Top 5 Takeaways

1. Continued Benefits of Mandated Reporting: Mandated NAS case reporting helps quantify NAS incidence and guides state program development.
2. Challenges in Long-Term Surveillance: Persistent data collection challenges and infrastructural gaps limit states’ capacity for long-term surveillance beyond initial case reporting.
3. Infrastructure Needs: Development of additional infrastructure is necessary for states to advance NAS surveillance beyond initial case reporting.
4. Programmatic Successes: States have expanded education and access to maternal medication for opioid use disorder (MOUD) and established partnerships with perinatal quality collaboratives.
5. Variability in Reporting Timeliness: Significant differences exist in the timeliness of NAS case reporting among the six states, ranging from 28 to 180 days.

Original Article Author and Citation

Corresponding Author

Shahla M. Jilani, shahla.jilani@hhs.gov, 202-815-1970

Suggested Citation

Jilani SM, West K, Jacobus-Kantor L, et al. Evaluation of State-Led Surveillance of Neonatal Abstinence Syndrome — Six U.S. States, 2018–2021. MMWR Morb Mortal Wkly Rep 2022;71:37–42. DOI: http://dx.doi.org/10.15585/mmwr.mm7102a1

Summary

This study evaluates the effectiveness of state-led surveillance of Neonatal Abstinence Syndrome (NAS) in six U.S. states from 2018 to 2021. The study found that mandated NAS case reporting continues to be beneficial in determining NAS incidence and guiding state program development. However, it also identified ongoing challenges in data collection and infrastructural gaps that hinder long-term surveillance efforts. The study highlights the need for additional infrastructure to support extended surveillance and programmatic development to address the needs of opioid- and substance-exposed mother-infant dyads.

Methods

The study utilized a questionnaire and interviews with state health department officials from six states (Arizona, Florida, Georgia, Kentucky, Tennessee, and Virginia) to review postimplementation efforts of NAS surveillance. Data were collected on initial case reporting, outcomes follow-up, quality assurance measures, and resources used. The analysis focused on similarities and differences in surveillance features and programmatic development since the enactment of state-mandated NAS case reporting.

Discussion

The study found that while mandated NAS case reporting has helped quantify NAS incidence and guide program development, significant challenges remain in long-term surveillance. These challenges include collecting missing information, assessing data accuracy, and sharing reports with other agencies. States reported a lack of infrastructure as a primary barrier to extended surveillance. Despite these limitations, states have made notable programmatic advancements, such as expanding education and access to MOUD and establishing partnerships with perinatal quality collaboratives.

Conclusion

Mandated NAS case reporting provides valuable short-term epidemiologic data, but infrastructural and resource limitations hinder long-term surveillance efforts. States need to develop additional infrastructure and capacity to bridge the gap between initial case reporting and longer-term needs analysis and support for affected infants and families. Addressing these challenges can enhance the effectiveness of NAS surveillance and improve outcomes for opioid- and substance-exposed mother-infant dyads.

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