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Correlating Scores but Contrasting Outcomes for Eat Sleep Console Versus Modified Finnegan. Hosp Pediatr 2021 Apr;11(4):350-357

Date

03/04/2021

Pubmed ID

33653727

DOI

10.1542/hpeds.2020-003665

Scopus ID

2-s2.0-85105112878 (requires institutional sign-in at Scopus site)   13 Citations

Abstract

OBJECTIVES: The Modified Finnegan Neonatal Abstinence Scoring System (M-FNASS) and the newer Eat, Sleep, and Console (ESC) model guide the clinical management of neonatal opioid withdrawal syndrome (NOWS). In this study, we evaluate how the M-FNASS and ESC model directly compare in inpatient practice. We hypothesized that ESC scores would correlate with M-FNASS scores, whereas ESC management would reduce health care use for infants with NOWS.

METHODS: In this retrospective cohort study, we compared management of infants with NOWS admitted to nursery settings. Epoch 1 was managed by using an M-FNASS algorithm. Epoch 2 was scored simultaneously with the M-FNASS and ESC model and managed by using the ESC approach. In the statistical analysis, we compared M-FNASS and ESC scores and outcomes between epochs.

RESULTS: A total of 158 infants provided 2101 scoring instances for analysis. Demographic characteristics were similar between epochs. ESC scores significantly correlated with overall M-FNASS scores and specific M-FNASS domains. Receiver operating characteristic (ROC) curve analysis revealed that an ESC score containing at least 1 "no" was best predicted by an M-FNASS cutoff value of 7.5 (sensitivity 0.84; specificity 0.70; area under the curve = 0.842). Length of stay (median 9.5 vs 5 days; P = .0002) and initiation (53% vs. 33%; P = .018) and duration of pharmacologic treatment (median 11 vs 7 days; P = .0042), as well as length of stay for infants who were pharmacologically treated (median 15 vs 10 days; P = .0002), were significantly reduced with ESC-based management after adjustment for covariates.

CONCLUSIONS: The ESC approach meaningfully correlates with the M-FNASS to detect NOWS. Management with the ESC approach continues to be associated with reduced health care use when compared with an M-FNASS approach, implying that the ESC approach may facilitate higher-value inpatient care.

Author List

Ryan K, Moyer A, Glait M, Yan K, Dasgupta M, Saudek K, Cabacungan E

Authors

Erwin Cabacungan MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Kris Harlander Saudek MD Professor in the Pediatrics department at Medical College of Wisconsin
Kelsey S. Ryan MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Ke Yan PhD Associate Professor in the Pediatrics department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Analgesics, Opioid
Humans
Infant, Newborn
Inpatients
Neonatal Abstinence Syndrome
Retrospective Studies
Sleep