Comparison Between Finnegan Scores and Eat Sleep Console Method for Detection and Management of Neonatal Abstinence Syndrome

Background: Neonatal abstinence syndrome (NAS) is a compilation of withdrawal symptoms in infants due to maternal antenatal substance use. The Finnegan Neonatal Abstinence Scoring System (FNASS) has been widely used to direct pharmacologic treatment for NAS. In early September 2019, CAMC-Nursery started using the “Eat, Sleep, Console (ESC) Approach” which focuses on infant function and comfort, rather than reducing all signs of opioid withdrawal. Thus, we wished to assess the ESC approach, specifically examining the use of non-pharmacological treatments, length of stay (LOS), and pharmacological therapy.

Methods: We retrospectively reviewed medical records of full-term neonates born at CAMC Women & Children’s Hospital during 9/2019-9/2020 with documented prenatal opiate exposure and monitored for NAS symptoms in the nursery. We recorded FNASS and ESC measures for the first 5 days of life as well as LOS and need for pharmacological therapy. Data on neonates managed by the nursery in the 12 months prior to 9/2019 was obtained to compare outcomes pre vs. post ESC implementation.

Results: A total of 64 neonates managed by the ESC model met all inclusion criteria. The most common non-pharmacological treatments recorded as needing to be increased included parent/caregiver presence (34% of all ESC recordings), rooming-in (28%), skin-to-skin contact (27%), and holding infant (17%). With the ESC approach, 16 infants met FNASS criteria for pharmacological treatment, but did not receive methadone. However, statistical differences between neonates managed by pre-ESC, FNASS model (n = 71) vs. ESC approach (n=64) were not found for pharmacological therapy usage (34% vs. 27% of infants receiving methadone, p= 0.36) and LOS (median: 5 (2-32) vs. 5.5 (2-30) days, p=0.54.

Conclusion: The ESC approach has the potential to reduce pharmacological therapy usage in NAS management. However, parental presence, and rooming in options remain a challenge at CAMC. In order to optimise the non pharmacological approach of ESC, institutions like CAMC will have to improvise on their limited resources as it affects the ability of parents to be present at bedside, room in with the baby, and increase skin to skin contact, breastfeeding and other comforting measures.