44 - Does Utilization of Eat Sleep Console Versus the Finnegan Score to Care for Neonates Affected by Maternal Use of Opioids Decrease Utilization of Hospital Resources?

Publication Number: 3041.44

Mark J. Polak, West Virginia University School of Medicine, Morgantown, WV, United States; Alessandra M. Gest, West Virginia University School of Medicine, Morgantown, WV, United States; Russell Mathews, West Virginia University School of Medicine, Morgantown, WV, United States; Tammi M. Clutter, West Virginia University Children's Hospital, Washington, PA, United States; Renee Saggio, West Virginia University Department of Pediatrics, Morgantown, WV, United States; Lesley A. Cottrell, West Virginia University, Morgantown, WV, United States; M. Cody Smith, West Virginia University, Morgantown, WV, United States

Background: Prenatal opioid exposure is a major health concern. Newborns are at risk for neonatal opioid withdrawal syndrome (NOWS). The Finnegan Neonatal Abstinence Scoring System (FNASS), and Eat, Sleep, Console (ESC) Are used as tools for managing infants with prenatal opioid exposure. The case mix index (CMI) is a numerical measure of patient complexity summarizing the average resource intensity of a hospital's inpatient population (cost, length of stay, care intensity). It is calculated as the average Medical Severity Diagnosis Related Group (MS-DRG) weight of a group of patients. Previously, we have modified MS-DRGs for research (r-DRG). We further modified the r-DRGs to reflect only opiate exposure (r-DRG 794) and NOWS (r-DRG 793) (table). The average of r-DRG weights gives the r-CMI.

Objective: Does ESC decrease resources necessary for caring for opiate exposure & management of NOWS compared to FNASS, demonstrated by the r-CMI (without other neonatal comorbidities that would code to other MS-DRGs).

Design/Methods: A retrospective cohort chart review of newborns exposed to opioids in utero and their mothers was conducted in two epochs. (approved by West Virginia University IRB). Epoch 1:252 infants born between January 2022 and March 2024; FNASS group. Epoch 2:83 infants born between March 2024 and August 2025; ESC group. An r-DRG was assigned to each infant based on exposure only (r-DRG 794) or NOWS (r-DRG 793). Average weights of r-DRGs used to calculate r-CMI for both groups.

Results: The r-CMI for the infants managed with ESC versus FNASS are detailed in the figure. The decrease in r-CMI with ESC was not significant. There were significant differences between the ESC and FNASS cohorts in several areas. NOWS (40.0% vs 65.0% p=0.05), length of hospital stay (6±5 days vs 11±13 days p < 0.001), rescue morphine (11.3% vs 29.0% p=0.01), and morphine taper (5% vs 17% P=0.01) were significantly lower in the ESC cohort compared to the FNASS group. There were fewer infants placed into foster care (20.3% vs 32.7% p=0.05) and more parental involvement (80% vs 65%, p=0.01) in the ESC group.

Conclusion(s): When used as a tool for caring for infants with opiate exposure and management of NOWS, ESC was associated with a significant improvements for care of infants with prenatal opiate exposure compared to those assessed using FNASS. The r-CMI for the ESC cohort is marginally lower than that for the FNASS cohort though this decrease did not reach significance. There are positive changes related to application of ESC, however the amount of hospital resources necessary to care for these infants remained similar.

Table
MS-DRGs and r-DRGs with weights. For this project only r-DRG 794 (opioid exposure) and r-DRG 793 (NOWS) were used.

Figure
Comparison of the research Case Mix Index (r-CMI) for infants managed with Eat Sleep Console (ESC) versus Finnegan Neonatal Abstinence Scoring System (FNASS) in the care of neonates affected by maternal use of opioids.