Clinical Guidelines
NNEPQIN sponsors multi-disciplinary teams to create & adapt evidence-based guidelines for clinically important topics. Please email NNEPQIN@hitchcock.org for more information on guidelines being developed or revised.
Dartmouth Hitchcock Medical Center’s Center for Addiction Recovery in Pregnancy & Parenting (CARPP) also offers many professional resources related to clinical treatment and recovery support.
Table of contents
- NEW: 2024 FINAL VBAC Guideline Revision
- Hypertension in pregnancy – 2019 update
- Neonatal Therapeutic Hypothermia – 2017 Update
- Toolkit for the Perinatal Care of Women with Substance Use Disorders – 2021 Update
- Screening for Alcohol, Tobacco and Drug Use in Pregnancy – 2018 Update
- Toolkit for the Care of Substance Exposed Newborns – 2020 Update
VBAC Guidelines 2024
Hypertension in pregnancy – 2019 update
Neonatal Therapeutic Hypothermia – 2017 Update
Toolkit for the Perinatal Care of Women with Substance Use Disorders – 2021 Update
This toolkit was developed by a multidisciplinary group of obstetric, pediatric, neonatal, and addiction treatment providers and nurses to assist front-line perinatal care providers to improve the quality and safety of care provided to pregnant women with substance use disorders in northern New England.
- NNEPQIN Toolkit Updated 11_5_21
- Section 1 RESPECTFUL PERINATAL CARE FOR PEOPLE WITH SUBSTANCE USE DISORDERS Updated 11_5_21
- Section 2 SCREENING AND ASSESSMENT Updated 11_5_21-2
- Section 3 TOOLS BY SUBSTANCE Updated 11_5_21-3
- Section 4 TOOLS TO SUPPORT PATIENT NEEDS Updated 11_5_21-4
- Section 5 BEST PRACTICE IMPLEMENTATION AND QUALITY IMPROVEMENT Updated 11_5_21-5
- Section 6 OTHER LEARNING OPPORTUNITIES FOR PROVIDERS Updated 11_5_21-6
- Section 7 NNEPQIN Toolkit ADDITIONAL REFERENCES Updated 11_5_21-7
Screening for Alcohol, Tobacco and Drug Use in Pregnancy – 2018 Update
Toolkit for the Care of Substance Exposed Newborns – 2020 Update
NNEPQIN Substance Exposed Newborn Monthly Webinar Series — SHAREABLE
- NNEPQIN Webinar Series 2019
- NNEPQIN Webinar Series 2020 to Date
- 3 Part Recovery Friendly Care Practices Webinar Series 12.18 2.19
Staff Education and Resources — SHAREABLE MATERIALS
Infant Feeding Guidance
Care of Opioid Exposed Newborns/NAS/NOWS
- http://www.nationalperinatal.org/Infographics
- http://www.nationalperinatal.org/resources/Documents/Prematurity/Providers_5%20ways.pdf
- How to Care for a Baby with NAS
Trauma Informed Care
- Trauma-Informed-Care.carpp
- https://store.samhsa.gov/system/files/sma14-4884.pdf
- https://www.youtube.com/channel/ Search for Dr. Cruz, What is Trauma-Informed Care?
- http://traumainformedcareproject.org/
- SAMHSA’s 6 Principles of Trauma Informed Care
Adverse Childhood Experiences Study (ACES)
- https://www.rwjf.org/en/library/collections/aces.html
- https://www.youtube.com/channel/ Search for: Nadine Harris Burke TED Talk ACES
Harm Reduction
Pregnancy
- NNEPQIN – Toolkit for Perinatal Care of Women with Substance Use Disorder
- Maine Snuggle ME Guidelines: Tools for Caring for Women with Addiction and Their Babies (Maine)
- Clinical Guidance for Treating Pregnant and Parenting Women with Opioid Use Disorders and Their Infants – Substance Abuse and Mental Health Service Administration (SAMHSA)
- Addiction Technology Transfer Center Network (ATTC) Perinatal Provider Toolkit
- National Perinatal Association
Parent Education and Resources – SHAREABLE MATERIALS
Community and HV Resources
Support for Parents From Healthy Families America:
Care of Opioid Exposed Newborns/NAS/NOWS
- Newborn Care Diary – 7 days
- Nonpharmcareparents
- PSN Skin to Skin Care Brochure 07
- http://www.nationalperinatal.org/Infographics
- How to Care for a Baby with NAS
Dartmouth-Hitchcock Opioid Exposed Newborn Parent Folder Materials
- D-H BathSalts_bifold4x9_press5 (1)
- Cuddler Program brochure 201707-160.EN2
- DHMC POSC Template 8.22.19 final
- Boyle Family Resource Guide 201907-164g.PRESS
- Community Resource Centers 201907-164d.PRESS
- Dvlp Support Team Letter 201907-164c.PRESS
- Mother-Baby Recovery Coach 201907-164f.PRESS
- Newborn Care Diary 201907-164a.PRESS – need 7 days double sided
- POSC_PatientMaterial_1-10-20.docx
- Heater Rd Recovery friendly PCPs for families
- D-H Marijuana bifold 201612-271.PRESS
- NAS/NOWS_D-H_brochure press
- NNEPQIN CHaD NAS NOWS Parent Education Pamphlet FINAL 8.20
- (It is allowable to adopt the pamphlet to hospital’s needs, in line with your policies/practices. Please keep the current logos but you can add your own as well.)
