Our mission is to develop a prenatal QI initiative that will address issues of verbal screening, brief interventions and successful referrals for treatment for every pregnant mother in the state with opioid use disorder. This effort will be the vital prelude to hospital based efforts which are now underway in 52 hospitals across North Carolina.  We are planning to conduct this work virtually with a total of four one hour noontime calls every two weeks beginning March 16th.  We will make very rough drafts available before each session as we develop an aim statement, action plan, key driver diagram and metrics which will direct our prenatal efforts.

Register for the calls - 

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Enter your Birth Certificate Audit Forms here

For those of you requiring IRB approval click here

Joining the Initiative

Please submit a PQIT Roster for your team

Roster Changes: Please make sure to submit any changes in your team roster.  We would like to be able to provide all team members with the latest information about the initiative and we can only do that with your help.

State of the State

Please help PQCNC, and our Partners, by getting your team together to complete and discuss the State of the State survey.  Please don't overthink the questions, or your answers, discuss with your team and answer as seems appropriate.  Download the survey here - when you have completed the questions click here to record your answers

Pre-work/Work Action Plan 

Required pre-work/work for participation in clOUDi - click here to complete the PQCNC clOUDi Success in Quality Survey


2023 Final Snapshot - Download the Snapshot here - when you have completed the questions click here to enter your data

Initiative Charter/Action Plans/Work Plans 

PQCNC clOUDi Charter

PQCNC clOUDi Maternal Action Plan

PQCNC clOUDi Infant Action Plan


Initiative Data: The official start date for Initiative Data Collection is January 01 2021.

PQCNC clOUDi Data Collection Plan

PQCNC clOUDi Maternal Patient Data Collection

PQCNC clOUDi Maternal Patient Data Collection Dictionary

PQCNC clOUDi Infant Patient Data Collection

PQCNC clOUDi Infant Patient Data Collection Dictionary

PQCNC clOUDi Maternal Monthly Data Collection

PQCNC clOUDi Maternal Quarterly Data Collection

PQCNC clOUDi Infant Monthly Data Collection


Delphi Bulk Data Submission

PQCNC clOUDi BUlk Data Submission  - instructions for preparing and submitting your data

PQCNC clOUDi Bulk Data Submission Mom Patient Sample Spreadhseet - sample spreadsheet containing an examples of data for submission (click to view, right click and download to save)

PQCNC clOUDi Bulk Data Submission Mom Patient Data Sample Spreadhseet - sample spreadsheet containing an examples of data for submission (click to view, right click and download to save)

PQCNC clOUDi Bulk Data Submission Infant Patient Sample Spreadhseet - sample spreadsheet containing an examples of data for submission (click to view, right click and download to save)

PQCNC clOUDi Bulk Data Submission Infant Patient Data Sample Spreadhseet - sample spreadsheet containing an examples of data for submission (click to view, right click and download to save)


Accessing Reports

Attention Data Collectors:  

Instructions on how to obtain access to Delphi to submit data.


A multitude of webinars will be available on-demand to assist you in your work

Team Meetings: 

Your team will need to schedule at least monthly meetings to review data, make plans for PDSA cycles, and plan for next steps. 

Executive Champion:

Please set up times to meet with your Executive Champions to update them on your progress and to ask for their help to meet your goals. PQCNC would suggest you meet with them every other month but no less than every quarter.


NC Drug User Health Resource Guide - Current available resources including testing, vacinations, clinics, food pantries and community meals, shelter and long-term housing...

NC Opioid Dashboard from NCDHHS - Current NC data (follow link, choose Metric Summary Table in left-hand column.  Read introductory paragraphs for 2018 data.  Orange table represents NC data for 2019)

Perinatal Substance Use Disorders Treatment - North Carolina has been at the forefront of offering treatment for perinatal substance use disorders for over 25 years. Wraparound services, understanding of the fourth trimester, the importance of medication-assisted treatment, and learning from past false predictions regarding illicit prenatal exposure contribute to a nurturing, supportive approach for the mother, child, and families.

