MDCalc

Eat, Sleep, Console (ESC)

Assists with management of infants with neonatal abstinence syndrome (NAS).

Eat: Can infant eat ≥1 ounce per feed or breastfeed well?

Sleep: Can infant sleep ≥1 hour?

Console: Can infant be consoled within 10 minutes?

Result:

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Management

  • If all three questions are answered “yes”, the infant is considered to be well managed and no further interventions are necessary.

  • If any of the three questions is answered “no”, increase the following nonpharmacologic interventions if possible:

    • Feeding on demand.

    • Swaddling and holding.

    • Low stimulation environment.

    • Parental presence.

  • If no improvement, consider NICU consult (if available) and consider starting morphine at 0.05 mg/kg per dose every 3 hours or increase dosing by 0.01 mg/kg per dose.

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