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Correspondence to Dr Ju-Lee Oei; [email protected]
WHAT IS ALREADY KNOWN ON THIS TOPIC
For infants with neonatal abstinence syndrome, the eat, sleep and console (ESC) model is an alternative treatment to the usual Finnegan Neonatal Abstinence Scoring System (FNASS). The ESC has been implemented in neonatal units worldwide, despite most of its data originating from largely observational studies. It is unclear how ESC compares to FNASS in short-term and long-term outcomes.
WHAT THIS STUDY ADDS
This systematic review and meta-analysis of observational data found that 12 American studies demonstrated shorter lengths of stay, shorter total time medicated and lower medication rate with ESC compared with FNASS. These were cohort and quality improvement studies with significant heterogeneity, small sample sizes and methodological differences.
HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY
While this review has demonstrated ESC is associated with shorter length of stay and lower medication rates, these must be interpreted in the context of significant heterogeneity and small sample sizes. Large and well-designed studies, including countries outside of the USA, are required before lasting conclusions about the benefits of ESC versus FNASS are made.
Introduction
Close clinical observation to inform prompt and appropriate treatment is key to preventing serious complications in sick patients. In infants with neonatal abstinence syndrome (NAS), suboptimally treated withdrawal leads to serious consequences, including death.1 In 1975, the Finnegan Neonatal Abstinence Scoring System (FNASS) was proposed as a tool to rate the severity of narcotic withdrawal in newborn infants.2 In the initial cohort of 55 infants, a detailed and standardised assessment with the FNASS was found to significantly reduce the need for (54% vs 70%) and duration of (8 vs 6 days) pharmacological treatment as well as length of hospitalisation (21 vs 5 days).2
The FNASS is now the most commonly used clinical tool for assessing and treating infants at risk of NAS, but it has limitations.3 Originally developed as a research tool,2 the FNASS is considered to be a complex (21–30 items depending on the version) and subjective tool that is prone to errors.4 5 It has never been validated in many populations in which it is currently used, including preterm infants, infants exposed to non-opioid drugs or even those with...