Aims In view of increasing incidence of babies with NAS, conduct a regional survey of practice and to devise, implement and audit care pathway.

Methods Questionnaire survey of all neonatal units in Northern England was conducted. Subsequently, evidence based, community oriented, multi-professional care pathway was developed and implemented. This included: 1. Identify at risk mothers, screen, and ensure multidisciplinary action plan. 2. Following delivery, baby kept with mother and breastfed, screened and immunised. 3. Modified Finnegan Score, Oramorph treatment with standard weaning protocol. 4. Pre-discharge Strategy meetings with social services and discharge planning. 5. Twice weekly follow up of early discharged infant by Community Neonatal Nurse, physiotherapy assessment and consultant review. 6. Close working with families and teaching healthcare professionals. The practice was audited after 1 year.

Results On questionnaire survey, 38% of units had no NAS protocol, 88% units did not do third trimester infection screening and no cranial sonograms were performed. 67% units kept baby until fully detoxified and no targeted follow up was practised. Forty one babies were audited after one year of change in practice. 20 needed Oramorph therapy; 28 (68%) babies had cranial sonograms and 22 (54%) received Hepatitis B vaccination. Average hospital stay reduced to 9 days from 23 days. Only 2 (5%) babies were lost to follow up.

Conclusions The care of the infant with NAS can be improved with introduction of evidence based protocols and multi-agency working. This reduced hospitalisation, offered better family support and coordinated care for the infant in need.