Daily Dose: "Eat, Sleep, Console" Approach for Neonatal Opioid Withdrawal

Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

On May 2, 2023, we reported on a study published in NEJM that examined the safety, efficacy, and generalizability of the Eat, Sleep, Console (ESC) approach as compared with usual care for neonatal opioid withdrawal syndrome (NOWS).

The study

Investigators enrolled 1305 infants with NOWS born at ≥36 weeks’ gestation at 26 sites described in the study as geographically diverse, including both academic centers and community hospitals. In randomly assigned order, hospitals transitioned from care for infants with NOWS that used the Finnegan tool to care directed by the ESC approach. Staff was trained on the use of the new approach during a 3-month transition period during which no infants were enrolled. Baseline characteristics between the usual care group (n= 702) and ESC group (n-603) were similar.

The findings

Of the 1305 infants enrolled, 837 (64%) met the trial definition of readiness for discharge. In an intention-to-treat analysis of these infants, the number of days from birth until readiness for hospital discharge was 8.2 in the ESC group and 14.9 in the usual-care group (adjusted mean difference, 6.7 days; 95% CI, 4.7 to 8.8), for a rate ratio of 0.55 (95% CI, 0.46 to 0.65; P<.001). The effect of ESC was consistent during the trial, despite some heterogeneity across treatment sites. Mean length of hospital stay was shorter for infants treated with ESC than for those treated using the Finnegan tool at 7.8 days vs 14.0 days (mean difference, 6.2 days; 95% CI, 4.6 to 7.7; rate ratio, 0.56; 95% CI, 0.49 to 0.64).

There was a very significant difference between the 2 groups in use of opioids: 52% in the usual care group vs 19.5% in the ESC group (absolute difference, 32.5 percentage points; relative risk, 0.38; 95% CI, 0.30 to 0.47).

Note from authors

"The observed treatment effect for this trial, which was greater than hypothesized, supports the generalizability of the Eat, Sleep, Console approach across diverse sites and varied populations, including those not previously represented in the literature. Although heterogeneity in treatment effect was anticipated, given the variation known to exist across hospitals, further study of potential contributors (eg, site variation in population, location of care, and use of nonpharmacologic interventions as part of usual care) is warranted and will further inform the use of this care approach."

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