Community Child Protection Team Review Guide: A Guide for Local Community Child Protection Teams’ Review of Substance Affected Infants/Plan of Safe Care Cases - The following guidance is presented to assist county departments and local Community Child Protection Teams through the review process, and to better understand and identify the factors associated with infants who are substance affected.

North Carolina Pregnancy and Opioid Exposure Project

Pregnancy Medical Home Care Pathway: Maternal Substance Use in Pregnancy

Pregnancy Medical Home Care Pathway: Maternal Substance Use in Pregnancy Appendix

NC MATTERS - provides support to providers around managing perinatal substance use and mental health.  They provide real-time psychiatric consultation to any perinatal provider in North Carolina, and will also provide a virtual, one-time psychiatric assessment for patients free of charge.  NC MATTERS also identifies accessible treatment resources for appropriate patient referrals



The United States opioid epidemic - Addressing this epidemic requires addressing the stigma associated with opi- oid use disorders and its treatment, improving access to efficacious treatment options, specifically methadone and buprenorphine, and reducing opioid overdose fatalities with distribution of the opioid antagonist and overdose reversal agent naloxone

Maternal Opioid Use Disorder and Neonatal Abstinence Syndrome Among Rural US Residents, 2007–2014 - This study describes the trajectory and characteristics associated with diagnosis of maternal OUD or NAS among rural residents who gave birth at different types of hospitals based on rural/urban location and teaching status.

Treating Women Who Are Pregnant and Parenting for Opioid Use Disorder and the Concurrent Care of Their Infants and Children : Literature Review to Support National Guidance

A Public Health Response to Opioid Use in Pregnancy - Several state governments responded to this increase by prosecuting and incarcerating pregnant women with substance use disorders; however, this approach has no proven benefits for maternal or infant health and may lead to avoidance of prenatal care and a decreased willingness to engage in substance use disorder treatment programs. A public health response, rather than a punitive approach to the opioid epidemic and substance use during pregnancy, is critical

Opioid use disorder during pregnancy in Tennessee: expediency vs. science - In one third of states, however, Medicaid reimbursement will cover the cost of buprenorphine, but not methadone, to treat opioid use disorder in pregnant women. This commentary explores the clinical and policy rational and consequences of this policy

Opioid Use Disorder Documented at Delivery Hospitalization — United States, 1999–2014

ACOG Committee Opinion - Substance Use Disorders: Ethical Issues in Obstetric and Gynecologic Practice - The ACOG Committee on Ethics presents an ethical framework for incorporating practices to optimize care of patients with  substance use disorder and resolving common related ethical dilemmas



A COLLABORATIVE APPROACH TO THE TREATMENT OF PREGNANT WOMEN WITH OPIOID USE DISORDERS - Practice and Policy Considerations for Child Welfare, Collaborating Medical, and Service Providers

Clinical Guidance for Treating Pregnant and Parenting Women with Opioid Use Disorder and Their Infants

Opioid use disorder in pregnancy - Many factors affect opioid use disorder treatment choices during pregnancy; however, when a pregnant person is medically eligible for a therapy and multiple options are available locally, the ultimate decision regarding treatment selection should be left up to the patient and strong support services provided. This approach to treatment results in optimal maternal and neonatal outcomes and long-term maternal engagement and retention in care.

Opioid Use Disorder in Pregnancy - information and guidance for clinicians working with and treating this population.

Opioid Use Disorder in Pregnancy: Health Policy and Practice in the Midst of an Epidemic - emphasizing the importance of safe and responsible opioid-prescribing practices, expanding the availability and accessibility of medication-assisted treatment and standardizing care for neonates at risk of neonatal abstinence syndrome.

