237 - Postnatal opioid treatment in the Eating, Sleeping, and Consoling for Neonatal Opioid Withdrawal (ESC-NOW) randomized controlled trial

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 237
Publication Number: 237.127

Lori A. Devlin, University of Louisville School of Medicine, Louisville, KY, United States; Zhuopei Hu, University of Arkansas for Medical Sciences, Little Rock, AR, United States; Stephanie L. Merhar, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Songthip Ounpraseuth, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR, United States; Brian Martin. Smith, Duke, Durham, NC, United States; Michele C. Walsh, NICHD, Bethesda, MD, United States; Abhik Das, RTI International, Rockville, MD, United States; Jeannette Y. Lee, University of Arkansas for Medical Sciences, Little Rock, AR, United States; Alan E. Simon, National Center for Health Statistics, SILVER SPRING, MD, United States; Rosemary Higgins, Florida Gulf Coast University, Fort Myers, FL, United States; Ward Rice, St. Elizabeth Healthcare, Edgewood, KY, United States; David A. Paul, Pediatrics, Newark, DE, United States; Jessie Maxwell, University of New Mexico, albuquerque, NM, United States; Sucheta Telang, University of Louisville, Louisville, KY, United States; Camille Fung, University of Utah, Salt Lake City, UT, United States; Tanner Wright, USF Health Morsani College of Medicine, Tampa, FL, United States; Anne Marie Reynolds, University at Buffalo, Buffalo, NY, United States; Julie Ross, Medical University of South Carolina, Charleston, SC, United States; Jennifer McAllister, Cincinnati Children's Hospital, Cincinnati, OH, United States; Moira Crowley, Case Western Reserve University School of Medicine, Cleveland, OH, United States; Sophie Shaikh, Duke, Durham, NC, United States; Karen M. Puopolo, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Lori Christ, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Jaime Brown, MUSC and VCOM, Inman, SC, United States; Julie Riccio, Golisano Children's Hospital at The University of Rochester Medical Center, Rochester, NY, United States; Kara Wong Ramsey, University of Hawaii, John A. Burns School of Medicine, Honolulu, HI, United States; Lauren Tucker, University of Mississippi School of Medicine, Jackson, MS, United States; Karen R. McAlmon, Winchester Hospital, Winchester, MA, United States; Krishna Dummula, University of Kansas School of Medicine, Kansas City, KS, United States; Julie Weiner, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States; Jessica White, Sanford Children's Hospital, Sioux Falls, SD, United States; Meghan Howell, Tulane University School of Medicine, New Orleans, LA, United States; Sarah Newman, Nebraska Medicine, Omaha, NE, United States; Jessica Snowden, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR, United States; Leslie Young, Robert Larner, M.D., College of Medicine at the University of Vermont, Burlington, VT, United States; NICHD Neonatal Research Network, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, United States; IDeA States Network, National Institutes of Health, North Bethesda, MD, United States

Presenting Author(s)

Lori A. Devlin, DO, MHA, MS (she/her/hers)

Professor Pediatrics
University of Louisville School of Medicine
Louisville, Kentucky, United States

Background:

The Eat, Sleep and Console care approach (ESC) substantially reduces the proportion of infants receiving pharmacologic treatment for neonatal opioid withdrawal syndrome (NOWS) compared to usual care (UC) with the Finnegan Neonatal Abstinence Scoring Tool. When infants with NOWS have withdrawal that is not adequately treated with non-pharmacologic interventions alone, pharmacologic treatment continues to be an important component of care. Further understanding of the influence of ESC on pharmacologically treated infants is needed to address current knowledge gaps in the field.

Objective:

Evaluate initiation and duration of opioid treatment and length of stay among pharmacologically treated infants assessed and managed with ESC verses UC.

Design/Methods:

We studied a cohort of pharmacologically treated infants within ESC-NOW, a stepped-wedge cluster randomized controlled trial. Infants were ≥ 36 weeks’ gestation and treated for NOWS at one of 26 study hospitals. Participating hospitals maintained their pre-trial practices for pharmacologic treatment including opioid type, dosing approach, and use of adjuvant medications. For each outcome, namely length of opioid treatment, time from birth until initiation of the first opioid dose, peak opioid dose, and length of hospital stay (LOS), we used generalized linear mixed-models with appropriate distribution and link function to adjust for the stepped-wedge design and maternal and infant characteristics.

Results:

The study enrolled 1306 infants of whom 474 infants were pharmacologically treated [329/703 (47%) in the UC group and 145/603 (24%) in the ESC group]. Among these 474, demographic characteristics for the infants and their mothers were similar between the UC and ESC groups except for ethnicity and rurality (Table 1). The adjusted mean length of opioid treatment was 5.4 (95%CI:2.4-8.4) days shorter in the ESC than in the UC group (11.2 vs. 16.5 days; P=0.001). The adjusted time from birth to initiation of pharmacologic treatment was 23.1 (95%CI:8.7-37.5) hours longer in the ESC group (75.9 vs. 52.8 hours; P< 0.001) but there was no difference in mean peak opioid doses between groups (0.13 vs. 0.11 morphine mg equivalents/kg). The mean LOS was 6.2 (95%CI:3.1-9.4) days shorter in the ESC than in the UC group (16.5 vs. 22.7 days; P< 0.001).

Conclusion(s):

The ESC care approach was associated with a shorter length of opioid treatment and hospital stay among infants pharmacologically treated for NOWS. Compared to UC, use of ESC did not result in a higher peak opioid dose, though pharmacologic treatment was initiated later.