- Purple Pod draft brochure 4.7.19
- Resource list to help with POSC (2)
Pregnancy
- D-H BathSalts_bifold4x9_English
- D-H BathSalts_bifold4x9_Spanish
- D-H Marijuana bifold 201612-271.English
- D-H Marijuana bifold 201612-271.Spanish
- Colorado – Know the Facts Marijuana and Your Baby – Patient Hand Out
- Use in Pregnancy
- Sample Parent Letter
- http://www.nationalperinatal.org/resources/Pictures/redesign/4%20things.png
Plan of Supportive Care – SHAREABLE MATERIALS
Link to NH POSC Website Resources: NH Plans of Safe Care
Parent Education Resources
Staff Education Resources
- NNEPQIN Plan of Safe and Supportive Care Webinars 2019
- NH POSC Template – PDF version in English
- NH POSC Template – PDF version in Spanish
- NH POSC Provider Letter 7-15-19
- POSC 101 Webinar by Lucy Hodder, David Laflamme, Kali Giovanditto – 1.20
- NH POSC Guidance Document 8-15-19
- NH POSC Additional Q&A Doc
- NH POSC Implementation Checklist
- Supporting Mothers and Infants Key Facts about Perinatal Substance Exposure
- NH POSC Coordinating Services and Supports for Mothers with SUD and their Babies
- NH Pregnant & Parenting Services and Supports List 6.19
- NH Pregnant & Parenting Services and Supports Map
- NH Perinatal SUD Projects 6-3-19
ESC Care Tool
The ESC Care Tool© is currently being studied for its safety and efficacy within the Northern New England Perinatal Quality Improvement Network (NNEPQIN) and Perinatal Neonatal Quality Improvement Network of Massachusetts (PNQIN), as well as in several statewide and provincial perinatal QI collaboratives (PQC). A national NIH-funded multi-center step-wedge cluster randomized clinical trial is now also underway with aims of assessing short- and long-term outcomes associated with use of the ESC Care Tool in the care of opioid exposed newborns in varied clinical settings and with varied populations across the United States. At this time, the ESC Care Tool developers have asked that the ESC Care Tool and its formal training materials and resources be shared only with hospitals participating within a statewide or provincial PQC that has the commitment and infrastructure to perform a formal QI initiative that includes implementing the ESC Care Tool in a structured and systematic manner with formal training in its development and implementation, inter-rater reliability testing, and tracking of efficacy and safety outcomes.
If your hospital is participating in the NNEPQIN, PNQIN, or a previously approved statewide or provincial PQC ESC Care Tool QI Initiative, or you serve in a leadership role in your state’s or province’s PQC and are interested in learning more about using the ESC Care Tool and its training materials in a formal PQC QI initiative, please email NNEPQIN@hitchcock.org with the following:
Your Name & Title:
Your Hospital Affiliation:
Your PQC’s Name:
Your PQC Leadership Role:
Your Email Address:
Following this email, members and leaders of previously-approved PQCs will be given a link and password to the password-protected ESC Care Tool webpage. Materials found here may be used by participating PQC leaders, hospitals and their staff but are not to be shared publicly beyond these individuals/settings.
If you do not hold a leadership role in your affiliated PQC, but think that your PQC would be interested in a formal ESC Care Tool QI initiative, we ask that you please contact your PQC leader(s) and ask that they reach out to us directly.
Thank you kindly,
NNEPQIN and The ESC Care Tool Development Team
Key State Contacts
If you have any questions related to caring for substance-exposed newborns, please reach out to the following key contacts in your state:
NH hospitals:
- Bonny Whalen: Bonny.L.Whalen@hitchcock.org
- Vicki Flanagan: Victoria.A.Flanagan@hitchcock.org
VT hospitals:
- Michelle Shepard: Michelle.Shepard@med.uvm.edu
- Jerilyn Metayer: Jerilyn.Metayer@uvmhealth.org
ME hospitals:
- Alan Picarillo: APicarillo@mmc.org
- Kelley A. Bowden: BOWDEK@mmc.org
- Amy Belisle: Amy.Belisle@maine.gov
MA hospitals:
- Elisha Wachman: Elisha.Wachman@bmc.org
- Mary Houghton: Mhoughto@bidmc.harvard.edu
Additionally, anyone can reach out to the Center for Addiction Recovery in Pregnancy and Parenting (CARPP) for clinical guidance for mothers or infants with perinatal substance exposure at the following website: https://www.dartmouth-hitchcock.org/carpp OR phone number 603-653-1800.