Treatments for opioid use disorder among pregnant and reproductive-aged women - Treatment for opioid use disorder falls into four overlapping do- mains: medication management, medical care, behavioral/mental health care, and psychosocial support. This review  discusses these domains with an emphasis on pregnant women and women of reproductive age. Treatment for opioid use disorder is most effective when all providers coordinate care in an informed, nonjudgmental, patient-centered approach.

Models of care for opioid dependent pregnant women - A care model that integrates prenatal care, medication assisted treatment and behavioral health services delivered in a trauma-informed environment can improve prenatal care attendance and thus have far-reaching positive implications for both the woman and her newborn child.

Medical complications of opioid use disorder in pregnancy - outlines some associated medical complications of OUD both in general and some of which are unique to pregnancy: infectious diseases, soft tissue infections, endocarditis, cholestasis of pregnancy, and overdose.


Medication Assisted Treatment

Pharmacological treatment of opioid use disorder in pregnancy - Pharmacotherapy, or medication-assisted treatment (MAT), is a critical component of a comprehensive treatment plan for the pregnant woman with opioid use disorder (OUD).

Methadone, Buprenorphine, and Naltrexone for the Treatment of Opioid Use Disorder in Pregnant Women - comparing the pregnancy outcomes of methadone, buprenorphine, and naltrexone in clinical trials and discussing the potential behavioral and developmental effects of these agents seen in offspring in animal studies

Treating women with opioid use disorder during pregnancy in Appalachia: Initial neonatal outcomes following buprenorphine + naloxone exposure - Use of buprenorphine + naloxone shows relative safety in pregnancy.

Transitioning from methadone to buprenorphine maintenance in management of opioid use disorder during pregnancy. - Pregnant women transitioned from methadone to buprenorphine maintenance showed maternal and neonatal outcomes comparable to studies of women on buprenorphine throughout pregnancy. Infants born to buprenorphine-maintained women who abstained from illicit substances and other prescribed psychotropic medications experienced less severe NAS and shorter hospitalizations

Buprenorphine compared with methadone to treat pregnant women with opioid use disorder: a systematic review and meta-analysis of safety in the mother, fetus and child - Moderately strong evidence indicates lower risk of preterm birth, greater birth weight and larger head circumference with buprenorphine treatment of maternal opioid use disorder during pregnancy compared with methadone treatment, and no greater harms.





Screening, brief intervention, and referral to treatment for opioid and other substance use during infertility treatment - provides an overview of screening, brief intervention, and referral to treatment (SBIRT), a public health approach shown to be effective in ameliorating the harms of substance use.

Implementing SBIRT (Screening, Brief Intervention and Referral to Treatment) in primary care: lessons learned from a multi-practice evaluation portfolio. - describes pragmatic best practices to successfully create, implement, and sustain SBIRT.

Alcohol and Drug Screening, Brief Intervention, and Referral to Treatment (SBIRT) Training and Implementation: Perspectives from 4 Health Professions.

Screening, Brief Intervention and Referral to Treatment(SBIRT): rationale, program overview and cross-site evaluation 

Development and evaluation of two instruments for assessing screening, brief intervention, and referral to treatment (SBIRT) competency - discusses 2 proficiency checklists: the SBIRT Proficiency Checklist (SPC), composed of 22 questions for videotaped interviews, and the Clinical SBIRT Proficiency Checklist (CSPC), composed of 13 questions for direct clinical observation.

Development of the SBIRT checklist for observation in real-time (SCORe). -  flexible method for assessing adherence to evidence-based Screening, Brief Intervention and Referral to Treatment service protocols.

