February 21, 2019

The United States has no national tracking system for babies born with neonatal abstinence syndrome (NAS), just a patchwork quilt of state systems that are not always accurately counting the number of babies born affected by opioids, March of Dimes says.

In 2017, March of Dimes and the U.S. Centers for Disease Control and Prevention (CDC) awarded grants to three states -- Illinois, New Mexico, and Vermont -- to obtain state-level, population-based estimates of babies born with NAS. A study published today in CDC’s journal Morbidity & Mortality Weekly Report found that the three states’ estimates of the number of babies born with NAS varied widely.

March of Dimes and the authors of the study note that these three states are building on existing methods from state birth defects surveillance programs to count babies affected by NAS. March of Dimes officials urged other states across the country to create or improve NAS tracking efforts.

“It’s very difficult to treat moms and newborns affected by opioid use, and to allocate the resources needed for them, without knowing the exact frequency of the problem in your state,” says Rahul Gupta, MD, MPH, MBA, Chief Medical & Health Officer for March of Dimes. “We urge all states to adapt birth defects surveillance programs to measure NAS incidence so that all moms and babies can get the health care they need, no matter which state they are born in.”

Dr. Gupta also noted that March of Dimes has made it a priority to help and support pregnant women and babies affected by opioid use and keep them safe. This includes policy initiatives aimed at providing care for mother and baby, such as access to comprehensive services; priority access to drug treatment programs and flexible treatment; immunity during prenatal visits; and more provider education.

NAS is a drug withdrawal syndrome that can occur in newborns exposed to opioids and other addictive substances during pregnancy. Recent U.S. estimates indicate that, from 2004–2014, NAS incidence increased from 1.5 to 8.0 per 1,000 hospital births. The authors of today’s paper note that these estimates were based on diagnostic codes identified in hospital discharge data (HDD), and little is known about how well these codes identify NAS.

Today’s study utilized methodology developed in state birth defects surveillance programs and verified potential cases using a consistent definition and medical chart review. The study found that Illinois’s NAS incidence rates (3.0 per 1,000 births in 2015 and 2016) were higher than previous estimates determined using passive surveillance methods.  NAS incidence rates for New Mexico and Vermont were 7.5, and 30.8 per 1,000 births, respectively, in 2015 -- slightly lower than previously reported HDD‐based estimates for these states (8.5 and 33.3 per 1,000 births).

“Leveraging Existing Birth Defects Surveillance Infrastructure to Build Neonatal Abstinence Syndrome Surveillance Systems — Illinois, New Mexico, and Vermont, 2015–2016,” by Jennifer N. Lind, PharmD and team including Caroline C. Alter, MS, formerly of March of Dimes,  appears in today’s issue of MMWR.