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Florida Perinatal Quality Collaborative

NAS Initiative

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Neonatal Abstinence Syndrome Initiative

Mother with Crying Newborn

The United States is battling an opioid epidemic, which has resulted in increasing illicit use and misuse of prescription opioids among pregnant women. Neonatal abstinence syndrome (NAS), in which infants exhibit postnatal withdrawal symptoms most commonly due to chronic in utero exposure to opioids, is one unfortunate sequelae of the opioid epidemic. It manifests as a combination of central nervous system irritability, autonomic nervous system hyperactivity, respiratory difficulties, and gastrointestinal dysfunction. The majority of pregnant women taking illicit drugs, using prescribed opioids, or receiving opioid replacement therapy will deliver an infant having withdrawal symptoms, and many of these infants will develop NAS and require pharmacologic management. NAS infants are more likely to have a diagnosis of prematurity, low birth weight, respiratory complications, seizures, and feeding difficulty. Beyond the neonatal period, they are at risk for behavioral problems, learning problems, visual disorders, and psychosocial difficulties (for example, risk for child abuse, foster placement).

Despite awareness of a rising NAS incidence, there is a scarcity of evidence-based management for NAS, lack of improvement in length of inpatient stay, and a rise in health care costs, which highlight the considerable variations in its management by pediatricians and neonatologists. The FPQC hopes to address variability in NAS management.  

  • The NAS Initiative Tool Box contains tool kit documents, example hospital guidelines and helpful websites, screening tools, plan of safe care and discharge materials, patient education materials, and more. This resource is updated regularly throughout the project. 

    Online Tool Box for NAS Hospitals

    Newly Added Tool Box Resources:

    • Provider Education video modules
  • NAS End of Initiative Celebration - June 2, 2020

    NAS Data Collection: Definitions, Procedures, and Tools - December 4, 2018

    Pharmacologic Management - January 15, 2019

    Eat, Sleep, Console: The Colorado Experience - February 19, 2019

    Connecting to the World Outside - March 19, 2019

    Inter-Rater Reliability - April 16, 2019

    Non-Pharmacologic Management - May 2019

  • Manatee Memorial Hospital 

    BayCare-Morton Plant Hospital 

    St. Vincent's Medical Center (Riverside) 

    Nemours Children's Hospital 

    Tradition Medical Center 

    Martin Medical Center 

    Tampa General Hospital 

    St. Joseph's Women's Hospital 

    Winter Haven Women's Hospital 

    Golisano Children's Hospital of Southwest Florida 

    AdventHealth Waterman 

    Winnie Palmer Hospital NICU 

    AdventHealth Tampa 

    Medical Center of Trinity 

    Winnie Palmer Hospital Newborn Nursery 

    University of Florida Health Jacksonville 

    Lakeland Regional Health 

    Sacred Heart Hospital Pensacola/Studer Family Children's Hospital 

    Mease Countryside Hospital 

    Sarasota Memorial Hospital 

    Fort Walton Beach Medical Center 

    Naples Community Hospital 

    University of Florida Health - Gainesville 

    Bayfront Health Spring Hill 

    AdventHealth Memorial Medical Center 

    Baptist Health South

    Halifax Health Medical Center

    Nicklaus Children’s Hospital 

    Plantation General Hospital

    Holtz Children's/Jackson Memorial Hospital

    Holmes Regional Medical Center

    Gulf Coast Regional Medical Center (Panama City)

    AdventHealth for Children