(103) Evaluating the Transition from Finnegan Scoring to Eat, Sleep, Console Across Nursery and NICU Settings for Neonatal Opioid Withdrawal Syndrome

Background: The Eat-Sleep-Console (ESC) care approach simplifies the assessment of infants with NOWS by focusing on non-pharmacologic management and the functional impact of clinical withdrawal symptoms. The multi-center ESC-NOW trial demonstrated that ESC decreased hospital length of stay and proportion of infants receiving pharmacologic treatment when compared with the traditional Finnegan tool, but it did not evaluate affected neonates from the continuum of delivery to treatment unit to discharge.

Objectives: By comparing the frequency of NICU transfer and pharmacologic treatment in infants with NOWS managed using Finnegan scoring vs. ESC methods, our study helps establish evidence of the impact of this transition between a newborn nursery and NICU setting. This allows better application of evidence-based care both locally and nationally while providing details on NICU transfer rates.

Design/Methods: This is a retrospective cohort study of infants born between 2016 and 2024 at the Ohio State University (OSU) newborn nursery and Nationwide Children’s (NCH) NICU at OSU. Infants born from 2016 to Sept 12, 2023 are included in the Finnegan (Pre) period and infants born from Sept 13, 2023 to October 1, 2024 are included in the ESC (Post) period. Retrospective chart review data was obtained through a combination of extraction and abstraction from both the OSU and NCH EPIC systems. This study is approved by the NCH (#STUDY00004237) and OSU (#2024N0011) IRBs.

Results: A total of 1636 infants met inclusion criteria, including 93 infants in the ESC period. In infants affected by NOWS at the OSU newborn nursery, transfer to the OSU NICU for further care occurred in 24% of babies in the Finnegan scoring group and 33% in the ESC approach group. This gives an absolute increase of 9% in the ESC group.

Conclusions: The ESC-NOW trial demonstrated multiple benefits of ESC when compared to the traditional Finnegan tool, but until now, the effects on the continuum of delivery to treatment unit to discharge were unknown. This project demonstrates that treatment decisions guided by ESC increased the transfer rate from newborn nursery to NICU when compared to traditional Finnegan scoring. This could be due to a multitude of reasons, including limited access to non-pharmacologic interventions in the newborn nursery, a critical component of ESC. Safely preventing transfer could result in increased opportunities for infants to stay with their mother during a critical bonding time.