A retrospective cohort study of neonatal abstinence syndrome patients following implementation of Eat Sleep Console Protocol

Background Neonatal abstinence syndrome (NAS) is a set of withdrawal symptoms experienced in a newborn if they have been exposed to substances such as opioids prior to birth. The incidence of NAS in British Columbia as well as NAS-related healthcare burden, has been increasing within the last several years. Aim To determine whether the novel Eat, Sleep, Console (ESC) approach to NAS improves outcomes such as length of hospitalization compared to Finnegan Neonatal Abstinence Scoring System (FNASS) approach in the treatment of neonatal patients with NAS admitted to the Neonatal Intensive Care Unit (NICU). Methods Retrospective paper and electronic chart review of neonatal patients born at ≥35 weeks gestation and ≤28 days of life with prenatal exposure to opioids and admitted to Kelowna General Hospital (KGH) Neonatal Intensive Care Unit (NICU) between January 2018 and February 2023. Results The primary outcome of hospital length of stay was 19.5 days for the ESC group and 27.5 days for FNASS (p=0.039). Secondary outcomes of total weaning morphine doses (53 vs 147; p<0.001), percentage requiring maintenance dosing (43.8% vs 100%; p<0.001), and length of wean (8.2 vs 18.1 days; p=0.003) were significantly less with ESC. Percentage who received only as needed morphine was greater with ESC (37.5% vs 0%; p<0.001). Total morphine dose (11.2mg vs 22.5mg; p=0.09) and adverse events (6% vs 11.7%; p=0.54) were not statistically significantly different. Conclusions Compared to FNASS, ESC approach improves several outcomes for NAS patients admitted to the NICU including a reduction in length of hospitalization by 8 days.