THE EAT-SLEEP-CONSOLE (ESC) APPROACH:
A PARADIGM SHIFT
Founded by PoK Chair, Dr. Matthew Grossman, MD, the ESC approach offers a more holistic and developmentally supportive model of care for infants with NOWS/NAS. It prioritizes non-pharmacological interventions and family involvement, leading to improved outcomes and a more positive experience for both infants and their families. The core principles of ESC are:
EAT: Focus on ensuring adequate nutrition and responsive feeding practices that follow the infant's cues. This includes frequent on demand feeding, supporting breastfeeding, and addressing feeding difficulties.
SLEEP: Promote a quiet and comfortable environment that encourages sleep and minimizes disturbances. This involves clustering care activities, dimming lights, and minimizing noise.
CONSOLE: Provide comfort and support to the infant through swaddling, skin-to-skin contact, rocking, and other soothing techniques. Parental, or volunteer, involvement is crucial in this aspect.
Outcomes Supporting the ESC Approach
Several studies have demonstrated the benefits of the ESC approach in comparison to the traditional Finnegan method. Highlights of the findings include:
Shorter Hospital Stays
Reduced Need for Medication
Improved Infant Comfort
Enhanced Family Involvement & Bonding
ESC has been linked to significantly shorter hospital stays for infants with NOWS/NAS. This reduces healthcare costs and allows families to return home sooner.
The emphasis on non-pharmacological interventions in ESC often leads to a decreased need for medication, minimizing the risks associated with prolonged opioid or phenobarbital exposure.
Conclusion
ESC actively encourages parental involvement in all aspects of care, strengthening the parent-infant bond and promoting breastfeeding.
By prioritizing comfort and minimizing disturbances, ESC supports positive neurodevelopmental outcomes for infants with NOWS/NAS.
The ESC approach represents a significant advancement in the care of infants with NOWS/NAS. By addressing the shortcomings of the Finnegan approach and prioritizing non-pharmacological interventions, family involvement, and patient-centered dyadic care, ESC leads to improved outcomes for infants, reduces healthcare costs, and strengthens family bonds. The growing body of evidence supporting ESC makes it the preferred model of care for infants with NOWS/NAS.
Clinical Research
Link to Randomized Controlled Trial Young LW, Ounpraseuth ST, Merhar SL, et al. Eat, Sleep, Console Approach or Usual Care for Neonatal Opioid Withdrawal. N Engl J Med. 2023;388(25):2326-2337. doi:10.1056/nejmoa2214470
Link to Quality Improvement Project Blount T, Painter A, Freeman E, Grossman M, Sutton AG. Reduction in Length of Stay and Morphine Use for NAS With the "Eat, Sleep, Console" Method. Hosp Pediatr. 2019 Aug;9(8):615-623. doi: 10.1542/hpeds.2018-0238. Epub 2019 Jul 8. PMID: 31285356.
Link to Quality Improvement Project Parlaman J, Deodhar P, Sanders V, Jerome J, McDaniel C. Improving Care for Infants With Neonatal Abstinence Syndrome: A Multicenter, Community Hospital-Based Study. Hosp Pediatr. 2019 Aug;9(8):608-614. doi: 10.1542/hpeds.2019-0083. Epub 2019 Jul 15. PMID: 31308049.
Link to Quality Improvement Project Grossman MR, Berkwitt AK, Osborn RR, Xu Y, Esserman DA, Shapiro ED, Bizzarro MJ. An Initiative to Improve the Quality of Care of Infants With Neonatal Abstinence Syndrome. Pediatrics. 2017 Jun;139(6):e20163360. doi: 10.1542/peds.2016-3360. Epub 2017 May 18. PMID: 28562267; PMCID: PMC5470506.
Link to Study Grossman MR, Lipshaw MJ, Osborn RR, Berkwitt AK. A Novel Approach to Assessing Infants With Neonatal Abstinence Syndrome. Hosp Pediatr. 2018 Jan;8(1):1-6. doi: 10.1542/hpeds.2017-0128. PMID: 29263121.