Proxy Finnegan Component Scores for Eat, Sleep, Console in a Cohort of Opioid-Exposed Neonates

Evaluating the Association between Prenatal Care Visits and Adverse Perinatal Outcome in Pregnancies Complicated by Opioid Use Disorder

OBJECTIVE

This study aimed to evaluate the association between number of prenatal care visits and adverse perinatal outcome among pregnant individuals with opioid use disorder (OUD).

STUDY DESIGN

This is a retrospective cohort of singleton, nonanomalous pregnancies complicated by OUD that delivered from January 2015 to July 2020 at our academic medical center. Primary outcome was the presence of composite adverse perinatal outcome, defined as one or more of the following: stillbirth, placental abruption, perinatal death, neonatal respiratory distress syndrome, need for morphine treatment, and hyperbilirubinemia. Logistic and linear regression estimated the association between the number of prenatal care visits and the presence of adverse perinatal outcome. A Mann-Whitney U test evaluated the association between number of prenatal care visits and length of hospital stay for the neonate.

RESULTS

A total of 185 patients were identified, of which 35 neonates required morphine treatment for neonatal opioid withdrawal syndrome. During pregnancy, most individuals were treated with buprenorphine 107 (57.8%), whereas 64 (34.6%) received methadone, 13 (7.0%) received no treatment, and 1 (0.5%) received naltrexone. The median number of prenatal care visits was 8 (interquartile range: 4-10). With each additional visit per 10 weeks of gestational age, the risk of adverse perinatal outcome decreased by 38% (95% confidence interval [CI]: 0.451-0.854). The need for neonatal intensive care and hyperbilirubinemia also significantly decreased with additional prenatal visits. Neonatal hospital stay decreased by a median of 2 days (95% CI: 1-4) for individuals who received more than the median of eight prenatal care visits.

CONCLUSION

Pregnant individuals with OUD who attend fewer prenatal care visits experience more adverse perinatal outcome. Future research should focus on barriers to prenatal care and interventions to improve access in this high-risk population.

KEY POINTS

· Use of prenatal care affects newborn outcomes.. · More prenatal care shortens neonatal hospital stay.. · Prenatal care reduces certain adverse outcomes..

Assessing the Eat, Sleep, Console model for neonatal abstinence syndrome management at a regional referral center

OBJECTIVE

We assessed the efficacy of the Eat, Sleep, Console (ESC) model for neonatal abstinence syndrome at a regional referral center by examining non-pharmacological treatments, parental presence, length of stay (LOS), and pharmacological therapy.

STUDY DESIGN

We retrospectively reviewed medical records from 2018 to 2020 to compare neonatal outcomes between the 12 months prior to 12 months post ESC implementation.

RESULT

A total of 71 neonates pre-ESC and 64 neonates post-ESC implementation were included. There were no statistical differences between pre-ESC vs. ESC periods for pharmacological therapy (34% vs. 27%, p = 0.36) or LOS (median: 5.0 vs. 5.5 days, p = 0.54). During the ESC period, 41% of examined 4-h periods had no parent/caregiver presence. Decreased parental presence associated with pharmacological treatment (p < 0.001).

CONCLUSION

At our hospital which serves a geographically dispersed patient population, ESC model implementation did not decrease pharmacological therapy rates or LOS. Parental/caregiver presence may be a factor in the ESC model producing maximal benefits.

The Eat, Sleep, Console Method: A Literature Review

Neonatal abstinence syndrome (NAS) is a significant public health problem in the United States. The most commonly used tool to assess and treat infants with NAS is the Finnegan Neonatal Abstinence Scoring System (FNASS). The more recently developed Eat, Sleep, Console (ESC) method simplifies assessment of NAS. Current research suggests promising outcomes with the ESC method in areas such as length of hospital stay (LOS) and amount of medication needed to treat NAS. A literature review was conducted to answer the following question: In newborn infants with NAS born at 36 weeks of gestation or older, does the ESC method reduce the use of medication and LOS when compared with the FNASS? All of the studies reporting on LOS and medication usage rates reported a decrease in both when moving to the ESC method from FNASS.