IMPROVING NEONATAL OUTCOMES: ENHANCED EAT, SLEEP, CONSOLE MODEL

Abstract

Background: Neonatal Abstinence Syndrome (NAS) has increased 383% since 2000, with Arizona experiencing rates substantially higher than the national average. The traditional Finnegan Neonatal Abstinence Scoring System (FNASS) has limitations including subjectivity and poor interrater reliability, prompting the exploration of alternative approaches. Purpose: This thesis examines the effectiveness of the Eat, Sleep, Console (ESC) method compared to FNASS in managing NAS and proposes an enhanced protocol for infants with polysubstance or fentanyl exposure. Methods: A literature review of CINAHL and PubMed Central databases (2017-2024) identified nine studies evaluating ESC implementation. Studies included in the literature review included meta-analyses, retrospective cohort designs, and quality improvement projects comparing ESC and FNASS outcomes. The PICOT question examined ESC's effectiveness in decreasing medication administration and length of hospitalization in neonates with NAS. Results: Evidence consistently demonstrated that ESC reduces hospital length of stay (47-67% reduction), decreases pharmacological interventions (79-88% reduction in morphine use), and enhances family engagement. However, emerging evidence suggests limitations for infants exposed to fentanyl or multiple substances, necessitating individualized approaches. Conclusions: The enhanced ESC model, which integrates functional ESC assessments with tailored nonpharmacologic interventions for complex exposures, represents an evidence-based advancement in NAS management practices. Implementation recommendations include standardized nursing education, caregiver empowerment programs, and ongoing quality improvement monitoring using the Plan-Do-Study-Act framework.