The number of newborns exposed to opioids during pregnancy is rapidly growing with at least one newborn diagnosed with Neonatal Opioid Syndrome (NOWS) every 24 hours (National Institute of Child Health and Human Development [NICHD], 2023). Previously referred to as Neonatal Abstinence Syndrome (NAS), the treatment for NOWS varies widely among health care centers and until recently there has been limited research published on the effectiveness of treatments. Until 2018, the 21-sympton scale, Finnegan Neonatal Abstinence Scoring Tool (FNAST) was the most widely used tool to assess newborn withdrawal (Finnegan et al., 1975; Hein et al., 2021). In 2018, Grossman et al. recognized the need for a less intrusive assessment that could focus on the newborn's ability to eat well, sleep undisturbed, and be consoled with relative ease. They developed Eat, Sleep, Console (ESC), an alternative approach (Grossman et al., 2018).

ESC assessment prioritizes non-pharmacologic approaches such as a low-stimulation environment, swaddling, skin-to-skin care, and breastfeeding with a hallmark feature of encouraging parental involvement in the assessments (NICHD, 2023). Initiated immediately after birth and while mother and baby are still hospitalized, the protocol includes nurse-assisted maternal assessments of withdrawal symptoms every 3 hours after feeding. Assessments include the infant's ability to: tolerate an age-appropriate amount of feeding, effectively breastfeed, sleep undisturbed for more than 1 hour post feeding, be held, and consoled within 10 minutes. Pharmacologic interventions are withheld if all measures met (Wortham & Bianchi, 2022). Grossman et al. (2018) found ESC significantly reduced treatment with morphine by day 8, eliminated hospital readmission, and significantly reduced the number of hospital days as compared to the Finnegan approach. Additional benefits to ESC are its holistic approach that keeps mothers and babies together, increases maternal confidence, and promotes a stronger maternal-infant bond (Wortham & Bianchi, 2022).

Although ESC has been used for the past 8 years, there has been minimal research to compare the efficacy of these two approaches until recently. In a cluster-randomized controlled trial at 26 US-based hospitals with 837 newborns diagnosed with NOWS, those cared for using the ESC approach were ready for discharge 6.7 days earlier and were 67% less likely to receive pharmacologic treatment than those cared for using the FNAST (Young et al., 2023). Once nurses are knowledgeable and familiar with ESC to support a change in practice to this more family-focused assessment process, the role of the nurse as educator, coach, and support person in facilitating ESC is critical (Wortham & Bianchi, 2022). More research is needed to support routine adoption of Eat, Sleep, Console as standard care for infants with NOWS, but these early results are promising.

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