Population-Level Changes in Infant Outcomes Associated With State “Eat Sleep Console” Initiative

OBJECTIVE Massachusetts implemented the “Eat, Sleep, Console” (ESC) initiative to manage neonatal abstinence syndrome (NAS) through its state Perinatal-Neonatal Quality Improvement Network (PNQIN) starting in 2017. This study examined the population-level changes in infant outcomes associated with the implementation of the initiative. METHODS We used Massachusetts’ Pregnancy to Early Life Longitudinal (PELL) Data System, a population-based data system linking live birth certificates and fetal death records to corresponding hospital discharge records for birthing women and infants over time. Our study included full-term, normal-weight singletons with NAS, based on recorded diagnosis codes, born in Massachusetts from 2012 to 2019. Interrupted time-series analysis assessed the changes in birth hospitalization length of stay (LOS) and costs, as well as monthly rates of 30-, 60- and 90-day infant readmissions before (2012–2016) and after (2018–2019) initiative implementation. Analyses were conducted in 2024. RESULTS We identified 5857 infants with NAS; the majority were non-Hispanic white (85.2%) and were covered by public insurance (89.7%). Implementation of the initiative was associated with decreased average total cost of birth hospitalizations (−$5763, 95% CI = −$9705, −$1820). Although not significantly associated with initiative implementation, there was a downward trend in LOS during both the pre-initiative and post-initiative periods. No significant difference was found in infant readmissions. CONCLUSIONS Implementation of the ESC initiative was associated with a population-level decrease in the average total cost of birth hospitalizations for infants with NAS. Future research may explore the drivers of cost reductions and assess differences by demographic subgroups.