Influence of Eat, Sleep, and Console on Infants Pharmacologically Treated for Opioid Withdrawal
Authors: Lori A. Devlin, Zhuopei Hu, Stephanie L. Merhar, Songthip T. Ounpraseuth, Alan E. Simon, Jeannette Y. Lee, Abhik Das, Margaret M. Crawford, Rachel G. Greenberg, P. Brian Smith, Rosemary D. Higgins, Michele C. Walsh, Ward Rice, David A. Paul, Jessie R. Maxwell, Camille M. Fung, Tanner Wright, 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, 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 The function-based eat, sleep, console (ESC) care approach substantially reduces the proportion of infants who receive pharmacologic treatment for neonatal opioid withdrawal syndrome (NOWS). This reduction has led to concerns for increased postnatal opioid exposure in infants who receive pharmacologic treatment. However, the effect of the ESC care approach on hospital outcomes for infants pharmacologically treated for NOWS is currently unknown. Objective To evaluate differences in opioid exposure and total length of hospital stay (LOS) for pharmacologically treated infants managed with the ESC care approach vs usual care with the Finnegan tool. Design, Setting, and Participants This post hoc subgroup analysis involved infants pharmacologically treated in ESC-NOW, a stepped-wedge cluster randomized clinical trial conducted at 26 US hospitals. Hospitals maintained pretrial practices for pharmacologic treatment, including opioid type, scheduled opioid dosing, and use of adjuvant medications. Infants were born at 36 weeks’ gestation or later, had evidence of antenatal opioid exposure, and received opioid treatment for NOWS between September 2020 and March 2022. Data were analyzed from November 2022 to January 2024. Exposure Opioid treatment for NOWS and the ESC care approach. Main Outcomes and Measures For each outcome (total opioid exposure, peak opioid dose, time from birth to initiation of first opioid dose, length of opioid treatment, and LOS), we used generalized linear mixed models to adjust for the stepped-wedge design and maternal and infant characteristics. Results In the ESC-NOW trial, 463 of 1305 infants were pharmacologically treated (143/603 [23.7%] in the ESC care approach group and 320/702 [45.6%] in the usual care group). Mean total opioid exposure was lower in the ESC care approach group with an absolute difference of 4.1 morphine milligram equivalents per kilogram (MME/kg) (95% CI, 1.3-7.0) when compared with usual care (4.8 MME/kg vs 8.9 MME/kg, respectively; P = .001). Mean time from birth to initiation of pharmacologic treatment was 22.4 hours (95% CI, 7.1-37.7) longer with the ESC care approach vs usual care (75.4 vs 53.0 hours, respectively; P = .002). No significant difference in mean peak opioid dose was observed between groups (ESC care approach, 0.147 MME/kg, vs usual care, 0.126 MME/kg). The mean length of treatment was 6.3 days shorter (95% CI, 3.0-9.6) in the ESC care approach group vs usual care group (11.8 vs 18.1 days, respectively; P &amp;amp;lt; .001), and mean LOS was 6.2 days shorter (95% CI, 3.0-9.4) with the ESC care approach than with usual care (16.7 vs 22.9 days, respectively; P &amp;amp;lt; .001). Conclusion and Relevance When compared with usual care, the ESC care approach was associated with less opioid exposure and shorter LOS for infants pharmacologically treated for NOWS. The ESC care approach was not associated with a higher peak opioid dose, although pharmacologic treatment was typically initiated later. Trial Registration ClinicalTrials.gov Identifier: NCT04057820