By Rebecca Brakeley, MD; Sara Tarolli, MD; Kylie Guy, BA; Hannah Giger, DO; Jennifer Marsidi, DO; Bryan Olson, MS-4; Kathryn Graff Low, Ph.D., Bates College
Background
In 2017, the opioid epidemic was declared a public health emergency. That year, over 1.7 million Americans were diagnosed with opioid use disorder and cases continue to rise1. Consequently, there has been a substantial increase in infants with Neonatal Abstinence Syndrome (NAS), an opioid withdrawal syndrome that presents as a constellation of symptoms reflecting autonomic dysregulation, GI distress, and central nervous system hyperactivity. From 2004 to 2014, the incidence of NAS in the United States increased 433%, from 1.5 to 8.0 per 1,000 hospital births2. In 2015, Maine had one of the highest reported rates of NAS-associated newborn hospitalizations in the nation of 35.3 per 1000 births2. In light of this epidemic, alternative care models with a more holistic, function-focused approach have been proposed3.
Since 1974, Finnegan Neonatal Abstinence Syndrome Score (m-FNASS), a modality that focuses on medication management for withdrawal symptoms, has been the standard of care4. However, the limitations of m-FNASS include prolonged hospitalization, separation of parent/baby dyad in bay style NICUs, and increased exposure to pharmacologic interventions4,5. In 2014 Dr. Grossman et al. conducted a retrospective study at Yale New Haven Children’s Hospital that introduced a novel approach, Eat, Sleep, Console (ESC), to assess and treat infants with NAS. This care model focuses on infant functionality as measure of withdrawal severity and non-pharmacologic care as the mainstay of treatment5.
Increasingly, ESC is being implemented throughout the country. In December 2018, as a community hospital in Maine serving a rural and low-income area, we implemented the ESC protocol to investigate and evaluate a way to better serve our community which is disproportionally affected by the opioid epidemic. Prior to this, we utilized the m-FNASS. This study compares short-term neonatal outcomes before and after the adoption of the ESC protocol. Endpoints investigated were comparison of readmission rates, length of stay, NICU admission rates/separation of parent/baby dyad, breastfeeding rates, cost of admission, and pharmacologic intervention with morphine between the two protocols 6,7,8. Our hypothesis is the ESC protocol reduced readmission rate, decreased length of stay (NICU and total), reduced separation of parent/baby dyad, reduced cost, decreased total morphine exposure, and increased breastfeeding rates in the hospital.