Clinical Guidelines

NNEPQIN sponsors multi-disciplinary teams to create & adapt evidence-based guidelines for clinically important topics. Please email 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

Hypertension in pregnancy – 2019 update

Neonatal Therapeutic Hypothermia – 2017 Update

VBAC Guidelines 2019

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.

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

Staff Education and Resources — SHAREABLE MATERIALS

Infant Feeding Guidance

Care of Opioid Exposed Newborns/NAS/NOWS

Trauma Informed Care

Adverse Childhood Experiences Study (ACES)

Harm Reduction


Parent Education and Resources – SHAREABLE MATERIALS

Community and HV Resources

Support for Parents From Healthy Families America:

Care of Opioid Exposed Newborns/NAS/NOWS

Dartmouth-Hitchcock Opioid Exposed Newborn Parent Folder Materials


Plan of Supportive Care – SHAREABLE MATERIALS

Link to NH POSC Website Resources: NH Plans of Safe Care

Parent Education Resources

Staff Education Resources

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 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:

VT hospitals:

ME hospitals:

MA hospitals:

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: OR phone number 603-653-1800.