Clincal Guidance for Treating Pregnant and Parenting Women with Opioid Use Disorder and Their Infants - Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Services Administration (SAMHSA) 

AIM Opioid Screening Tools Overview - Descriptions, pros, cons, links to validated screening tools

Integrated 5P's - validated inpatient and outpatient tool for violence, mental health, tobacco, alcohol, and illicit substances

Screening for Prenatal Substance Use: Development of the Substance Use Risk Profile-Pregnancy Scale - - development of a three-item Substance Use Risk Profile-Pregnancy scale

Substance Use Risk Profile-Pregnancy Scale (SURP-P) - validated prenatal clinic screening tool for alcohol and substances


Pain Management

Perioperative pain management strategies among women having reproductive surgeries - This review presents opioid-sparing strategies for perioperative pain management among women undergoing reproductive surgeries and procedures. Recommendations are provided regarding the use of nonsteroidal anti-inflammatory drugs, acetaminophen, other adjunctive medications, and regional anesthetic blocks. Additional considerations for chronic opioid users or patients using opioid replacement or antagonist therapy are discussed.

The opioid epidemic and pregnancy: implications for anesthetic care. - Acute and chronic pain management strategies in opioid-tolerant parturients are reviewed




Stop Talking ‘Dirty’: Clinicians, Language, and Quality of Care for the Leading Cause of Preventable Death in the United States - Use of the more medically and scientifically accurate “substance use disorder” terminology is linked to a public health approach that captures the medical malfunction inherent in addiction. Use of this term may decrease stigma and increase help-seeking. In contrast, tough, punitive, language, including the word “war,” in “war on drugs,” is intended to send an uncompromising message, “You use, you lose,” in the hopes of deterring drug involvement. Accompanying this aggressive rhetoric are terms such as drug “abuse” and drug “abusers,” implying willful misconduct (ie, “they can help it and it is their fault”). This language increases stigma and reduces help-seeking.

Opioid use and stigma: The role of gender, language and precipitating events - results indicated that there were higher stigmatizing attitudes overall towards a male, an in- dividual labeled as a “drug addict” and an individual who took prescription opioids from a friend. Interaction effects also showed that a female labeled with an “opioid use disorder” and male labeled as a “drug addict” were rated with higher stigma. The findings from our study are the first to show that information about gender, precipitating events and language matter when assessing stigma and opioid use and may affect the delivery of patient care.

Using Science to Battle Stigma in Addressing the Opioid Epidemic: Opioid Agonist Therapy Saves Lives - the medical community can and must take a leadership role in ensuring our approach is driven by science and not stigma.

Frequent experience of discrimination among people who inject drugs: Links with health and wellbeing - findings highlight that frequent discrimination may lead to worse health and wellbeing among people who inject drugs (PWID). If our findings are supported by other research, policies aimed at reducing discrimination against PWID may be warranted or improved.

Implicit and explicit internalized stigma: Relationship with risky behaviors, psychosocial functioning and healthcare access among people who inject drugs - To the degree that participants had internalized the stigma about their group (measured explicitly), they felt less comfortable attending Needle Syringe Programs, had greater severity of dependence, and experienced more depressive symptoms.

Opiate Use Disorder in Pregnancy: Addressing Stigma - From the Education Workgroup ACOG/AIM Project

Pregnant women and substance use: fear, stigma, and barriers to care - This study explored the experiences of substance-using mothers as they navigated health and criminal justice consequences and accessed needed resources in the community.

Methadone versus buprenorphine for the treatment of opioid abuse in pregnancy: science and stigma - While increased access to treatment is important, particularly in rural areas, there are multiple medical and psychosocial reasons to recommend comprehensive substance abuse treatment for pregnant women suffering from substance use disorders rather than office-based provision of maintenance medication.

ANTI-STIGMA TOOLKIT A Guide to Reducing Addiction-Related Stigma - A guide to provide the addiction treatment and recovering community with practical information and tools to enhance their capacity to engage in effective stigma reduction efforts

Changing BSN Students’ Stigma Toward Patients Who Use Alcohol and Opioids Through Screening, Brief Intervention, and Referral to Treatment (SBIRT) Education and Training: A Pilot Study - After a 15-week semester that included (a) SBIRT education and (b) weekly clinical experiences with patients who had alcohol use problems the undergraduate nursing students’ stigma decreased as measured by three of the five subscales.

