Eat, sleep, console method and the management of neonatal opioid withdrawal syndrome: A literature review

Rhoads, Sarah C.; Waskosky, Aksana

doi:10.1016/j.jnn.2021.10.006

Cited by 3 publications

(4 citation statements)

References 14 publications

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“…Therefore, correctly identifying as many of the opioid-exposed infants who may have previously been identified as P04.49 (the "other drugs" category) is a worthwhile objective. The timing of the introduction of code P04.14 coincided with increased use of the ESC method for determining the need for pharmacologic therapy, 13 which could also affect the total numbers of opioid exposure diagnoses, 14…”

Section: Discussionmentioning

confidence: 99%

“…First, it was limited by our inability to control for the use of ESC protocol, which increased during the period observed. 13 ESC reduces the use of pharmacologic therapy by recommending treatment be given only to infants who cannot eat, sleep, or be consoled. Physicians may use code P04.14 in place of code P96.1 if the infant does not have withdrawal symptoms severe enough to require pharmacologic treatment 15 and, as a result, fewer infants may be receiving a NOWS diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, correctly identifying as many of the opioid-exposed infants who may have previously been identified as P04.49 (the “other drugs” category) is a worthwhile objective. The timing of the introduction of code P04.14 coincided with increased use of the ESC method for determining the need for pharmacologic therapy, 13 which could also affect the total numbers of opioid exposure diagnoses, 14 the use of code P04.14 in place of code P96.1, and the use of multiple opioid exposure codes during the course of treatment. To obtain the most accurate measure of neonatal opioid exposure, states should monitor the use of codes P96.1 and P04.14 and should consider monitoring code P04.49 if resources are available.…”

Section: Discussionmentioning

confidence: 99%

“…12 Before the introduction of code P04.14, the less specific code P04.49, which refers to "other" drug exposure, was sometimes used. 9 The introduction of code P04.14 coincided with many hospitals moving to the "eat, sleep, console" (ESC) method of treating NOWS, 13 which recommends that pharmacologic therapy be used only for infants who cannot eat, sleep, or be consoled. 14 This change in treatment protocol could reduce NOWS diagnoses in favor of opioid exposure diagnoses.…”

mentioning

confidence: 99%

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Trends in Neonatal Opioid Withdrawal Syndrome and Opioid Exposure Diagnoses Among Infants With Private Health Insurance, 2016-2021: Introduction of the P04.14 ICD-10-CM Code

et al. 2023

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Objective: The opioid epidemic has led to a surge in diagnoses of neonatal opioid withdrawal syndrome (NOWS). Many states track the incidence of NOWS by using the P96.1 International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code for “neonatal withdrawal symptoms from maternal use of drugs of addiction.” In October 2018, an ICD-10-CM code for neonatal opioid exposure (P04.14) was introduced. This code can be used when an infant is exposed to opioids in utero but does not have clinically significant withdrawal symptoms. We analyzed the effect of the P04.14 code on the incidence rate of NOWS (P96.1) and “other” neonatal drug exposure diagnoses (P04.49). Methods: We used private health insurance data collected for infants in the United States from the first quarter of 2016 through the third quarter of 2021 to describe incidence rates for each code over time and examine absolute and percentage changes before and after the introduction of code P04.14. Results: The exclusive use of code P96.1 declined from an incidence rate per 1000 births of 1.08 in 2016-2018 to 0.70 in 2019-2021, a −35.7% (95% CI, −47.6% to −23.8%) reduction. Use of code P04.49 only declined from an incidence rate of 2.34 in 2016-2018 to 1.64 in 2019-2021, a −30.0% (95% CI, −36.4% to −23.7%) reduction. Use of multiple codes during the course of treatment increased from an average incidence per 1000 births of 0.56 in 2016-2018 to 0.79 in 2019-2021, a 45.5% (95% CI, 24.8%-66.1%) increase. Conclusion: The introduction of ICD-10-CM code P04.14 altered the use of other neonatal opioid exposure codes. The use of multiple codes increased, indicating that some ambiguity may exist about which ICD-10-CM code is most appropriate for a given set of symptoms.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Trends in Neonatal Opioid Withdrawal Syndrome and Opioid Exposure Diagnoses Among Infants With Private Health Insurance, 2016-2021: Introduction of the P04.14 ICD-10-CM Code

et al. 2023

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Implementing the eat, sleep, console method into a tertiary care delivery center

Rhoads,

Waskosky,

Thomas

2025

Journal of Neonatal Nursing

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A mini review of what matters in the management of NAS, is ESC the best care?

Pomar

2023

Front. Pediatr.

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As the use of opioids and polysubstance by pregnant women has increased over the years, there has also been a sharp increase in cases of neonatal abstinence syndrome (NAS). Classically, infants affected by NAS have been cared for in neonatal intensive care units resulting in an increase of healthcare expenditure and resource utilization as well as separation from the families. Consequently, the Eat, Sleep, and Console (ESC) tool was developed and promoted as a novel method that focuses on maternal/infant dyad during hospital stay while decreasing the use of pharmacological interventions and therefore decreasing the length of stay and healthcare expenditure. Thus, it has been implemented in several hospitals in the United States. Although the training of staff has been proposed and the interventions of sleep, eat, and console are defined, there still exists a lack of standardization of this practice specifically in regard to the type of associated non-pharmacological practices as well as the reports of its short- and long-term outcomes.

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Eat, sleep, console method and the management of neonatal opioid withdrawal syndrome: A literature review

Cited by 3 publications

References 14 publications

Trends in Neonatal Opioid Withdrawal Syndrome and Opioid Exposure Diagnoses Among Infants With Private Health Insurance, 2016-2021: Introduction of the P04.14 ICD-10-CM Code

Trends in Neonatal Opioid Withdrawal Syndrome and Opioid Exposure Diagnoses Among Infants With Private Health Insurance, 2016-2021: Introduction of the P04.14 ICD-10-CM Code

Implementing the eat, sleep, console method into a tertiary care delivery center

A mini review of what matters in the management of NAS, is ESC the best care?

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