Meta-analysis finds Eat-Sleep-Console care reduces neonatal opioid withdrawal hospital stay

BackgroundNeonatal opioid withdrawal syndrome (NOWS) is increasingly prevalent and is frequently managed with pharmacologic opioid therapy, raising concerns regarding early-life opioid exposure and prolonged hospitalization. Interventions aimed at reducing pharmacologic exposure while maintaining safety have emerged, most notably care-model–based approaches. This study aims to systematically review the evidence evaluating interventions designed to reduce pharmacologic opioid exposure in neonates with NOWS compared with standard care.MethodsA systematic review was conducted in accordance with PRISMA guidelines. PubMed/MEDLINE, Cochrane CENTRAL, and Google Scholar were searched from inception through the final search date. Randomized controlled trials, comparative observational studies, and quality-improvement studies evaluating exposure-reduction strategies were included. Interventions of interest primarily comprised care-model approaches such as Eat–Sleep–Console (ESC). Outcomes included duration of opioid therapy, cumulative opioid exposure, length of hospital stay, and safety outcomes. Due to substantial heterogeneity across studies, findings were synthesized narratively.ResultsSix studies met inclusion criteria, comprising three randomized studies and three observational or quality-improvement studies. Meta-analysis of randomized evidence showed ESC-based care significantly reduced hospital stay length (MD −6.50 days; 95% CI −9.63 to −3.36; p