National Collaborative on Maternal OUD - Stigma and Opioid Use

Stigma, Discrimination, treatment Effectiveness, and Policy: Public Views About Drug Addiction and Mental Illness


Stigma Training:

Changing Language to Change Care: Stigma and Substance Use Disorder - This module is within 22 module core curriculum on SUD that provides an overview of evidence-based practices in the prevention, identification, and treatment of substance use disorders and co-occurring mental disorders. You may access the complete course listing here


Stigma Videos - click for Stigma Videos


Stigma Survey Tools:

Attitudes Toward Buprenorphine Scale (ATBS)- Adapted

Provider attitudes regarding patients with substance use disorder during the perinatal period - Pre-Course Survey

Provider attitudes regarding patients with substance use disorder during the perinatal period - Post-Course Survey



Pregnancy Planning for Women Being Treated for Opioid Use Disorder

Medications to Treat Opioid Use Disorder During Pregnancy

Are you taking medicine for opioid use disorder and are pregnant or thinking about having a baby?

the facts about BUPRENORPHINE for Treatment of Opioid Addiction

Opioid Use Disorder and Pregnancy: Taking helpful steps for a healthy pregnancy



NCDHHS Infant Plan of Safe Care

NAS/NOWS Toolkits

Ohio Perinatal Quality Collaborative

NEOQICNAS NAS Driver Diagram

NAS Toolkit Minnesota Hospital Association

East Tennessee State University NAS Toolkit 

Infants with Prenatal Substance Exposure: Yale New Haven Children's Hospital's Approach 

CHoSen Collaborative, Colorado



Eat Sleep & Console videos - click here for Eat Sleep & Console Videos

ChoSEN Quality Improvement Collaborative Hospital Checklist for the Adoption of ESC  - checklist of assessment items for adoption of ESC


NAS/NOWS General:  The following articles are from national Groups and organizations as well as background articles.

Neonatal Opioid Withdrawal Syndrome - an overview of the effect of the opioid crisis on the mother-infant dyad and recommendations for management of the infant with opioid exposure, including clinical presentation, assessment, treatment, and discharge

Neonatal abstinence syndrome - examines the history, incidence and pathophysiology of NAS as diagnostic screening approaches, scoring tools, differing management approaches and recommendations for continued work to improve the care of infants with NAS.

Neonatal Abstinence Syndrome Incidence and Health Care Costs in the United States, 2016

Neonatal Drug Withdrawal:  AAP’s statement on neonatal drug withdrawal.  This statement updates information about the clinical presentation of infants exposed to intrauterine drugs and the therapeutic options for treatment of withdrawal and is expanded to include evidence-based approaches to the management of the hospitalized infant who requires weaning from analgesics or sedatives.

Opiate treatment for opiate withdrawal in newborn infants (Review):  Cochran review of current literature assessing effectiveness and safety of using opiates for withdrawal in infants.

Neonatal Abstinence Syndrome Clinical Practice Guidelines:  Practice guidelines created by the Provincial Council for Maternal Child Health in Ontario

Prenatal Substance Abuse Short- and Long-term Effects on the Exposed Fetus:  AAP Committee on Substance Abuse and Committee on Fetus and Newborn report on the most common drugs involved in prenatal exposure, addresses primary care pediatrician’s role in prenatal exposure includes prevention, identification of exposure, recognition of medical issues, protection of the infant and follow-up of the exposed infant.

Neonatal abstinence syndrome:  A review that discusses the complex nature of maternal and other factors that can affect the infant’s display of neonatal abstinence syndrome (NAS), clinical presentation and treatment of NAS, and the impact of recent findings on future directions for research.

NICU Nurses’ Lived Experience:  primary aim of this qualitative methods study was to describe the lived experiences of neonatal intensive care unit (NICU) nurses with ethical and morally challenging issues.

