Neonatal Abstinence Syndrome (NAS) Diagnosis Varies Greatly Due a Lack of Standard Definition: Report

The rate of infants born addicted to opioids has increased dramatically in recent years, as the opioid crisis continues to worsen. However, a new report warns that a lack of defined criteria for the withdrawal problems, known as neonatal abstinence syndrome, may be leading to widely different rates among reporting doctors.

In a study published this month in the medical journal Pediatrics, researchers evaluated data on 121 opioid-exposed infants born at Vanderbilt University Medical Center in 2018, comparing six commonly used clinical and surveillance definitions of opioid exposure and NAS.

Because there is no standard definition for determining neonatal abstinence syndrome (NAS) and assessing withdrawal symptoms among infants, the rates of diagnosis varied greatly.

The proportion of infants who met criteria for NAS were based on the definition the individual doctors used, ranging from 17% for infants who received morphine to 53% for infants with the diagnostic code for opioid exposure.

While all of these definitions should qualify for a neonatal abstinence syndrome diagnosis, not every infant received the proper diagnosis. The findings indicate 23% of infants received a clinical diagnosis of NAS by a medical provider while 34% received the diagnostic code for NAS at discharge, not during treatment in the hospital.

“We found significant variability in the incidence of opioid exposure and NAS among a single-center population using 6 common definitions,” the researchers noted. “Our findings suggest a need to develop a gold standard definition to be used across clinical, research, and public health surveillance settings.”

Prior research has shown opioid exposure during pregnancy, or a diagnosis of NAS, leads to low cognitive scores and stunted physical development later in childhood. The number of infants experiencing NAS symptoms has skyrocketed in recent years, nearly doubling from 2012 to 2016.

Another recent study indicated infants born with drug withdrawal symptoms increased significantly from 2010 to 2017, tied directly to increasing rates of pregnant women diagnosed with opioid use disorder during the same time period. The worsening opioid abuse epidemic has led to an increase in the number of infants born addicted and suffering from drug withdrawal.

The researchers in this latest study are calling for a standardized NAS definition to be used across all clinical, research, and public health surveillance settings to more accurately track and treat the problem for mothers and children.