Evaluation of the Implementation of the Eat, Sleep, Console Model for Newborns with Neonatal Abstinence Syndrome (NAS)

Abstract

Approximately 30-50% of infants exposed to opioids in-utero will experience symptoms of neonatal abstinence syndrome (NAS) which include multisystem disturbance, often warranting admission to intensive care (Hudak & Tan, 2012). In Louisiana from 2003-2013, the number of infants born with NAS quadrupled, and Medicaid expenditures increased six-fold to 8.7 million dollars for inpatient-related services (Louisiana Department of Health, 2016). Although the Finnegan scoring system is the most widely used NAS assessment and treatment tool, its focus on medical management rather than nonpharmacologic care and infant function often leads to increased initiation of pharmacologic treatment and prolonged length of stay. The purpose of this scholarly project was to implement and evaluate the use of the ESC NAS care approach, in place on the Finnegan scoring system, for newborns admitted to the neonatal intensive care unit (NICU) at a women and children’s hospital in southwest Louisiana. Project aims included improving the poor management of NAS based on Finnegan scoring alone, optimizing family-centered patient care, and reducing healthcare costs through decreased pharmacologic therapy and length of stay. The project design was a pre/post quality improvement analysis. Baseline data sets obtained from 35 term infants treated with the Finnegan system from July 2017 to July 2019 were compared to data sets collected from six term infants treated with the ESC approach from October 2020 to March 2021 to determine if patient outcomes improved. The mean length of stay of the pre-ESC implementation group was 21.26 days with a mean length of pharmacologic treatment of 15.69 days. The post-ESC implementation group had a decrease in mean length of pharmacologic treatment to 2.83 days with an associated decrease in mean length of stay of 12.67 days. Through the optimization of non-pharmacologic interventions and increased involvement of parents and caregivers in the care of their newborn, this function-based assessment tool has led to improved patient outcomes, including but not limited to decreased pharmacologic treatment and length of stay.