Mixed-Methods Evaluation of Massachusetts' Neonatal Abstinence Syndrome Surveillance System, 2020-2022

The Massachusetts Department of Public Health established neonatal abstinence syndrome surveillance as an active, state-wide, population-based system using the Council of State and Territorial Epidemiologists (Tier 1) neonatal abstinence syndrome standardized surveillance case definition. This evaluation assessed the Massachusetts neonatal abstinence syndrome surveillance system and estimated the completeness and positive predictive value of case ascertainment methods.

Neonatal abstinence syndrome surveillance system was evaluated through a system user survey (n=12) and neonatal abstinence syndrome surveillance system data reports to identify strengths and limitations. Completeness of case ascertainment using 6 neonatal abstinence syndrome-related ICD-10-CM codes was estimated using capture-recapture methodology for births between April 1, 2020, and September 30, 2020. The positive predictive value of the codes was estimated using data for births between April 1, 2020, and December 31, 2022 (n=2,455).

Neonatal abstinence syndrome surveillance system was found to be simple to use, flexible, and representative, with opportunities to improve timeliness. Case ascertainment was estimated to be 85.9% complete. ICD-10-CM code P96.1 had the highest positive predictive value for confirmed cases (69.9%) and for all case types (confirmed, probable, and suspect) combined (95.1%). P04.40 had the lowest positive predictive value for confirmed cases, whereas P04.1A had the lowest positive predictive value for all case types (43.5% for both codes).

ICD-10-CM codes with higher positive predictive values can be utilized for neonatal abstinence syndrome case ascertainment, especially in jurisdictions with limited resources for case confirmation. Other sources of case ascertainment can be added to improve the completeness of neonatal abstinence syndrome surveillance. Findings from this evaluation can guide the evaluation and case ascertainment methods for jurisdictions already conducting or interested in establishing neonatal abstinence syndrome surveillance using the Council of State and Territorial Epidemiologists neonatal abstinence syndrome standardized surveillance case definition.