kimberly G. McKee, Carl D’Angio, Rachel Jones, Dacia Terrano, Stephanie Solpietro, Lisa Brei, Lisa Krokovich, Sema Hart, John Pastore, Ashley Kern, Margaret Mars, Patricia Volker, Annette Mioneo Brady, Kelsey Voelker, Emily Horn, Melissa Moreland, Marcia Kneusel, Maya Balakrishnan, Jillian Childres, Melissa Hanniman, Rebecca White, Robin K. Ohls, Mariana Baserga, Bhanu Muniyappa, Julie Shakib, Carrie A. Rau, Shawna Baker, Kathie Coleman, Kandace M. McGrath, Brandy Petersen, Jael Waldvogel, Monika Bracken, Meredith Ferrin, Holly DeSantis, Traci Perkins, Manndi C. Loertscher, Karen McAlmon, Justin Goldstein, Asimenia Angelidou, Nancy Donahue
Journal: JAMA Pediatrics (2024)

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