NAS Management Algorithm Treat or not to Treat:  Example algorithm for determining whether to treat the infant

NAS Management Algorithm Stabilization on Morphine:  Example algorithm for maintaining or increasing dose of morphine

NAS Management Algorithm Weaning:  Example algorithm for weaning morphine

NAS Management Algorithm Backsliding:  Example algorithm for infants that have difficulties with weaning

PQCNC NAS Swimlane:  High-level process map indicating the steps in the identification, evaluation, treatment, and discharge of a patient.  Pages 1-4 look at the individual process of each area.  Page 5 shows the entire process


NAS/NOWS Identification: The following articles are related to methods for identification of exposure

Perinatal Effects of Combined Use of Heroin, Methadone, and Amphetamine during Pregnancy and Quantitative Measurement of Metabolites in Hair:  There has been very limited research on the clinical features of newborns exposed to combined use of heroin, methadone, and amphetamine in the uterus. This study describes a technique for the quantification of drug metabolites in neonatal hair samples

Opioid Detection in Maternal and Neonatal Hair and Meconium:  Characterization of an At-Risk Population and Implications to Fetal Toxicology:  Identification of maternal opioid abuse in pregnancy is often difficult to ascertain in the absence of a reliable self-report. This study aimed to characterize an at-risk neonatal population for opioid exposures as well as other drugs of abuse and alcohol 

Identification and Management of Neonatal Abstinence Syndrome:  This article focuses on drug abuse during pregnancy, the withdrawal symptoms it may cause in the infant, ways to recognize an infant experiencing neonatal abstinence syndrome, and available scoring tools and treatment options.

Identifying Infants at Risk for Neonatal Abstinence Syndrome:  The main objective of this study was to analyze the consistency in using a standardized newborn toxicology screening protocol to identify infants at risk of developing neonatal abstinence syndrome

Drugs of abuse testing in meconium: In spite of increased sample preparation time relative to blood and urine, the long metabolic history, coupled with the ease and wide window of collection of meconium make it the ideal matrix for determining fetal drug exposure.

Comparison of meconium and neonatal hair analysis for detection of gestational exposure to drugs of abuse:  In cases of clinical suspicion and a negative neonatal urine test, both meconium and hair are effective biological markers of in utero illicit drug exposure. Meconium may be more sensitive, but neonatal hair is available for three months whereas meconium is available for only one or two days.

Neo Methods for Neonatal Drug Screening:  Article that describes perinatal and neonatal complications of maternal use of cocaine, alcohol, opiates, and barbiturates in pregnancy. Provides established cutoffs of conventional immunoassays of urine for common substances of abuse. List the advantages of using meconium testing for substances of abuse. Describes the role of fatty acid ethyl esters in detecting prenatal alcohol exposure.

Prenatal Substance Exposure:  Maternal Screening and Neonatal Identification and Management:  Article that describes physical and neurobehavioral problems of neonates who were exposed to maternal substances of abuse. Delineates the purpose of universal screening. Characterizes the areas of inquiry represented by the 4P’s Plus assessment. Describes the significant features of neonatal abstinence syndrome. Delineates supportive measures for management of infants exposed prenatally to substances of abuse

Effectiveness of a targeted screening program in identifying infants with positive urine toxicology screening results in a regular neonatal nursery:  Study that compared the effectiveness in identifying infants with positive results on urine screening for drugs of abuse of a universal screening program and a targeted screening program on the basis of clinical suspicion.

Identifying Infants at Risk for Neonatal Abstinence Syndrome:  Main objective of this study was to analyze the consistency in using a standardized newborn toxicology screening protocol to identify at risk of developing NAS

Testing for fetal exposure to illicit drugs using umbilical cord tissue vs meconium:  Study with the objective of assessing the agreement of testing for exposure contrasting specimens of meconium vs umbilical cord tissue.  Umbilical cord tissue performs as well as meconium in assessing fetal drug exposure to amphetamines, opiates, cocaine, and cannabinoids. Results of studies using the cord may have a more rapid return to the clinician.


