Symptom-based dosing shortened discharge readiness time in NOWS

What the study found: Symptom-based dosing for infants with neonatal opioid withdrawal syndrome (NOWS) led to a shorter time to medical readiness for discharge than a scheduled opioid taper among infants cared for with Eat, Sleep, Console (ESC), a care approach that focuses on whether infants can eat, sleep, and be consoled.
Why the authors say this matters: The authors conclude that symptom-based dosing may better align opioid treatment with withdrawal severity, and the findings indicate it reduced time to medical readiness for discharge in the ESC setting.
What the researchers tested: In a cluster crossover randomized clinical trial at 23 US hospitals, infants at least 36 weeks' gestation and at risk for pharmacologic treatment were assigned to symptom-based dosing or scheduled opioid taper, using site-specific opioid algorithms. Hospitals used either ESC or Finnegan-based care, a symptom scoring system for withdrawal severity, and each site used its preferred primary opioid.
What worked and what didn't: In the ESC cohort, time to medical readiness for discharge was shorter with symptom-based dosing than with scheduled taper (9.18 vs 11.61 days; adjusted mean ratio 0.79). There was no difference in initiation of pharmacologic treatment or length of stay, and 35% of infants in the symptom-based group still needed scheduled opioid dosing because intermittent dosing did not control withdrawal severity. In the Finnegan cohort, there were no significant differences in time to medical readiness for discharge or length of stay.
What to keep in mind: The abstract reports that the inpatient composite safety outcome occurred rarely, but it does not provide a fuller safety discussion here. The main positive finding was reported for infants cared for with ESC, while the Finnegan cohort did not show significant differences.

Key points

• Symptom-based dosing shortened time to medical readiness for discharge in infants cared for with ESC.
• In the ESC cohort, readiness for discharge was 9.18 days with symptom-based dosing versus 11.61 days with scheduled taper.
• There was no difference in starting pharmacologic treatment or in length of stay in the ESC cohort.
• Thirty-five percent of infants in the symptom-based group needed scheduled opioid dosing because intermittent dosing was not enough.
• In the Finnegan cohort, there were no significant differences in readiness for discharge or length of stay.