Impact of Eat, Sleep, Console versus Finnegan Neonatal Abstinence Scoring System on Neonatal Outcomes: A Meta-Analysis

Background There are limited high-quality syntheses supporting the use of Eat, Sleep, Console (ESC) approach over Finnegan Neonatal Abstinence Scoring System (FNASS) for Neonatal abstinence syndrome (NAS). Objective To compare outcomes with ESC versus FNASS Data Sources Medline, EMBASE, PsycINFO, Web of Science and CINAHL until March 2025 Study Eligibility Criteria English-language articles comparing outcomes with ESC and FNASS. Appraisal and Synthesis Methods Random effects meta-analysis to calculate risk ratios (RR), absolute risk reduction (ARR) and mean difference (MD) with 95% confidence intervals (95%CI) and certainty of evidence (CoE) using the GRADE approach. Results We identified 30 observational studies and one randomized controlled trial (RCT). Based on meta-analysis of observational studies, ESC may be associated with reduced need for pharmacological treatment [n=7403; RR 0.51, 95%CI, 0.41-0.63, ARR 23.9%, low CoE]. ESC may also be associated (very low CoE) with shorter length of hospital stay [n=7146, MD -4.33; 95%CI -5.66 to-2.99], fewer neonatal intensive care unit admissions [n=2112; RR 0.69, 95%CI 0.51-0.93, ARR 10.1%], decreased hospital costs [n=273; MD -13,341, 95%CI -15993 to -10690], shorter duration of pharmacological treatment [n=3021; MD -4.97 days, 95%CI -5.68 to -4.26] and higher 30-day readmission risk [n=3390; RR 1.43, 95%CI 1.02-1.99, ARR 1.2%]. Limitations Risk-of-bias; Heterogeneity in outcomes; low-to-very-low CoE. Conclusions Based on low CoE largely from observational studies, ESC may reduce treatment duration, hospital stay, and hospital costs. Well-powered RCTs assessing a range of patient important outcomes are required to confirm the optimal assessment approach for NAS outcomes. Systematic Review Registration PROSPERO CRD42024530639.