NAS/NOWS Evaluation:  The following articles are related to methods to evaluate for NAS 

The Opioid Exposed Newborn:  Assessment and Pharmacologic Management:  Review from the NIH to provide health care professionals with current evidence and practical guidelines for optimal evaluation and pharmacologic management of opioid exposed newborns.

Finnegan neonatal abstinence scoring system:  normal values for the first 3 days and weeks 5-6 in non-addicted infants:  The purpose of this study was to assess the variability of the scores in newborns and infants not exposed to opiates during the first 3 days of life and during 3 consecutive days in weeks 5 or 6.

Establishment of Inter-observer Reliability Using the Finnegan Neonatal Abstinence Scoring Tool:  Presentation that discusses the importance of attaining reliability with clinical screening tools and helping to determine inter-observer reliability

Management of neonatal abstinence syndrome in neonatal intensive care units:  a national survey:  Aim of the study was to determine the monitoring and treatment of NAS in NICU’s following opiate or polydrug exposure in utero

Implementing Practice Guidelines and Education to Improve Care of Infants With Neonatal Abstinence Syndrome:  Purpose was to develop and implement a program for the management of NAS and the use of the Finnegan tool.


NAS/NOWS Treatment:  The following articles are related to treatment of NAS 

Eat Sleep Console

CHoSen Collaborative, Colorado Eat Sleep Console Provider Training


Development and application of a primer and reference assessment tool for neonatal abstinence syndrome: A phase I pilot study - describing the development and preliminary usability of an electronic bedside primer and decision support tool for medical providers, with embedded, interactive education and reference modules.

Managing Abstinence in Newborns - In 2003, an alternative model of care for infants at risk of developing NAS was established at a large academic medical center in up- state SC. This case report describes the multidisciplinary, coordinated- care model, titled Managing Abstinence in Newborns (MAiN), and lessons learned from 15 years of MAiN development and implementation efforts.

Clonidine as an Adjunct Therapy to Opioids for Neonatal Abstinence Syndrome:  A Randomized Controlled Trial:  Objective of the study was to determine if oral clonidine would reduce the duration of opioid detoxification for neonatal abstinence syndrome.

ABM Clinical Protocol #21:  Guidelines for Breastfeeding and the Drug-Dependent Woman:  Purpose of this protocol is to provide evidence-based guidelines for the evaluation and management of the drug-dependent woman choosing to breastfeed

Methadone Maintenance and Breastfeeding in the Neonatal Period:  This study-evaluated concentrations of methadone in breast milk among breastfeeding women and concentrations of methadone in maternal and infant plasma in both groups.  Results contribute to the recommendation of breastfeeding for methadone-maintained women

Effects of Breast Milk on the Severity and Outcome of Neonatal Abstinence Syndrome Among Infants of Drug-Dependent Mothers:  The purpose of this research was to assess the effects of breast milk on the severity and outcome of neonatal abstinence syndrome.

Buprenorphine:  A Newer Drug for Treating Neonatal Abstinence Syndrome:  Article reviews current literature on Buprenorphine and use in NAS

Comparison of chlorpromazine versus morphine hydrochloride for treatment of neonatal abstinence syndrome:  Aim of study was to compare the duration of treatment for neonatal abstinence syndrome (NAS) using chlorpromazine versus morphine hydrochloride.  Conclusion: CP appears to shorten the duration of NAS compared with MH. Larger prospective randomized trials are needed to confirm our findings.

Use of clonidine in the prevention and management of neonatal abstinence syndrome:  Presentation of case series in which clonidine was used for the prevention and management of patients with NAS.  Data suggest that clonidine may be a reasonable alternative to more traditional agents used to prevent or treat NAS.

Diluted tincture of opium (DTO) and phenobarbital versus DTO alone for neonatal opiate withdrawal in term infants:  The purpose of this study was to test the hypothesis that treatment of neonatal opiate withdrawal (NOW) in the term infant with diluted tincture of opium (DTO) and phenobarbital was superior to treatment with DTO alone.

