Case Classification Flowchart

Case classification as a part of Tier 1 surveillance for NAS can be complex and is based on a combination of clinical or diagnostic criteria (i.e. clinical signs, chief complaint, or provider diagnosis) as well as evidence of substance exposure (i.e. positive laboratory testing or documentation of substance use by the birthing parent during pregnancy). There are two classifications for neonates meeting the Tier 1 case definition for NAS: (1) confirmed cases that capture neonates with NAS and exposure to opiate, benzodiazepine, or barbiturate (OBB) substances, and (2) suspect cases that capture neonates with NAS and exposure to non-OBB or unknown types of substances. OBBs are the substances most commonly associated with withdrawal signs in neonates, however public health surveillance for NAS in neonates exposed to other types of substances allows for early public health detection of novel or emerging substances associated with NAS.

If you’d like more help walking through the case definition to classify a case, you can utilize this short quiz to reach the right classification.