Early postnatal weight changes in opioid-exposed infants managed using the Finnegan Neonatal Abstinence Scoring System Versus Eat, Sleep, Console.

Abstract

BackgroundDespite the many clinical benefits of Eat, Sleep, Console (ESC) to manage infants with neonatal abstinence syndrome (NAS), a recent article theorized that ESC may place infants at an increased risk of excessive postnatal weight loss. The objective of this study was to compare weight changes in the early postnatal period among infants exposed to opioids in utero and managed using 1) the Finnegan Neonatal Abstinence Scoring System (FNASS) or 2) ESC.MethodsPre-post analysis of medical records for opioid-exposed infants born July 1, 2017-May 31, 2023. Type of feeding (exclusive breastfeeding, formula only, combination) and weight changes were compared between the FNASS (n = 45) and ESC (n = 25) groups.ResultsType of feeding differed significantly between the groups during the first 5 days of life and at discharge: higher proportions of the FNASS group were exclusively breastfed and higher proportions of the ESC group received formula. There were no significant differences in daily weight changes over the first 5 days of life when we controlled for type of feeding. The average daily weight change during hospitalization did not differ significantly between the two groups (FNASS: median = -53.3 grams/day [IQR: -65.2, -40.8]; ESC: median = -45.9 [IQR: -57.8, -25.5]; p = 0.19).ConclusionsWe found no evidence of excessive weight loss in the early postnatal period among opioid-exposed infants managed using ESC as compared to FNASS. However, our findings suggest that breastfeeding should be more actively promoted and supported when centers transition from the FNASS model to ESC.