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Help for Babies Born Dependent on Opioids

Posted on by Lawrence Tabak, D.D.S., Ph.D.

A woman sitting in bed feeds a sleepy newborn baby with a bottle
Credit: Shutterstock/Alena Ozerova

It’s been estimated that every 18 minutes in the United States, a newborn baby starts life with painful withdrawals from exposure to opioids in the womb. It’s called neonatal opioid withdrawal syndrome (NOWS), and it makes for a challenging start in life. These infants may show an array of withdrawal symptoms, including tremors, extreme irritability, and problems eating and sleeping.

Many of these infants experience long, difficult hospital stays to help them manage their withdrawal symptoms. But because hospital staff have no established evidence-based treatment standards to rely on, there is substantial variation in NOWS treatment around the country. There also are many open questions about the safest and most-effective way to support these babies and their families.

But answers are coming. The New England Journal of Medicine just published clinical trial results that evaluated care for infants with NOWS and which offer some much needed—and rather encouraging—data for families and practitioners [1]. The data are from the Eating, Sleeping, Consoling for Neonatal Opioid Withdrawal (ESC-NOW) trial, led by Leslie W. Young, The University of Vermont’s Larner College of Medicine, Burlington, and her colleagues Lori Devlin and Stephanie Merhar.

The ESC-NOW study is supported through the Advancing Clinical Trials in Neonatal Opioid Withdrawal (ACT NOW) Collaborative. ACT NOW is an essential part of the NIH Helping to End Addiction Long-term (HEAL) Initiative, an aggressive effort to speed scientific solutions to stem the national opioid public health crisis and improve lives.

The latest study puts to the test two different approaches to care for newborns with NOWS. The first approach relies on the Finnegan Neonatal Abstinence Scoring Tool. For almost 50 years, doctors primarily assessed NOWS using this tool. It is based on a scoring system of 21 signs of withdrawal, including disturbances in a baby’s nervous system, metabolism, breathing, digestion, and more. However, there have been concerns that this scoring tool has led to an overreliance on treating babies with opioid medications, including morphine and methadone.

The other approach is known as Eat, Sleep, Console (ESC) care [2]. First proposed in 2014, ESC care has been adopted in many hospitals around the world. Rather than focusing on a long list of physical signs of withdrawal, this approach relies on a simpler functional assessment of whether an infant can eat, sleep, and be consoled. It emphasizes treatments other than medication, such as skin-to-skin contact, breastfeeding, and care from their mothers or other caregivers in a calm and nurturing environment.

The ESC care approach places an emphasis on the use of supportive interventions and aims to empower families in the care and nurturing of their infants. While smaller quality improvement studies of ESC have been compelling, the question at issue is whether the Eat, Sleep, Console care approach can reduce the time until infants with NOWS are medically ready to go home from the hospital in a wide variety of hospital settings—and, most importantly, whether it can do so safely.

To find out, the ESC-NOW team enrolled 1,305 infants with NOWS who were born after at least 36 weeks gestation. The study’s young participants were largely representative of infants with NOWS in the U.S., although non-Hispanic Black and Hispanic infants were slightly overrepresented. The babies were born at one of 26 U.S. hospitals, and each hospital was randomly assigned to transition from usual care using the Finnegan tool to the ESC care approach at a designated time.

Each hospital had a three-month transition period between the usual care and the ESC to allow clinical teams time to train on the new approach. The trial primarily aimed to understand if there was a significant difference in how long newborns with NOWS spent in the hospital before being medically ready for discharge between those receiving usual care versus those receiving ESC care. Researchers also assessed infants for safety, tracking both safety events that occurred during the hospital stay and events that occurred after the baby left the hospital, such as non-accidental trauma or death during an infant’s first three months.

The reported results reflect 837 of the 1,305 infants, who met the study definition of being medically ready for discharge. Infants who were discharged before meeting the study criteria, which were informed by the 2012 American Academy of Pediatrics recommendations for monitoring of infants with NOWS, were not included in the primary analysis.

Among the 837 infants, those who received ESC care were medically ready for discharge significantly sooner than those who received usual care. On average, they were medically ready to go home after about eight days compared to almost 15 days for the usual care group.

Many fewer infants in the ESC care group were treated with opioids compared to the usual care group (19.5 percent versus 52.0 percent). In more good news for ESC care, there was no difference in safety outcomes through the first three months despite the shorter hospital stays and reduced opioid treatment in the hospital. Infants who were cared for using the ESC care approach were no more likely to visit the doctor’s office, emergency room, or hospital after being discharged from the hospital.

More long-term study is needed to evaluate these children over months and years as they continue to develop and grow. Many of the infants in this study will be evaluated for the first two years of life to assess the long-term impact of ESC care on development and other outcomes. These findings offer encouraging early evidence that the ESC care approach is safe and effective. Although there was some variability in the outcomes, this study also shows that this approach can work well across diverse hospitals and communities.

The ESC-NOW trial is just one portion of the NIH Heal Initiative’s ACT NOW program, focused on gathering scientific evidence on how to care for babies with NOWS. Other studies are evaluating how to safely wean babies who do receive treatment with medication off opioids more quickly. The ACT NOW Longitudinal Study also will enroll at least 200 babies with prenatal opioid exposure and another 100 who were not exposed to better understand the long-term implications of early opioid exposure.

