Neonatal Abstinence Syndrome (NAS)
Neonatal drug dependency or withdrawal symptoms, known as neonatal abstinence syndrome (NAS), occur from maternal use of opiates such as heroin, methadone, and prescription pain medications. Symptoms of NAS include fever, diarrhea, irritability, trembling, and increased muscle tone. Along with a rise in prescription drug abuse, nationally the incidence of NAS nearly tripled over the past decade with substantial increases in health care costs. Opioid use by pregnant women represents a significant public health concern given the association of opioid exposure and adverse maternal and neonatal outcomes, including preterm labor, stillbirth, neonatal abstinence syndrome, and maternal mortality. Nationally, the prevalence of opioid use disorder more than quadrupled during 1999–2014 (from 1.5 per 1,000 delivery hospitalizations to 6.5; p<0.05). Women may use opioids as prescribed, may misuse prescription opioids, may use illicit opioids such as heroin, or may use opioids as part of medication-assisted treatment for opioid use disorder. Regardless of the reason, women who use opioids during pregnancy should be aware of the possible risks during pregnancy, as well as her potential treatment options for opioid use disorder. Prevention strategies exist along the continuum from preconception, prenatal, postpartum, and infant/childhood stages to help avert substance-exposed pregnancies and improve outcomes for infants born with NAS.
Neonatal abstinence syndrome (NAS) is a postnatal drug withdrawal syndrome primarily caused by maternal opiate use.
Opioid use disorder (OUD) is defined as a problematic pattern of opioid use that leads to serious impairment or distress. Opioid use during pregnancy can affect women and their babies.
NAS: Counts and rates of infants born with Neonatal abstinence syndrome (NAS) based on inpatient hospitalization records were identified by ICD-9-CM diagnosis code 779.5 (drug withdrawal syndrome in newborn) and ICD-10-CM diagnosis code P96.1 (neonatal withdrawal symptoms from maternal use of drugs of addiction) present on the record for Virginia residents only. Due to the transition to ICD-10 in the last quarter of 2015; the 2015 rate should be interpreted with caution. Data for 2016 and onward are based on ICD-10-CM.
Possible iatrogenic cases, identified by ICD-9-CM diagnosis codes 765.00-765.05, 770.7, 772.1x, 777.5x, 777.6 and 779.7, were excluded from the numerator. Birth hospitalizations were identified by ICD-9-CM diagnosis codes V30.xx-V39.xx, where the 4th and 5th digit is either 00, 01, 10 or 11, and ICD-10-CM diagnosis codes of Z38.00, Z38.01, Z38.1, Z38.2, Z38.30, Z38.31, Z38.4, Z38.5, Z38.61, Z38.62, Z38.63, Z38.64, Z38.65, Z38.66, Z38.68, Z38.69, Z38.7, or Z38.8. Those with an indication of transfer from another hospital were excluded to avoid duplication. NAS case data presented here are derived from data provided by Virginia Health Information (VHI) to the Virginia Department of Health (VDH) Office of Information Management (OIM).
- NAS counts represented on this dashboard are not suppressed.
OUD: Opioid Use Disorder (OUD) counts and rates are based on inpatient hospitalization records were identified from diagnoses of opioid dependence (ICD-9-CM 304.00–304.03, 304.70–304.73) and nondependent opioid abuse (ICD-9-CM 305.50–305.53) present on the record for Virginia residents only. Investigation of ICD-10-CM/PCS transition is ongoing. Thus, 2016 data have not been provided and there is no update from 2015 Q1-Q3 based on ICD-9-CM. Updated data will be provided when available.
Data for 2015 represents only three quarters of the year (January through September) due to the transition to ICD-10 in the last quarter of 2015; thus the rate should be interpreted with caution as it does not represent a full year of change relative to 2014. The annual number of in-hospital delivery discharges were identified from ICD-9-based diagnostic and procedure codes pertaining to obstetric delivery using the algorithm described by Kuklina et al. OUD case data presented here are derived from data provided by Virginia Health Information (VHI) to the Virginia Department of Health (VDH) Office of Information Management (OIM).
- OUD counts represented on this dashboard are not suppressed.
Kuklina, E.V., Whiteman, M.K., Hillis, S.D. et al. Matern Child Health J (2008) 12: 469. https://doi.org/10.1007/s10995-007-0256-6
- Patrick SW, Shumacher RE, Benneyworth BD et al. Neonatal Abstinence Syndrome and Associated Health Care Expenditures, 2000-2009. JAMA. 2012 May 9. 307(18):1934-40. http://jamanetwork.com/journals/jama/fullarticle/1151530
- Haight SC, Ko JY, Tong VT, Bohm MK, Callaghan WM. Opioid Use Disorder Documented at Delivery Hospitalization — United States, 1999–2014. MMWR Morb Mortal Wkly Rep 2018;67:845–849. DOI: http://dx.doi.org/10.15585/mmwr.mm6731a1
- Opioid Use During Pregnancy | CDC. (2019, July 1). Retrieved from https://www.cdc.gov/pregnancy/opioids/index.html.
- Association of State and Territorial Health Officials (ASTHO). Neonatal Abstinence Syndrome: How States Can Help Advance the Knowledge Base for Primary Prevention and Best Practices of Care. 2014. http://www.astho.org/prevention/nas-neonatal-abstinence-report/
- Ko JY, Wolicki S, Barfield WD, et al. CDC Grand Rounds: Public Health Strategies to Prevent Neonatal Abstinence Syndrome. MMWR Morb Mortal Wkly Rep 2017;66:242–245. DOI: http://dx.doi.org/10.15585/mmwr.mm6609a2
- Substance Use During Pregnancy | CDC. (2019, July 24). Retrieved from https://www.cdc.gov/reproductivehealth/maternalinfanthealth/substance-abuse/substance-abuse-during-pregnancy.htm.