Neonatal Abstinence Syndrome

Neonatal Abstinence Syndrome (NAS) is a constellation of signs of withdrawal in a neonate after in utero exposure to substances, primarily opiates, benzodiazepines, and barbiturates. Public health surveillance for NAS can provide valuable data to estimate incidence and track trends, plan treatment and prevention efforts, and link people who are pregnant or postpartum with substance use disorder (SUD) and their families to clinical resources and services. Public health surveillance for NAS is also complex due to variations in the type of surveillance conducted for NAS across jurisdictions, differing legal authority for reporting and surveillance, bias and stigma affecting patient diagnosis and laboratory testing, and the presence of punitive social or legal practices.

In 2019 the first Council of State and Territorial Epidemiologists position statement defining a Neonatal Abstinence Syndrome Standardized Case Definition was adopted as 19-MCH-01. The adoption of this position statement aimed to standardize the case ascertainment and case classification methods used across jurisdictions. In 2023 an update to the 2019 position statement was adopted, 23-MCH-01. These position statements outline two methods (tiers) of surveillance for NAS: (1) timely case reporting based on public health legal authority, and (2) case ascertainment based on claims-based administrative data. The tiered approach allows states to conduct surveillance for NAS based on their resources and regulations.

About the Implementation Guide

This implementation guide is an accumulation of resources for use by jurisdictions working to implement a surveillance program for NAS. The primary focus of many topics in this guide are for jurisdictions conducting Tier 1 surveillance (provider reporting based on public health legal authority) as this type of surveillance can be more complex and resource intensive, however jurisdictions aiming to conduct public health surveillance for NAS based on claims-based administrative data (Tier 2) may find benefits. Included are resources to provide additional explanation of the case definition, template tools for data collection and analysis, outlines and best practices for communicating with providers, and a compilation of links to available resources created by organizations across the nation.

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