438 - Frequency of Nasogastric Feeding Among Newborns with Opioid Withdrawal Syndrome Managed with the Modified Finnigan (MF) or Eat, Sleep, Console (ESC) Protocols

Publication Number: 438.5020

Raga S. Kilaru, Phoenix Children's Hospital, Phoenix, AZ, United States; Bethany Farretta, Phoenix Children's Hospital, Phoenix, AZ, United States; Angela Ibragimov, Valleywise Health Medical Center, Phoenix, AZ, United States; Bikash Bhattarai, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, United States

Background: The incidence of newborns with neonatal opioid withdrawal syndrome (NOWS) was 7.3 per 1000 hospital births in 2017, an increase from 2010. Appropriate management of NOWS hinges on accurate assessment of withdrawal symptoms. With the development of ESC, institutions are now transitioning away from MF due to improvement in length of stay and morphine exposure. Infants with NOWS have dysfunctional feeding patterns with one study noting 3.9% requiring nasogastric (NG) feeding when using ESC. No studies to date have compared the rate of NG use in infants on the modified Finnegan vs ESC protocols.

Objective: To compare the frequency of NG feeding among newborns with NOWS on the ESC versus MF protocols.

Design/Methods: A retrospective chart review was completed on newborns >34 weeks gestation with NOWS managed on either the ESC or modified Finnigan protocol at a community hospital nursery from 2019-2021. Demographic data, birth weight, meconium drug screen/cord drugs of abuse results, and NG use were collected. The data was summarized using frequencies and percentages for categorical data. Group comparisons were conducted using Chi-square analysis for categorical variables and a significance level of 0.05.

Results: Neonatal records of 65 newborns with NOWS were reviewed with 47 (72.3%) of them being term infants. There was no difference between groups regarding gestational age and birth weight. Of the term infants, 23 were managed on ESC and 24 on MF protocols with 18 (38.3%) requiring NG feeding. The ESC group had a statistically higher requirement for NG feeds in term infants compared to the MF group (14/23, 60.87% vs 4/24, 22.2%, p = 0.002). Within the 18 pre-term babies, frequency of NG feeds was relatively higher for ESC (6/9, 66.57%) compared to the MF (4/9, 44.44%, P=0.34), however this was not statistically significant. Additionally, more babies in the ESC group were concurrently positive for amphetamines compared to the MF group (16/32, 50% vs 5/33, 15.5%, p = 0.003).

Conclusion(s): Our study demonstrated a rate of NG use for infants on ESC protocol was 38.3%, which is higher than a previously published rate of 3.8%. This difference may suggest implementation variability among institutions since the ESC protocol is qualitative with feeding as a core component of scoring. Given the higher rate of methamphetamine exposure in infants managed by ESC in our studied cohort, concurrent methamphetamine positivity may contribute to worsened feeding dysfunction in infants and act as a confounder. Multi-institutional studies to compare the rate of NG use for infants on the ESC protocol would be helpful.