TOPLINE:

The Eat, Sleep, Console care approach was associated with a reduced need for pharmacologic treatment and shorter length of stay in the hospital for infants with neonatal opioid withdrawal syndrome (NOWS). Compared with usual care, the approach was particularly effective in shortening treatment duration for infants exposed to methadone.

METHODOLOGY:

• This post hoc subgroup analysis included 949 infants born at 36 or more weeks’ gestation who had antenatal exposure to medications for opioid use disorder (MOUD; 604 to buprenorphine and 345 to methadone) during the second or third trimester of pregnancy and were treated for NOWS at 26 sites in the US from September 2020 to March 2022.
• Hospitals started with their usual care and switched to the Eat, Sleep, Console care approach at their randomly allocated timepoint. The care approach focused on three key areas: whether the infant can eat enough, sleep for at least an hour , and be reasonably comforted.
• Outcomes included the proportion of infants who received pharmacologic treatment for NOWS, the length of hospital stay, and the length of treatment.
• The analysis examined associations of the type of MOUD and care approach with the outcomes.

TAKEAWAY:

• Infants managed with the Eat, Sleep, Console care approach were less likely to receive pharmacologic treatment for NOWS than those who received usual care (estimated means, 18.0% vs 57.4%; absolute difference, 39.4% [95% CI, 30.6%-48.2%]).
• The length of hospital stay was reduced by 5.4 days (95% CI, 1.9-8.8) for infants who received the care approach compared with those who received usual care (16.8 vs 22.2 days).
• For infants exposed to methadone, the care approach vs usual care reduced the mean adjusted length of treatment by 9.5 days (95% CI, 4.8-14.2).
• No significant difference in the length of treatment was found between the care approach and usual care for buprenorphine-exposed infants.

IN PRACTICE:

“The small percentage of infants who received pharmacologic treatment in the ESC [Eat, Sleep, Console] care approach group highlights the value of nonpharmacologic interventions as the first line of treatment in ameliorating NOWS symptoms,” the authors of the study wrote.

SOURCE:

This study was led by Sandra G.S. Beauman, MSN, RNC-NIC, of the Department of Pediatrics at the University of New Mexico in Albuquerque, New Mexico. It was published online on October 17, 2025, in The Journal of Pediatrics.

LIMITATIONS:

This study did not specify the timing of MOUD use during pregnancy, and it was unclear if any nonprescribed substances were used close to delivery. Details about specific opioid use during pregnancy were not clearly defined.

DISCLOSURES:

This study was supported by the National Institutes of Health, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the National Center for Advancing Translational Sciences. One author reported receipt of support from industry for research services. Two authors reported being codevelopers of the ESC Care Tool used in the trial, participated in design of the trial and development of training materials, and served as training faculty for hospitals who participated in the trial.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.