Lisa McGill-Vargas, MD
Sacred Heart Medical Center
Editor’s note: While Eat, Sleep, Console is conceptually a simplification of the traditional treatment paradigm for neonatal opiate withdrawal syndrome, many centers have found it challenging to create and implement a new system. The Washington Chapter of the American Academy of Pediatrics currently is working to develop a toolkit and education module to assist Washington hospitals seeking to transition to an ESC model. The toolkit will be available in the summer. If you are interested in participating in the project, please contact Jeff Stolz.
Also, the WCAAP has partnered with a legal team to develop a statewide program to assist mothers with opiate use disorder better advocate for themselves in their interactions with Child Protective Services and the courts. More about the program will be presented in a future Developments.
As opioid use has increased to epidemic proportions, in utero exposure has also increased, leading to growing numbers of opioid-exposed newborns who often present with withdrawal symptoms or neonatal opiate withdrawal syndrome (NOWS), also called neonatal abstinence syndrome (NAS). Traditionally infants with NOWS have been admitted to the neonatal intensive care unit (NICU) for lengthy assessments and pharmacologic treatment. Morphine solution is the most common drug therapy, and once it is started, infants undergo a slow methodical wean, prolonging hospital stays as long as 16 to 23 days.1
Recently, a new approach to NOWS, known as Eat, Sleep, Console (ESC), was developed at Yale New Haven Children’s Hospital, which narrows assessments to only the infant’s basic functions of eating, sleeping, and their ability to be consoled. The approach avoids the routine transfer to the NICU and maximizes non-pharmacological treatment, while stressing mom’s role (whenever possible) in consoling her baby. With the use of supportive, non-pharmacologic interventions, combined with the ESC assessments, Grossman et al found a decrease in hospital stay from 22.4 to 5.9 days and a decrease in morphine treatment from 98% to 14%.2
As this new approach is being implemented in hospitals across the state of Washington, there is an exciting potential to improve mother-infant bonding, decrease hospital length of stay, and decrease infant medication exposure. However, as this is implemented, vigilance is needed to ensure adequate education for both mothers and health care providers. Treatment for the baby starts before delivery by empowering mothers with training and techniques to care for her withdrawing baby. As with any change, continuous quality improvement is needed to track neonatal outcomes including weight gain and developmental outcomes. As we consider the transition to ESC, it is important to ensure close follow-up as little is known about the long-term implications for infants and health-care systems adopting this new system.
- Patrick SW, Davis MM, Lehman CU et al. Increasing incidence and geographic distribution of neonatal abstinence syndrome: United States 2009 to 2012. Journal of Perinatology. 2015;35:650-655.
- Grossman MR, Berkwitt AK, Osborn RR, et al. AN initiative to improve the quality of care of infants with neonatal abstinence syndrome. Pediatrics. 2017;139(6):e20163360.