Written by Kimiko Dunbar
Spoon Feed
The eat, sleep, console (ESC) method of managing infants with neonatal abstinence syndrome (NAS) has positive patient/system outcomes, but implementation is challenging due to resource limitations, stigma, and bias.
It works, but is it sustainable?
The ESC model of care was developed in 2014 for NAS, which focuses on the infant’s ability to perform normal baby functions rather than treating symptoms of withdrawal using the classic Finnegan scoring. The ESC model is known to reduce pharmaceutical treatment and length of stay for infants with NAS, although practice change can be challenging. This scoping review evaluates the ESC model, synthesizing findings from 34 studies on implementation strategies, barriers, facilitators, and outcomes. Generally, most institutions implemented ESC protocols using training and educating stakeholders rather than specific implementation frameworks. The most common barrier to implementation was related to resource limitation, specifically high staff turnover, room availability, and time constraints. Other barriers related to systemic factors, especially racism, bias, and stigma. Significant disparities were seen in patients whose first language was not English. The study highlights the impact of discrimination related to stigma on parents with a history of opiate use disorder and recommends systematic implementation strategies/frameworks to improve success of equitable implementation of ESC.
How will this change my practice?
Any providers who spend time in the newborn nursery are likely caring for infants with substance exposure. Unsurprisingly, bias and stigma are huge barriers to quality care for substance-exposed newborns. I’m inclined to be more cognizant of my own biases/stigma in caring for this population and to recognize instances where bias or stigma may be impacting their care. Further, I didn’t realize there were so many challenges in maintaining training and education in staff members. I’m not responsible for system-wide implementation at my institution, but I do think we have an opportunity to help educate new providers or other staff members with less experience implementing the ESC protocol.
Source
Implementing the Eat, Sleep, Console Model of Care: A Scoping Review. Hosp Pediatr. 2025 Mar 1;15(3):e108-e120. doi: 10.1542/hpeds.2024-008078. PMID: 39894047
