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Symptom-based dosing shortened discharge readiness in some newborns

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in
Research area:MedicinePediatrics, Perinatology and Child HealthPediatric Pain Management Techniques

What the study found

Symptom-based dosing, a treatment approach matched to withdrawal severity, shortened the time from birth to medical readiness for discharge in infants with neonatal opioid withdrawal syndrome compared with a scheduled opioid taper, but only in the Eat, Sleep, Console (ESC) care group. The study did not find the same benefit in the Finnegan-based care group.

Why the authors say this matters

The authors conclude that symptom-based dosing may better align treatment with withdrawal severity. They suggest this approach can reduce time to medical readiness for discharge for infants cared for with ESC.

What the researchers tested

The researchers ran a cluster, crossover randomized clinical trial at 23 US hospitals. Infants were at least 36 weeks' gestation and at risk for pharmacologic treatment for neonatal opioid withdrawal syndrome; hospitals used either ESC or Finnegan-based care and their preferred primary opioid.

What worked and what didn't

In the ESC primary outcome cohort, time to medical readiness for discharge was shorter with symptom-based dosing than with scheduled opioid tapering (9.18 vs 11.61 days). There was no difference in the risk of starting pharmacologic treatment or in length of stay in this cohort, and 35% of infants in the symptom-based group still needed scheduled opioid dosing because intermittent dosing did not control withdrawal severity. In the Finnegan cohort, there were no significant differences in time to medical readiness for discharge or length of stay.

What to keep in mind

The abstract reports limited benefit outside the ESC cohort. It also notes that the inpatient composite safety outcome occurred rarely, but the summary does not provide detailed safety interpretation. Other limitations are not described in the available abstract.

Key points

  • Symptom-based dosing was linked to a shorter time to medical readiness for discharge in infants cared for with ESC.
  • The ESC group showed 9.18 days vs 11.61 days for scheduled opioid tapering.
  • No significant difference was found in the Finnegan cohort for time to discharge readiness or length of stay.
  • About 35% of infants in the symptom-based group still required scheduled opioid dosing.
  • The study enrolled 626 infants from 23 US hospitals.

Disclosure

Research title:
Symptom-based dosing shortened discharge readiness in some newborns
Authors:
Lori A. Devlin, Denise C. Babineau, Stephanie L. Merhar, Sara B. DeMauro, Walter K. Kraft, Scott A. Lorch, Abhik Das, Scott A. McDonald, E. Leeon Rhodes, Augusto F. Schmidt, Lillian Trochinski, Margaret Crawford, Thitinart Sithisarn, Lawrence Leeman, Kelley Kovatis, Namasivayam Ambalavanan, Ryan Smith, Sucheta Telang, Jennifer A. Tioseco, Jennifer M. McAllister, Scott L. Wexelblatt, Bhanu Muniyappa, Patricia K. Williams, Susan Adeniyi-Jones, Crystal D. Hill, Tanner Wright, Gregory M. Sokol, Lynette Johnson, Richard Hall, Scott D. Duncan, Karen Puopolo, Krishna Dummula, Ann Anderson-Berry, Jonathan M. Davis, Brenda Poindexter, Leslie W. Young, Crystal Bass, Elizabeth Hendricks, David Paul, Jennifer Chambers, Amy Mackley, Ward Rice, Cathy Grisby, David Russell, Lisa Tully, Traci Beiersdorfer, Carla King, Cynthia Reid, Stephanie Wilson Archer, Henrietta Bada, Mina Hanna, Amanda Wilburn, Susan DeGraaff, Beth McKinney-Whitlock, Carrie Hobbs, Crystal Wilson, Anna E. Thomas, Hannah Rakow, Jessica Mendoza, Betsy Tudor, Loren Nallu, Mary Connolly, Allison Dymacek, Karen Herzing, Natalie Goodman, Erin Bohon, Aprill Shockley, Emily Smith, Jenny Auman, Anna Mazur, Shannon Barnes, Brittany Thomas, Eugene Turner, James Pickett, D Leblond, Savannah Moore, Courtenay Fulmor, Lisa Pullaro, Emily J. Murray, Megan Lennon Kundrat, Angela Pallotto, Melette Pearson, Myriam Peralta-Carcelen, Waldemar A. Carlo, Samuel J. Gentle, Sandra Turner, Rachel Benz, Sharon Owen, Vallon Williams, Allyson Cheathem, A. Keyes, Kristina Foster, Allison Scott, Madison Jessie, Sarah Morris, Jennifer Nason, Audrey Miller, Rachel Welch-Miles, Molly Hemmerle, Betty Oberle, Matt VanOrmer, Sarah Newman, Emilee Kendall, Kym Abraham, Sofia M Markee, Nicole Yonke, Jessie R. Maxwell, Sandra Beauman, Conra Lacy, Ashley Palmer, Elizabeth Kuan, Megan Dhawan, Mary Catherine Gambacorta, Jon Snyder, Melanie Risch, Hanna Rosewood, Ronnie Guillet, Julie Riccio, Melissa Moreland, Rachel Jones, Marcia Kneusel, Courtney Casey, Robin K. Ohls, Camille Fung, Carrie A. Rau, Kathie Coleman, Kandace M. McGrath, Manndi C. Loertscher
Institutions:
AtlantiCare, Children's Hospital of Oklahoma, Children's Hospital of Philadelphia, Children's Hospital of Philadelphia, Children's Hospital of Philadelphia, Children's Mercy Hospital, Christiana Care Health System, Cincinnati Children's Hospital Medical Center, Cincinnati Children's Hospital Medical Center, Cincinnati Children's Hospital Medical Center, Cincinnati Children's Hospital Medical Center, Emory University, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Golisano Children's Hospital, Good Samaritan Hospital, Indiana University – Purdue University Indianapolis, Indiana University School of Medicine, Mercy Hospital, Norton Hospital, Norton Hospital, Norton Women's and Children's Hospital, Perinatal Institute, Perinatal Institute, Perinatal Institute, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, Roshydromet, RTI Health Solutions, RTI Health Solutions, RTI Health Solutions, RTI Health Solutions, RTI Health Solutions, RTI Health Solutions, RTI International, RTI International, RTI International, RTI International, RTI International, RTI International, St. Elizabeth Healthcare, Thomas Jefferson University, Thomas Jefferson University, Tufts Medical Center, University of Alabama at Birmingham, University of Arkansas for Medical Sciences, University of Kansas Medical Center, University of Louisville, University of Louisville Hospital, University of Nebraska Medical Center, University of New Mexico, University of Oklahoma Health Sciences Center, University of Pennsylvania, University of Pennsylvania, University of Pennsylvania, University of Rochester, University of South Florida, University of Utah, University of Vermont
Publication date:
2026-04-25
DOI:
10.1001/jama.2026.5782
OpenAlex record:
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