Medical Student Queen's University Faculty of Health Sciences Kingston, Ontario, Canada
Background: Early postnatal growth failure is a serious concern for infants diagnosed with neonatal abstinence syndrome (NAS). Long-term complications from postnatal weight loss include neurodevelopmental delay, ischemic heart disease, hypertension, and metabolic disease. This study describes differences in growth parameters during the birth hospitalization of infants exposed to opioids in utero who are managed with the Finnegan Neonatal Abstinence Scoring System Scoring (FNASS) vs. “Eat, Sleep, Console” (ESC). Objective: To determine differences in growth during the birth hospitalization of infants exposed to opioids in utero who were managed with FNASS vs. ESC. Design/Methods: A pre-post study was conducted with data abstracted from Kingston Health Sciences Centre (KHSC) medical records using appropriate ICD codes of infants exposed to opioids in utero between July 1, 2017, to May 31, 2023. Patients were excluded if they were admitted directly to the NICU after birth and if there was no chart-confirmed opioid exposure. The data was analyzed using SPSS v. 29.0.1.0. FNASS and ESC groups were compared using Fisher’s exact test for categorical variables and independent samples t-test for normally distributed variables. Outcomes included average daily weight change between birth and hospital discharge and maximum percent weight loss over the first 5 days of life. These were reported using medians and interquartile ranges and compared using the Mann-Whitney U test. Results: Out of the 70 patients who met inclusion criteria, 45 infants were managed with FNASS and 25 with ESC. We found no significant differences between the groups in baseline data that might affect infant growth. Overall, the average daily weight change during hospitalization did not differ significantly between the two groups [FNASS: median=-53.3 grams/day (IQR: -65.4, -40.8); ESC: median=-45.9 (IQR: (-57.8, -25.5)]. Within the group of patients whose hospital stay was 5 days, however, the average daily weight change was significantly shorter for the ESC group. Among the 53 infants who were hospitalized for at least five days and whose weight dropped below birthweight on at least one of those days, the maximum percent weight loss was significantly lower for the ESC group [FNASS: median= -9.1% (IQR: -10.7, -7.7); ESC: median= -6.9% (IQR: -9.6, -5.4); p=0.02].
Conclusion(s): Our study does not support concerns about postnatal weight loss for ESC. In fact, two analyses demonstrated a reduction in percent weight loss in favor of ESC. This local study is a promising start for more multicenter, larger scale studies on ESC and growth.
