Newborns managed with The Eat, Sleep, Console (ESC) care approach for opioid withdrawal were more likely than those receiving traditional care to breastfeed during their hospital stay and to continue breastfeeding through discharge. ESC emphasizes non-pharmacologic care and teaches parents to care for their infants with a low-stimulation environment, including swaddling, skin-to-skin contact, and breastfeeding. ESC supports starting medication for withdrawal only if the non-pharmacologic remedies fail to improve symptoms. The findings provide evidence that the ESC care approach may help increase breastfeeding among infants experiencing opioid withdrawal.
The study, an analysis of a clinical trial of 1,305 newborns, appears in JAMA Pediatrics. The study was conducted by Stephanie L. Merhar, M.D., and colleagues in the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Neonatal Research Network and the NIH Environmental Influences on Child Health Outcomes (ECHO) Program Institutional Development Award States Pediatric Clinical Trials Network. NIH funding was provided by NICHD, the National Center for Advancing Translational Sciences, and the ECHO program.
Background
Newborns exposed to opioids in the womb are at risk for neonatal opioid withdrawal syndrome (NOWS). Symptoms of NOWS include tremors, excessive crying, irritability, and problems sleeping and feeding. Infants with NOWS may have frequent vomiting and diarrhea and lose weight after birth. Previous studies on the effect of the ESC approach on breastfeeding rates, known to be low for infants with NOWS, have shown mixed results.
An earlier clinical trial was conducted at 26 U.S. research hospitals and compared the ESC care approach to the traditional care approach. The ESC approach decreased the time infants were medically ready for discharge and reduced the proportion of infants receiving drug therapy for opioid withdrawal.
Results
For the current study, researchers analyzed data from the original trial to see how the ESC approach might influence infant feeding and growth. A total of 603 infants in the ESC group and 702 in the traditional care group were included in this study.
When compared to the traditional care group, infants in the ESC group were more likely to be exclusively breastfed (15.1 percent vs. 6.7 percent) or to receive any breast milk (38.8 percent vs. 27.4 percent). The authors also found that there was no difference in the proportion of infants who lost more than 10 percent of their birthweight. Although infants in the ESC group weighed less than infants in the traditional care group at 3 days old, the weights of both groups were similar when they were discharged from the hospital.
Significance
The authors noted that infants cared for with the ESC care approach were more likely to start and continue breastfeeding. This may have been due to the ESC infants being less likely to receive medications to treat NOWS, which may have allowed them to spend more time with their mothers. The authors concluded that the ESC approach may help improve breastfeeding among infants with NOWS.
Reference
Merhar, SL, et al. Infant feeding and weight trajectories in the eat, sleep, console trial: a secondary analysis of a randomized clinical trial. JAMA Pediatrics. 2024. Doi:10.1001/jamapediatrics.2024.2578
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