Eating, Sleeping, Consoling for Neonatal Opioid Withdrawal (ESC-NOW): a Function-Based Assessment and Management Approach study protocol for a multi-center, stepped-wedge randomized controlled trial

Preliminary data from the ACT NOW Current Experience Study, a chart review conducted at 25 sites within the ISPCTN and 5 sites within the NRN, found that all 30 participating sites used the FNAST or a modification of the FNAST for the assessment of infants with NOWS as part of usual institutional care. If an infant is able to feed effectively within 10 minutes of showing hunger (breast-feed well x 10 minutes or take 10 mL [or age-appropriate volume] by alternative feeding method), to sleep undisturbed for 1 hour or longer, and is able to be consoled within 10 minutes, pharmacologic treatment is not initiated or escalated. Initial eating, sleeping, consoling approach The ESC approach, an approach that emphasizes parental involvement, simplifies the assessment of infants with NOWS, and focuses interventions on non-pharmacologic therapies, began its evolution at Yale-New Haven Children’s Hospital over a 5-year period of QI work. Faculty at Children’s Hospital at Dartmouth-Hitchcock Medical Center, Boston Medical Center, and Yale-New Haven Children’s Hospital collaborated to develop training materials, including Instructional Manual, ESC Care Tool with definitions, Newborn Care Diary, ESC training video, and written