TOP 55 - Evaluating the Transition from Finnegan Scoring to Eat, Sleep, Console Across Nursery and NICU Settings for Neonatal Opioid Withdrawal Syndrome

Publication Number: 4759.TOP 55

Robert J. Nadler, Nationwide Children's Hospital, Columbus, OH, United States; Rakhi Gupta Basuray, Nationwide Children's Hospital, Columbus, OH, United States; Sara Conroy, Nationwide Children's Hospital, Columbus, OH, United States; Kristen L.. Benninger, Nationwide Children's Hospital, Columbus, OH, United States

Background: The Eat-Sleep-Console (ESC) care approach simplifies the assessment of infants with NOWS with a focus 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.

Objective: By comparing the frequency of NICU transfer and pharmacologic treatment in infants with NOWS who are managed using Finnegan scoring versus ESC methods, our study will establish evidence of the impact of this transition between a newborn nursery and NICU setting. This will allow better application of evidence-based care both locally and nationally while providing details on NICU transfer rates. Previous investigations have assessed either infants admitted to the NICU or infants admitted to the newborn nursery but never connected infants across locations.

Design/Methods: This is a retrospective cohort study of infants born between 2016 and 2025 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 Feb. 1, 2025 are included in the ESC (Post) period. Retrospective chart review data will be obtained through a combination of extraction and abstraction from both the OSU IHIS and NCH EPIC systems and then combined into a single dataset. Chi-squared testing will be used for the overall comparison of frequency of NICU transfer and need for pharmacologic treatment before and after the protocol change. Given the changes in opioid use since 2016, an interrupted time series analysis will be used to estimate a potential trend before the protocol change, any immediate impact on protocol change, and any potential trend after protocol change. This study is approved by the NCH and OSU IRB (NCH IRB #STUDY00004237; OSU IRB #2024N0011). Data collection for both the NCH NICU and OSU newborn nursery infants is undergoing and will be completed by 11/20/2025. Data analysis and abstraction will then take place and be completed to provide working results by January 31, 2026.

Table 1 Demographics *Preliminary*


Infants with prenatal opioid exposure born at OSU by year *Preliminary*


ESC vs Finnegan transfer rates *Preliminary*