Why we are recommending this best practice
Strategies for implementation
- Create a unit protocol for nurse scoring of functional measures, conduct nursing and staff education prior to implementation, and educate health care providers regarding guidelines for use of pharmacotherapy. Monitor acceptability and feasibility of this protocol within the hospital as well as readmission rates for infants.
- Examples of published methods emphasizing functional impairment are:
- Finnegan Symptom Prioritization. Most recent reports include poor feeding, poor sleep, and continuous crying as prioritized functional measures. Other components of the Finnegan score that are sometimes included are emesis, diarrhea, tachypnea, or fever.
- “Eat, Sleep, Console” prioritizes a newborn’s inability to take an age-appropriate volume of food, sleep more than one hour after feeding, or be consoled within ten minutes.
- Functional-based assessment and management of newborns with NAS should be designed for the specific hospital. The formal “Eat, Sleep, Console” (ESC) Care Tool and Training Materials are copyrighted by Boston Medical Center Corporation, Dr. Matthew Grossman, Mary Hitchcock Memorial Hospital, Dartmouth-Hitchcock Clinic (2017). The developers of the ESC tool report that it was “developed for quality improvement purposes and is not currently the established standard of care for the assessment of infants with NAS. The tool is currently undergoing further rigorous study to assess maternal and infant outcomes. The ESC Tool should be implemented in the context of the standardized training provided, and always as part of a comprehensive non-pharmacologic care approach.” The ESC Care Tool is currently being studied as part of the NNEPQIN and neoQIC New England collaboratives.
- Alternative strategies employ the use of a modified Finnegan checklist with the mother scoring subjective functional items (e.g., quality of cry, stool consistency, tremulousness, etc.).
- Wachman EM, Grossman M, Schiff DM, et al. Quality improvement initiative to improve inpatient outcomes for Neonatal Abstinence Syndrome. J Perinatol. 2018;38(8):1114-1122.
- Grossman MR, Berkwitt AK, Osborn RR, et al. An Initiative to Improve the Quality of Care of Infants With Neonatal Abstinence Syndrome. Pediatrics. 2017;139(6).
- Grossman MR, Lipshaw MJ, Osborn RR, Berkwitt AK. A Novel Approach to Assessing Infants With Neonatal Abstinence Syndrome. Hospital pediatrics. 2018;8(1):1-6.
- Holmes AV, Atwood EC, Whalen B, et al. Rooming-in to treat neonatal abstinence syndrome: improved family-centered care at lower cost. Pediatrics. 2016;137(6).
- Blount T, Painter A, Freeman E, et al. Reduction in length of stay and morphine use for NAS with the “Eat, Sleep, Console” Method. Hosp Pediatr. 2019;9(8):615-623.
- Kocherlakota P, Qian EC, Patel VC et al. A new scoring system for the assessment of Neonatal Abstinence Syndrome. Am J Perinatol. 2020;37(3):333-340.