31 - Comparative Outcomes of NOWS Diagnosis and Management: Evaluating the Effectiveness of Eat, Sleep, Console versus Finnegan Neonatal Abstinence Scoring System

Publication Number: 2028.31

Alessandra M. Gest, West Virginia University School of Medicine, Morgantown, WV, United States; M. Cody Smith, West Virginia University, 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; Mark J. Polak, West Virginia University School of Medicine, Morgantown, WV, United States

Background: Eat, Sleep, Console (ESC) has been characterized as decreasing length of stay (LOS), pharmacologic treatment, and resource utilization in neonates diagnosed with neonatal opioid withdrawal syndrome (NOWS) when used as a management tool instead of the more traditional Finnegan Neonatal Abstinence Scoring System (FNASS). Both FNASS and ESC are employed as diagnostic tools for NOWS in neonates with prenatal opioid exposure. However, no studies have compared the rates of NOWS diagnosis using the two tools.

Objective: This study hypothesized that there would be no significant difference in the rate of NOWS diagnosis or outcomes, including LOS or pharmacotherapy initiation, among opioid-exposed neonates assessed using the ESC or FNASS methods.

Design/Methods: This retrospective cohort study was approved by the Institutional Review Board of West Virginia University and involved a chart review of neonates exposed to opioids in-utero and their mothers in two epochs. Epoch 1 exclusively utilized FNASS and included 252 infants born between January 2022 and March 2024. Epoch 2 utilized ESC and involved 80 infants born between March 2024 and August 2025. The outcomes included NOWS diagnosis, LOS, and pharmacotherapy initiation and duration. Patient characteristics, including substance exposure details, comorbidities, and maternal characteristics, were also collected.

Results: Comparative analysis revealed significant differences between the ESC and FNASS cohorts in several key areas (Tables 1 and 2). The rate of NOWS diagnosis was significantly lower in the ESC group than in the FNASS cohort (40.0% vs. 65.0%, p = 0.05). LOS (6 ±5 days vs. 11 ±13 days, p < 0.001) and rescue morphine (11.3% vs. 29.0%, p = 0.01), and morphine taper (5% vs. 17%, P 0.01) were also significantly lower in the ESC cohort. There were significantly 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 compared to FNAS.

Conclusion(s): When used as a diagnostic tool for NOWS, ESC was associated with a significant reduction in the diagnosis of NOWS, as well as reduced LOS and pharmacotherapy initiation in neonates exposed to opioids in utero compared to those assessed using FNASS. The rate of NOWS diagnosis may also have been affected by other shifts between the two epochs of interest, including shifting trends in substance use in the community.

Table 1
table 1.jpegInfant Birth and Treatment Characteristics

Table 2
table 2.jpegMaternal Characteristics, Diagnoses, and Substance Use
‡ HELLP: Hemolysis, Elevated Liver enzymes and Low Platelets; GD