In the United States, at least one infant is born with Neonatal Opioid Withdrawal Syndrome (NOWS) every 24 minutes. Opioid-exposed newborns with NOWS can have symptoms including tremors, excessive crying and irritability as well as problems with consoling, feeding, and sleeping.
U.S. hospitals and birthing centers have widely used different approaches for assessing how to care for babies with NOWS. Many have expressed interest in implementing a promising approach called the Eat, Sleep, Console (ESC) care approach. Recent research results show the ESC care approach performed better on short-term outcomes than traditional approaches for treating opioid-exposed infants and a study to obtain long-term safety and outcome data is underway. In the meantime, a new planning resource outlines several preliminary steps hospitals can take when considering future implementation.
Considerations for Implementing the ESC Approach
For hospitals and birthing centers interested in the ESC care approach, the new planning resource outlines processes and steps that incorporate the structured ESC Care Tool™. The tool, developed by pediatricians and neonatologists, helps hospitals standardize ESC assessments, optimize non-pharmacologic care, and determine next steps in management for opioid-exposed newborns using the ESC care approach.
The new planning resource contains:
· Background information on NOWS and the ESC care approach
· A summary of recent clinical trial results
· A list of foundational components
· Steps to help plan for implementation
· Links to additional key resources and recommended reading
Caring for Infants with NOWS
For approximately 50 years, the Finnegan Neonatal Abstinence Scoring Tool (FNAST) has been the most commonly used tool to assess opioid-exposed newborns, but it can be subjective. Another concern is that it may overestimate the need to treat infants with opioid medications to manage their withdrawal symptoms.
The ESC care approach is meant to empower families in the care of their infants through education and shared decision making, which can build trust and help families feel valued and supported. It provides a function-based assessment of withdrawal severity centered around how well an infant can eat, sleep, and be consoled. ESC prioritizes non-pharmacologic care, including holding, swaddling, and rocking in low-stimulus environments, as first-line treatment.
New Data on the ESC Care Approach
The planning resource includes a summary of recent clinical trial results published in the New England Journal of Medicine. The research study, which was funded through the Helping to End Addiction Long-term® Initiative, or NIH HEAL Initiative®, assessed the effectiveness of the ESC care approach. Among 1,306 infants enrolled across 26 U.S. hospitals, researchers found that newborns cared for with ESC were medically ready for discharge approximately 6.7 days earlier than those cared for with FNAST. The study also showed that infants cared for with ESC were about 63% less likely to receive medication as part of their treatment.
At 3 months of age, there were no significant differences in the safety outcomes experienced by infants treated with the ESC care approach compared to those treated with the traditional approach. A two-year follow-up study is ongoing to further inform the long-term safety of the ESC care approach.
Read the planning resource, Considerations for Implementing the Eat, Sleep, Console Care Approach.