Arch Dis Child. 2025 May 20:archdischild-2025-328549. doi: 10.1136/archdischild-2025-328549. Online ahead of print.
ABSTRACT
IMPORTANCE: Vigilant clinical assessment is the key to preventing complications, including death, in infants at risk of neonatal withdrawal syndrome. The eat, sleep and console (ESC) is proposed as an alternative to usual care with Finnegan’s Neonatal Abstinence Scoring System (FNASS), but whether ESC improves infant outcomes is uncertain.
OBJECTIVE: To conduct a meta-analysis and systematic review of outcomes of studies comparing ESC to FNASS.
DATA SOURCES: PubMed, Embase, CINAHL and Cochrane were searched. There was no date restriction.
STUDY SELECTION: Published data from observational studies published in English were included. Randomised controlled trials, reviews and abstracts were excluded. Data was required to be converted to mean and SD to be included.
DATA EXTRACTION AND SYNTHESIS: Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines were used, and data were independently extracted by multiple observers. Data was pooled using a random-effects model.
MAIN OUTCOME AND MEASURES: Length of stay (LOS) in days, number of days medicated and proportion of infants medicated were the primary outcomes assessed. It was hypothesised prior to data collection that ESC would be associated with shorter LOS and a lower proportion of infants medicated, given key differences in infant assessment compared with the FNASS.
RESULTS: 12 studies, all from the USA, were published between 2018 and 2024. 10 quality improvement studies and two cohort studies compared ESC (n=1877) with historical controls using FNASS (n=2199). ESC decreased hospitalisation days (MD -4.11 days, 95% CI -6.04 to -2.19 days; p<0.0001; I2=95%; 10 studies; 3703 participants) and the proportion treated with withdrawal medications (OR 0.36, 95% CI 0.22 to 0.60; I2=89%; RD -0.22; 95% CI -0.34 to -0.10; p<0.0001; I2=93%; 12 studies; 4076 participants). One study assessed physical health up to 1 week after discharge (n=1), three assessed weight loss (n=3) and one assessed cost (n=1).
CONCLUSIONS AND RELEVANCE: The majority of evidence for a reduction in hospitalisation and need for withdrawal medication with ESC compared with FNASS is derived from quality improvement and cohort studies with almost no health information beyond 1 week after discharge. High-quality trials incorporating physiological measurements of infant stress and longer-term outcomes are needed.
REVIEW PROSPECTIVE REGISTRATION: CRD42024532169.
PMID:40393782 | DOI:10.1136/archdischild-2025-328549
