Using the Eat Sleep Console Model to Promote Optimal Care and Outcomes for Infants With Neonatal Abstinence Syndrome

Haaland, Grace; Kunkel, Melissa; Nguyen, Chi Mai; Wonder, Amy Hagedorn

doi:10.1097/anc.0000000000001028

Cited by 5 publications

(1 citation statement)

References 32 publications

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“…In response to these challenges, we adopted a familycentered, nonpharmacological approach called "Eat, Sleep, Console (ESC)." [8][9][10][11] This approach prioritizes feeding, sleeping, and consoling the infants as primary management strategies for NOWS. 8 A study conducted by Grossman et al in 2017 demonstrated a significant decrease in length of stay (LOS) from 22.4 to 5.9 days and a substantial reduction in morphine use from 98% to 14% after implementing a quality improvement (QI) approach that centered around nonpharmacological therapies and a simplified assessment using the ESC model.…”

Section: Introductionmentioning

confidence: 99%

Quality Improvement in Neonatal Care: Successful Adoption of the Eat, Sleep, Console Protocol in a Rural Hospital Setting

Phyu,

Bird,

Gupta

2024

Pediatric Quality &Amp; Safety

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Introduction: The United States faces a growing burden of neonatal opioid withdrawal syndrome in rural hospitals. Traditional treatments often extend hospital stays and medication use. The Eat, Sleep, and Console (ESC) approach offers a new management strategy but is challenging in resource-limited settings. This study aimed to apply ESC in rural hospitals to reduce neonatal intensive care unit admissions, decrease length of stay (LOS) to under 7 days, and lower medication use by more than 80% within a year. Methods: Our quality improvement initiative at rural hospitals implemented a multimodal approach for in utero opioid-exposed infants, involving staff education, electronic medical record updates, and nonpharmacological care strategies. Data from January 2020 to December 2023 assessed treatment impact, including pharmacotherapy need and hospital stay lengths, using statistical process control for analysis. Results: After ESC implementation, the percentage of opioid-exposed infants receiving pharmacological treatment significantly decreased from 60.7% to 7.9%. The average LOS was reduced from 14.5 days to 5.25 days. These improvements persisted for 24 months, with no readmissions within 30 days of discharge. This approach also reduced hospital charges by over $5 million, demonstrating its clinical and financial effectiveness. Conclusions: The multidisciplinary approach successfully implemented ESC in a resource-limited setting, significantly reducing both the LOS and medication exposure for opioid-exposed infants while also saving significant healthcare costs. This successful model has been adopted by at least four regional rural hospitals, thus broadening the program’s impact.

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Section: Introductionmentioning

confidence: 99%

Quality Improvement in Neonatal Care: Successful Adoption of the Eat, Sleep, Console Protocol in a Rural Hospital Setting

Phyu,

Bird,

Gupta

2024

Pediatric Quality &Amp; Safety

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Infant Feeding and Weight Trajectories in the Eat, Sleep, Console Trial

Merhar,

Hu,

Devlin

et al. 2024

JAMA Pediatr

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ImportanceInfants 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.ObjectiveTo evaluate feeding practices and weight trajectories in infants cared for with ESC vs usual care.Design, Setting, and ParticipantsESC-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.InterventionESC vs usual care.Main Outcomes and MeasuresOutcomes 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.ResultsThe 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 RelevanceIn 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 RegistrationClinicalTrials.gov Identifier: NCT04057820

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Hospital sequelae, discharge, and early interventions in infants with Neonatal Opioid Withdrawal Syndrome

Cheng

2024

Seminars in Perinatology

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Using the Eat Sleep Console Model to Promote Optimal Care and Outcomes for Infants With Neonatal Abstinence Syndrome

Cited by 5 publications

References 32 publications

Quality Improvement in Neonatal Care: Successful Adoption of the Eat, Sleep, Console Protocol in a Rural Hospital Setting

Quality Improvement in Neonatal Care: Successful Adoption of the Eat, Sleep, Console Protocol in a Rural Hospital Setting

Infant Feeding and Weight Trajectories in the Eat, Sleep, Console Trial

Hospital sequelae, discharge, and early interventions in infants with Neonatal Opioid Withdrawal Syndrome

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