Eat, Sleep, Console Approach

Grisham, Lisa M.; Stephen, Meryl M; Coykendall, Mary R; Kane, Maureen F; Maurer, Jocelyn A; Bader, Mohammed Y.

doi:10.1097/anc.0000000000000581

Cited by 65 publications

(29 citation statements)

References 12 publications

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“…This approach was devised to reduce the amount of opioids required by infants for NOWS management and to shorten hospitalizations for NOWS infants. Studies have shown that the ESC approach is a promising intervention for the management of NOWS infants (Achilles and Castaneda-Lovato 2019;Blount et al 2019;Dodds et al 2019;Grisham et al 2019;Parlaman et al 2019). It is unclear whether there is sufficient evidence to recommend the ESC approach as part of standard-of-care.…”

Section: Assessment and Diagnosismentioning

confidence: 99%

Neonatal Opioid Withdrawal Syndrome (NOWS): A Transgenerational Echo of the Opioid Crisis

Weller

Crist

Reiner

et al. 2020

Cold Spring Harb Perspect Med

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The incidence of neonatal opioid withdrawal syndrome (NOWS) has increased substantially in the setting of the opioid epidemic, a major public health problem in the United States. At present, NOWS has commonly used assessment and treatment protocols, but new protocols have questioned old practices. However, because of limited access to opioid use disorder (OUD) treatment and socioeconomic factors, many pregnant (and postpartum) women with OUD do not receive treatment. The pathophysiology of NOWS is not completely understood, although limited research studies have been conducted in humans and animals to better understand its etiology. Moreover, there is evidence that epigenetic and genetic factors play a role in the development of NOWS, but further study is needed. Animal models have suggested that there are deleterious effects of in utero opioid exposure later in life. Clinical research has revealed the harmful long-term sequelae of NOWS, with respect to cognitive function and childhood development. Many psychiatric disorders begin during adolescence, so as infants born with NOWS approach adolescence, additional clinical and molecular studies are warranted to identify biologic and psychosocial risk factors and long-term effects of NOWS. Additionally, access to specialized OUD treatment for pregnant women must be more readily available in the United States, especially in rural areas.

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Section: Assessment and Diagnosismentioning

confidence: 99%

Neonatal Opioid Withdrawal Syndrome (NOWS): A Transgenerational Echo of the Opioid Crisis

Weller

Crist

Reiner

et al. 2020

Cold Spring Harb Perspect Med

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“…The assessment and management of NOWS has been problematic, 16,38 in part because extant assessments rely on the subjective observations of health care professionals. 10,39 The findings of this cohort study suggest that acoustic cry analysis has potential as an objective measure of opioid withdrawal in the neonate. Cross-validated random forest models trained using newborn cry acoustics were able to generate accurate predictions (AUC, 0.90; accuracy, 0.85; sensitivity, 0.89; specificity, 0.83).…”

Section: Discussionmentioning

confidence: 80%

“…The assessment and management of NOWS has been problematic, in part because extant assessments rely on the subjective observations of health care professionals . The findings of this cohort study suggest that acoustic cry analysis has potential as an objective measure of opioid withdrawal in the neonate.…”

Section: Discussionmentioning

confidence: 92%

Newborn Cry Acoustics in the Assessment of Neonatal Opioid Withdrawal Syndrome Using Machine Learning

