A simpler assessment tool for newborns exposed to opioids means more mom time and fewer medications

Cailyn Morreale continued using buprenorphine during her pregnancy. Once her baby was born, the two were never separated. (Photo by Taylor Sisk, KFF Health News)

A new approach is helping mothers recovering from opioid addiction and newborns with opioid exposure stay together after birth. Historically, babies born with opioid exposure have been separated from their mothers and received heavy medications in neuro-intensive units, but "research has since indicated that in many, if not most, cases, those extreme measures are unnecessary," reports Taylor Sisk of KFF Health News. "A newer, simpler approach that prioritizes keeping babies with their families called Eat, Sleep, Console is being increasingly embraced."

Over the past decade, how pregnancy pairs with addiction treatment has changed, meaning most women can continue to take addiction-recovery medication throughout pregnancy. For Cailyn Morreale, a West Virginian from rural Mars Hill, the new methods helped her continue her recovery medicine, buprenorphine, and her care team assured her "that her baby would be assessed and monitored using the Eat, Sleep, Console approach," Sisk explains. "Morreale was never separated from her son. She was able to begin breastfeeding immediately. She was told, the trace of buprenorphine in her breast milk would help her son withdraw from it."

The Eat, Sleep, Console method is slowly replacing the older Finnegan Neonatal Abstinence Scoring System, which involved 21 evaluative questions. Sisk writes, "David Baltierra, former director of West Virginia University’s Rural Family Medicine Residency Program, chair of WVU’s Department of Family Medicine, suggests this protocol could simply be called 'parenting.' Baltierra and his colleagues have been training residents to use an Eat, Sleep, Console approach for a decade. . . .The results are persuading more health professionals to adopt the method."

A 2023 study found "babies treated this way were discharged from the hospital in nearly half the time and less likely to receive medication than those receiving Finnegan-based care," Sisk reports. "Matthew Grossman, an associate professor of pediatrics at the Yale School of Medicine, found a non-pharmacological-first approach works best. He said the Finnegan tool is useful but often too rigid. Under its scoring, one sneeze too many could send a baby to the NICU for weeks."

Research by Leila Elder and Madison Humerick, who each did their residency in WVU’s rural program, "found that median stays for newborns in withdrawal dropped from 13 days in 2016 to three in 2020," Sisk adds. "The simpler treatment also means more babies born in rural communities can receive care closer to home and has reduced the likelihood a mother will be released before her baby is cleared to go home."