I’ve been anxious to see the results of the ESC-NOW study for a few months. It’s been worth the wait. The results show that we’re headed in the right direction with learning how best to treat NOWS and help to improve the lives of these young children and their families in the months and years ahead.


[1] Eat, Sleep, Console Approach versus usual care for neonatal opioid withdrawal. Young LW, Ounpraseuth ST, Merhar SL, Newman S, Snowden JN, Devlin LA, et al. NEJM, 2023 Apr 30 [Published online ahead of print]

[2] An initiative to improve the quality of care of infants with neonatal abstinence syndrome. Grossman MR, Berkwitt AK, Osborn RR, Xu Y, Esserman DA, Shapiro ED, Bizzarro MJ. Pediatrics. 2017 Jun;139(6):e20163360.


SAMHSA’s National Helpline (Substance Abuse and Mental Health Services Administration, Rockville, MD)

“Eat, Sleep, Console” reduces hospital stay and need for medication among opioid-exposed infants, NIH news release, May 1, 2023

Helping to End Addiction Long-term® (HEAL) Initiative (NIH)

Advancing Clinical Trials in Neonatal Opioid Withdrawal (ACT NOW)

Environmental Influences on Child Health Outcomes (ECHO) Program (NIH)

Leslie Young (The University of Vermont, Larner College of Medicine, Burlington)

NIH Support: The Eunice Kennedy Shriver National Institute of Child Health and Human Development; National Center for Advancing Translational Sciences; Office of the Director


  • Claudette Chander says:

    A well-written article that encompasses and explains the many aspects of newborns coming in to the world addicted to opioids. It is a race to wean them off the addiction, and get these infants healthy again.
    As a nurse, I have seen and worked with these little ones. Its also so sad to see the addicted new mothers lack of interest in their infants as they crave their next high. Wishing the NIH every success in tackling our country’s insidious opioid crisis.

  • Terry Therese A Flood says:

    ESC, eat sleep and console is a great idea and does help the babies. The issue is finding the resources to continually console the babies.

  • Su says:

    This is wonderful news!

  • tdchinges says:

    These studies are of great help to the growth of babies.

  • Sandi says:

    I have to wonder if some of the success of ESC also has to do with mothers now on Suboxone rather than Methadone for their withdrawal. We’ve had great outcomes with ESC but most of the mothers we are seeing now are on Suboxone, unlike years ago when they were treated with Methadone.

  • leedaily says:

    These findings from the ESC-NOW study are incredibly promising and provide much-needed insight into the treatment of neonatal opioid withdrawal syndrome (NOWS). By comparing the traditional approach with the Eat, Sleep, Console (ESC) care method, this study offers evidence that ESC care can lead to shorter hospital stays and reduced opioid treatment for infants with NOWS. Importantly, the study also shows that ESC care is safe and can be effectively implemented across diverse hospital settings. These results mark a significant step forward in improving the lives of these vulnerable infants and their families.

  • Lisa Querin says:

    Good job. These babies deserve loving care

  • EVA MENDIS says:

    Help for Babies Born Dependent on Opioids” is an incredibly insightful and compassionate blog that sheds light on a deeply concerning issue. The author’s ability to articulate the challenges faced by babies born dependent on opioids is commendable.

    What sets this blog apart is its focus on providing practical solutions and support for these vulnerable infants. The author’s dedication to sharing resources and strategies for helping babies overcome their addiction and thrive is truly remarkable. By emphasizing the importance of early intervention and specialized care, the blog offers hope to families and healthcare professionals involved in the care of these babies.

  • mayshee says:

    Infants born addicted to opioids require prompt intervention. Non-pharmacological and pharmacological treatments, along with supportive care, aim to wean them off opioids and promote their well-being. Support for mothers struggling with addiction is crucial. Efforts to address the opioid crisis continue.

  • sara says:

    I just read your article on helping babies born dependent on opioids, and I must say, it hit me right in the feels. It’s incredible how much these little ones go through and how important it is to provide them with the support they need from the start. Kudos to you for shedding light on this often overlooked issue.

    I was particularly moved by your mention of the importance of a multidisciplinary approach when it comes to treating these babies. It’s so true that it takes a village to help them recover and thrive. The collaboration between medical professionals, social workers, and therapists is crucial in ensuring these infants receive the comprehensive care they deserve. The fact that some hospitals have established specialized units dedicated to their treatment is fantastic! It’s heartwarming to know that there are places where these babies and their families can find the resources and guidance they need during such a challenging time.

    Moreover, I greatly appreciate your emphasis on the importance of non-pharmacological interventions like cuddling, soothing music, and gentle touch. These seemingly small gestures can make a world of difference in the healing process for these babies. It’s remarkable how something as simple as human touch and nurturing can have such a profound impact on their development and well-being. I hope that your article reaches a wide audience and helps raise awareness about this issue, inspiring more people to support these little fighters and their families. Thank you for shining a light on this crucial topic.

  • muskan says:

    The sight of newborns entering the world addicted to opioids is a tragic and complex consequence of the ongoing opioid epidemic. As healthcare professionals, it is our duty to provide these infants with the best care possible and work tirelessly to ensure their healthy recovery. Simultaneously, it is essential to address the broader aspects of addiction, offering support to mothers to break free from the clutches of opioids. By working together as a society, with the support of institutions like the National Institutes of Health (NIH), we can hope for a brighter future, free from the devastating grip of the opioid crisis.

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