Standardization of State Definitions for Neonatal Abstinence Syndrome Surveillance and the Opioid Crisis

Area of Science:

• Public Health
• Neonatal Medicine
• Epidemiology

Background:

• Neonatal abstinence syndrome (NAS) rates have increased fivefold over the past decade.
• The opioid crisis has led to diverse state-level approaches to managing newborns affected by substance exposure.
• Variability in quantifying NAS burden hinders effective public health responses.

Purpose of the Study:

• To summarize and analyze clinical case and surveillance definitions of NAS across US jurisdictions.
• To understand the heterogeneity in NAS identification processes.
• To highlight the need for standardized definitions to improve data comparability.

Main Methods:

• Systematic review of clinical case definitions for NAS.
• Analysis of surveillance definitions and diagnosis codes used across states.
• Comparison of identification methods for NAS.

Main Results:

• Heterogeneous processes for identifying NAS were confirmed, driven by the opioid crisis.
• Clinical case definitions vary in their use of observed withdrawal signs and perinatal exposure evidence.
• Discordance in diagnosis codes used for surveillance definitions was observed.

Conclusions:

• Variability in NAS definitions complicates the production of comparable jurisdictional estimates.
• Standardized NAS definitions are essential for guiding national public health strategies and interventions.
• Consistent definitions will enhance comparability and improve prevention and treatment efforts for affected mothers and infants.