Identification and Management of Neonatal Abstinence Syndrome:  This article focuses on drug abuse during pregnancy, the withdrawal symptoms it may cause in the infant, ways to recognize an infant experiencing neonatal abstinence syndrome, and available scoring tools and treatment options.

A Retrospective Study of Length of Hospital Stay in Infants Treated for Neonatal Abstinence Syndrome With Methadone Versus Oral Morphine Preparations:  Purpose of study:  Length of hospital stay (LOS) of infants treated for neonatal abstinence syndrome (NAS) with methadone was compared to LOS of those treated with an oral morphine preparation (OMP, neonatal morphine solution, or deodorized tincture of opium).

The Opioid Exposed Newborn:  Assessment and Pharmacologic Management:  Review from the NIH to provide health care professionals with current evidence and practical guidelines for optimal evaluation and pharmacologic management of opioid exposed newborns.

Maternal and neonatal factors impacting response to methadone therapy in infants treated for neonatal abstinence syndrome:  Objective of study was To identify maternal and neonatal factors that impact response to methadone therapy for neonatal abstinence syndrome.

Neonatal Abstinence Syndrome:  Therapeutic Interventions:  This article provides an overview of the possible risks, benefits, and outcomes of pharmacologic and complementary therapies in the neonatal population, and illustrates the gaps in knowledge related to their use for neonatal withdrawal.

The Opioid Dependent Mother and Newborn Dyad:  Nonpharmacologic Care:  The purpose of this article is to review the contribution of maternal opioid dependency to the difficulties experienced by the mother-infant dyad and their treatment providers in the postnatal period, and the nonpharmacologic treatment of the infants with suggestions for practical measures with emphasis on the treatment of the mother and baby as an interactional dyad.

Update on the pharmacologic management of neonatal abstinence syndrome:  This review addresses risk factors and pathophysiology of NAS, summarizes parameters of common drugs used for the management of NAS, and reviews published literature of standard therapies as well as newer agents.

Differences in the profile of neonatal abstinence syndrome signs in methadone-versus buprenorphine-exposed neonates:  Aim was to compare the profile of signs of neonatal abstinence syndrome (NAS) in methadone- versus buprenorphine-exposed infants.

Management of neonatal abstinence syndrome:  a national survey and review of practice:  Aim was To ascertain the present management of neonatal abstinence syndrome (NAS) in neonatal units in the United Kingdom (UK) and Ireland

Rooming-in compared with standard care for newborns of mothers using methadone or heroin:  Objective was to evaluate the effect of rooming-in (rather than standard nursery care) on the incidence and severity of neonatal abstinence syndrome among opioid-exposed newborns and on the proportion of mothers who retain custody of their babies at hospital discharge.


NAS Discharge:  The following articles are related to discharge concerns for NAS patients

Hospital stay and short-term follow-up of children of drug-abusing mothers born in a urban community hospital:  Review of current NAS practices in regard to short term outcomes.  New ways to ensure better coordination of care should be developed.

Opioid Dependency in Pregnancy and Length of Stay for NAS:  Objective of the study was to examine opioid replacement therapy in pregnancy and effect on neonatal outcomes, including LOS for NAS.

Neonatal abstinence syndrome:  transitioning methadone-treated infants from an inpatient to an outpatient setting:  The objective of this study is to compare the safety and efficacy of a traditional inpatient only approach with a combined inpatient and outpatient methadone treatment program

A pilot study assessing the frequency and complexity of methadone tapers for opioid abstinence syndrome in children discharged to home:  The objective of this study was to determine the percentage of children discharged home on methadone tapers and to develop, assess, and implement an instrument for measuring the complexity of the methadone regimens.


PQCNC NAS Initiative Resources

PQCNC NAS Initiative Resources - Expert Team

PQCNC NAS Initative Resources - General