Susan F Townsend1,2,3,4, Camille D Hodapp5,6, Blair Weikel7, Sunah S Hwang7,8. 1. Pediatrix Medical Group, Colorado, CO, USA. sftownsend@gmail.com. 2. Neonatology, UCHealth Memorial Hospital, Colorado Springs, CO, USA. sftownsend@gmail.com. 3. Neonatology, Parkview Medical Center, Pueblo, CO, USA. sftownsend@gmail.com. 4. Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA. sftownsend@gmail.com. 5. Pediatrix Medical Group, Colorado, CO, USA. 6. Neonatology, Parkview Medical Center, Pueblo, CO, USA. 7. Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA. 8. Colorado Perinatal Care Quality Collaborative, Colorado, CO, USA.
Abstract
OBJECTIVE: Compare Eat, Sleep, Console (ESC) and limited opioid treatment on birth length of stay (LOS), postnatal opioid exposure, and 30-day re-hospitalizations in opioid-exposed newborns (OENs) in two hospital systems. STUDY DESIGN: Quality improvement teams supported change from scheduled methadone using Finnegan scores to standardized non-pharmacologic support using ESC. Intermittent morphine was used only if needed. Statistical process control charts examined changes over time. RESULT: Between 2017 and 2019 we treated 280 OENs ≥35 weeks' gestation, 101 and 179 per hospital. Post-ESC, LOS decreased 51.2% (16.8-8.2 days), postnatal opioid treatment decreased from 64.1 to 29.9%; percent decline in both hospitals was similar. 30-day re-hospitalizations were 5/103 (4.8%) pre-ESC, and 7/177 (4.0%) post-ESC (p = 0.72, NS). Multiple substance co-exposures were common (226/280, 80.7%). CONCLUSION: ESC and as needed morphine decreased LOS and postnatal opioid exposure for OENs in two hospital systems without increasing 30-day readmissions. ESC appears effective in OENs with multiple co-exposures.
OBJECTIVE: Compare Eat, Sleep, Console (ESC) and limited opioid treatment on birth length of stay (LOS), postnatal opioid exposure, and 30-day re-hospitalizations in opioid-exposed newborns (OENs) in two hospital systems. STUDY DESIGN: Quality improvement teams supported change from scheduled methadone using Finnegan scores to standardized non-pharmacologic support using ESC. Intermittent morphine was used only if needed. Statistical process control charts examined changes over time. RESULT: Between 2017 and 2019 we treated 280 OENs ≥35 weeks' gestation, 101 and 179 per hospital. Post-ESC, LOS decreased 51.2% (16.8-8.2 days), postnatal opioid treatment decreased from 64.1 to 29.9%; percent decline in both hospitals was similar. 30-day re-hospitalizations were 5/103 (4.8%) pre-ESC, and 7/177 (4.0%) post-ESC (p = 0.72, NS). Multiple substance co-exposures were common (226/280, 80.7%). CONCLUSION: ESC and as needed morphine decreased LOS and postnatal opioid exposure for OENs in two hospital systems without increasing 30-day readmissions. ESC appears effective in OENs with multiple co-exposures.
Authors: Jonathan M Davis; Jeffrey Shenberger; Norma Terrin; Janis L Breeze; Mark Hudak; Elisha M Wachman; Peter Marro; Erica L Oliveira; Karen Harvey-Wilkes; Adam Czynski; Barbara Engelhardt; Karen D'Apolito; Debra Bogen; Barry Lester Journal: JAMA Pediatr Date: 2018-08-01 Impact factor: 16.193
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