ESC in the literature
Our 6-pronged approach included:
(1) a commitment to nonpharmacologic care as first-line treatment;
(2) a simplified function-based approach to observation of the infant (Eat-Sleep-Console);
(3) improved prenatal education to prepare parents for
the newborn's postnatal course;
(4) a cuddler program;
(5) strategies to help parents remain at the bedside;
(6) change from morphine to methadone for infants who require medication for NAS.
Our obstetrics collaborators and outpatient pediatric colleagues have partnered with us to prepare mothers for delivery by strengthening them in their recovery prenatally and helping them maintain their recovery after discharge.
Among many improvements, our changes resulted in a decrease in medication
treatment for NAS (from 87% to 40%), a decrease in the need for adjuvant medication (from 34% to 2%), and a decrease in length of hospital stay (from 18 days to 10 days). The 3 most significant factors that have contributed to our success have been:
(1) a committed champion leader;
(2) a strong collaborative multidisciplinary team;
(3) a quality improvement approach that facilitates implementation of ideas easily and provides timely feedback to guide further change.
CHoSEN QIC provided educational support to help hospital teams develop and implement an ESC care pathway. Each hospital system had separate QI teams and provider staff, other than the neonatologists.
Non-pharmacologic interventions began at birth and included providing a low stimulation environment, clustering infant cares, swaddling, holding and gently rocking the infant, and on demand feedings. Parents or other caregivers were encouraged to room-in with the newborn whenever possible.
Options for rooming-in differed by hospital. At Memorial, rooming-in occurred in postpartum rooms or more limited spaces in the NICU. At Parkview, parents/caregivers roomed-in on postpartum or the general pediatric floor in a private room.
Breastfeeding was supported when appropriate (e.g., mothers not using illicit substances, or in treatment programs). When a parent was not available, both hospitals trained volunteer “cuddlers” to participate in the care pathway.
...ESC and as needed morphine decreased LOS and postnatal opioid exposure for OENs in two hospital systems without increasing 30-day readmissions. ESC appears effective in OENs with multiple co-exposures.
(*emphasis ours)