et al. 2022

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ImportanceThe assessment of opioid withdrawal in the neonate, or neonatal opioid withdrawal syndrome (NOWS), is problematic because current assessment methods are based on subjective observer ratings. Crying is a distinctive component of NOWS assessment tools and can be measured objectively using acoustic analysis.ObjectiveTo evaluate the feasibility of using newborn cry acoustics (acoustics referring to the physical properties of sound) as an objective biobehavioral marker of NOWS.Design, Setting, and ParticipantsThis prospective controlled cohort study assessed whether acoustic analysis of neonate cries could predict which infants would receive pharmacological treatment for NOWS. A total of 177 full-term neonates exposed and not exposed to opioids were recruited from Women &amp; Infants Hospital of Rhode Island between August 8, 2016, and March 18, 2020. Cry recordings were processed for 118 neonates, and 65 neonates were included in the final analyses. Neonates exposed to opioids were monitored for signs of NOWS using the Finnegan Neonatal Abstinence Scoring Tool administered every 3 hours as part of a 5-day observation period during which audio was recorded continuously to capture crying. Crying of healthy neonates was recorded before hospital discharge during routine handling (eg, diaper changes).ExposuresThe primary exposure was prenatal opioid exposure as determined by maternal receipt of medication-assisted treatment with methadone or buprenorphine.Main Outcomes and MeasuresNeonates were stratified by prenatal opioid exposure and receipt of pharmacological treatment for NOWS before discharge from the hospital. In total, 775 hours of audio were collected and trimmed into 2.5 hours of usable cries, then acoustically analyzed (using 2 separate acoustic analyzers). Cross-validated supervised machine learning methods (combining the Boruta algorithm and a random forest classifier) were used to identify relevant acoustic parameters and predict pharmacological treatment for NOWS.ResultsFinal analyses included 65 neonates (mean [SD] gestational age at birth, 36.6 [1.1] weeks; 36 [55.4%] female; 50 [76.9%] White) with usable cry recordings. Of those, 19 neonates received pharmacological treatment for NOWS, 7 neonates were exposed to opioids but did not receive pharmacological treatment for NOWS, and 39 healthy neonates were not exposed to opioids. The mean of the predictions of random forest classifiers predicted receipt of pharmacological treatment for NOWS with high diagnostic accuracy (area under the curve, 0.90 [95% CI, 0.83-0.98]; accuracy, 0.85 [95% CI, 0.74-0.92]; sensitivity, 0.89 [95% CI, 0.67-0.99]; specificity, 0.83 [95% CI, 0.69-0.92]).Conclusions and RelevanceIn this study, newborn acoustic cry analysis had potential as an objective measure of opioid withdrawal. These findings suggest that acoustic cry analysis using machine learning could improve the assessment, diagnosis, and management of NOWS and facilitate standardized care for these infants.

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“…If the infant's function is significantly affected, pharmacologic treatment may be necessary. 15 If eating, sleeping, and consolability are not disrupted, by withdrawal symptoms the infant does not require pharmacologic interventions, even when traditional NAS tool scores are elevated. 15 The criteria include the following:…”

Section: The Eat Sleep Console Management Programmentioning

confidence: 99%

Neonatal Abstinence Syndrome: Non-pharmacologic Interventions for the Maternal-Infant Dyad

MacMullen

Dulski

2023

MRAJ

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Neonatal Abstinence Syndrome (NAS) remains a concern for health care providers. The incidence of NAS has increased globally, and it has emerged as a worldwide health concern. In our previous article, we explored the efficacy of current pharmacologic treatment for NAS symptoms. Our purpose now is to focus on non-pharmacologic interventions for NAS symptoms and the involvement of caregivers, specifically the mother. We will discuss breastfeeding, rooming in, babywearing, the eat, sleep, console approach, and laser acupuncture. We intend to describe the involvement of the interdisciplinary team and all who care for these infants, including parents.

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Eat, Sleep, Console Approach

Cited by 65 publications

References 12 publications

Neonatal Opioid Withdrawal Syndrome (NOWS): A Transgenerational Echo of the Opioid Crisis

Neonatal Opioid Withdrawal Syndrome (NOWS): A Transgenerational Echo of the Opioid Crisis

Newborn Cry Acoustics in the Assessment of Neonatal Opioid Withdrawal Syndrome Using Machine Learning

Neonatal Abstinence Syndrome: Non-pharmacologic Interventions for the Maternal-Infant Dyad

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