Early postnatal weight changes in opioid-exposed infants managed using the Finnegan Neonatal Abstinence Scoring System Versus Eat,Sleep,Console

Abstract

Background

Despite the many clinical benefits of Eat, Sleep, Console (ESC) to manage infants with neonatal abstinence syndrome (NAS), a recent article theorized that ESC may place infants at an increased risk of excessive postnatal weight loss. The objective of this study was to compare weight changes in the early postnatal period among infants exposed to opioids in utero and managed using 1) the Finnegan Neonatal Abstinence Scoring System (FNASS) or 2) ESC.

Methods

Pre-post analysis of medical records for opioid-exposed infants born July 1, 2017-May 31, 2023. Type of feeding (exclusive breastfeeding, formula only, combination) and weight changes were compared between the FNASS (n = 45) and ESC (n = 25) groups.

Results

Type of feeding differed significantly between the groups during the first 5 days of life and at discharge: higher proportions of the FNASS group were exclusively breastfed and higher proportions of the ESC group received formula. There were no significant differences in daily weight changes over the first 5 days of life when we controlled for type of feeding. The average daily weight change during hospitalization did not differ significantly between the two groups (FNASS: median = −53.3 grams/day [IQR: −65.2, −40.8]; ESC: median = −45.9 [IQR: −57.8, −25.5]; p = 0.19).

Conclusions

We found no evidence of excessive weight loss in the early postnatal period among opioid-exposed infants managed using ESC as compared to FNASS. However, our findings suggest that breastfeeding should be more actively promoted and supported when centers transition from the FNASS model to ESC.

Keywords

neonatal abstinence syndrome neonatal growth outcomes neonatal opioid withdrawal syndrome

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References

Weller

Crist

Reiner

, et al. Neonatal opioid withdrawal syndrome (NOWS): a transgenerational echo of the opioid crisis. Cold Spring Harb Perspect Med 2021; 11: a039669.

Ruwanpathirana

Abdel-Latif

Burns

, et al. Prematurity reduces the severity and need for treatment of neonatal abstinence syndrome. Acta Paediatr 2015; 104: e188–e194.

Grisham

Stephen

Coykendall

, et al. Eat, sleep, console approach: a family-centered model for the treatment of neonatal abstinence syndrome. Adv Neonatal Care 2019; 19: 138–144.

Schiff

Grossman

. Beyond the Finnegan scoring system: novel assessment and diagnostic techniques for the opioid-exposed infant. Semin Fetal Neonatal Med 2019; 24: 115–120.

Grossman

Lipshaw

Osborn

, et al. A novel approach to assessing infants with neonatal abstinence syndrome. Hosp Pediatr 2018; 8: 1–6.

Nicholson

Waskosky

. The eat, sleep, console method: a literature review. Neonatal Netw 2022; 41: 333–340.

Hein

Clouser

Tamim

, et al. Eat, sleep, console and adjunctive buprenorphine improved outcomes in neonatal opioid withdrawal syndrome. Adv Neonatal Care 2021; 21: 41–48.

Ponder

Egesdal

Kuller

, et al. Project console: a quality improvement initiative for neonatal abstinence syndrome in a children's hospital level IV neonatal intensive care unit. BMJ Open Qual 2021; 10: e001079.

Favara

Smith

Friedman

, et al. Growth failure in infants with neonatal abstinence syndrome in the neonatal intensive care unit. J Perinatol 2022; 42: 313–318.

10.

Dryden

Young

Campbell

, et al. Postnatal weight loss in substitute methadone-exposed infants: implications for the management of breast feeding. Arch Dis Child Fetal Neonatal Ed 2012; 97: F214–F216.

11.

Martinez

Kastner

Taeusch

. Hyperphagia in neonates withdrawing from methadone. Arch Dis Child Fetal Neonatal Ed 1999; 80: F178–F182.

12.

Lee

Kim

Namgung

, et al. Prediction of postnatal growth failure among very low birth weight infants. Sci Rep 2018; 8(1): 3729.

13.

Yen

Maron

. Aberrant feeding and growth in neonates with prenatal opioid exposure: evidence of neuromodulation and behavioral changes. Front Pediatr 2022; 9: 805763.

14.

McKnight

Coo

Davies

, et al. Rooming-in for infants at risk of neonatal abstinence syndrome. Am J Perinatol 2016; 33: 495–501.

15.

Barker

Shaw

. Best (but oft-forgotten) practices: checking assumptions concerning regression residuals. Am J Clin Nutr 2015; 102: 533–539.

16.

Goldstein-Greenwood

. Bootstrapping residuals for linear models with heteroskedastic errors invites trouble. University of Virgina Library, 2024. Avaialble from: https://library.virginia.edu/data/articles/bootstrapping-residuals-linear-models-heteroskedastic-errors-invites-trouble

17.

Miller

Willier

. Baby STRENGTH: eat, sleep, console for infants with neonatal abstinence syndrome. Adv Neonatal Care 2021; 21: 99–106.

18.

Haaland

Kunkel

Nguyen

, et al. Using the eat sleep console model to promote optimal care and outcomes for infants with neonatal abstinence syndrome: a nurse-driven, multidisciplinary initiative. Adv Neonatal Care 2023; 23: 320–329.

19.

Slymon

Simpson

Mullin

, et al. Eat sleep console for the management of neonatal abstinence syndrome: a process and outcomes evaluation. J Pediatr Health Care 2023; 37: 402–413.

20.

Dodds

Koch

Buitrago-Mogollon

, et al. Successful implementation of the eat sleep console model of care for infants with NAS in a community hospital. Hosp Pediatr 2019; 9: 632–638.

21.

Mosca

Gianni

. Early nutrition: effects on infants’ growth and body composition. In: Saavedra

Dattilo

(eds). Early Nutrition and Long-Term Health. Woodhead Publishing, 2017, pp. 55–77.

22.

Matthews

Watson

Hermann

, et al. Exclusive breastfeeding rates upon hospital discharge at a tertiary center prior to and during the COVID-19 pandemic. J Obstet Gynaecol Can 2024; 46: 102669.

23.

Young

Ounpraseuth

Merhar

, et al. Eat, sleep, console approach or usual care for neonatal opioid withdrawal. N Engl J Med 2023; 388: 2326–2337.

24.

Savenije

Brand

. Accuracy and precision of test weighing to assess milk intake in newborn infants. Arch Dis Child Fetal Neonatal Ed 2006; 91: F330–F332.

25.

Institute of Medicine (US) . Committee on nutritional status during pregnancy. Milk volume. In: Nutrition During Lactation. Washington: National Academic Press, 1999, pp. 80–105.

26.

Arthur

Hartmann

Smith

. Measurement of the milk intake of breast-fed infants. J Pediatr Gastroenterol Nutr 1987; 6: 758–763.

27.

Matsiko

Hulshof

PJM

van der Velde

, et al. Comparing saliva and urine samples for measuring breast milk intake with the ²H oxide dose-to-mother technique among children 2-4 months old. Br J Nutr 2020; 123: 232–240.