উন্নত করার কিছু দেখছেন? একটি পরিবর্তন প্রস্তাব করুন।
Neonatal abstinence syndrome (NAS) is drug withdrawal in newborns, most often after exposure to opioids in the womb, though other substances can cause it too. Prenatal opioid exposure has also been linked to poor fetal growth, preterm birth, stillbirth and possibly certain birth defects.
From 2004 to 2014, NAS in the United States rose 433%, from 1.5 to 8.0 per 1,000 hospital births. By 2014, a baby with signs of NAS was born every 15 minutes.
Most tracking has relied on hospital discharge data, which undercount NAS and arrive long after the fact — too late to steer help where it's needed. Some states have responded by making NAS a legally reportable condition. This CDC evaluation looked at how that has worked.
The six states
A search of state laws on January 3, 2018, found six states requiring NAS reporting — from hospitals and providers to the state health department, from the health department to the legislature, or both. Officials in each state answered a 28-item questionnaire and a follow-up interview between March and May 2018.
| State | Law in effect | Reported by | Reported to | Time frame |
|---|---|---|---|---|
| Arizona | 2017 | Providers and facilities | Health department | 5 business days |
| Florida | 2014 | Providers and facilities | Health department | 6 months |
| Georgia | 2017 | Providers and facilities; health department | Health department; legislature | 30 days, set by the department; annually to the legislature |
| Kentucky | 2013 and 2014 | Providers and facilities | Health department | At diagnosis |
| Tennessee | 2017 | Health department | Legislature | Annually |
| Virginia | 2017 | Providers and facilities | Health department | 1 month |
Only Georgia and Virginia define NAS in the law itself. Tennessee added NAS to its reportable disease list in 2013 under existing authority.
What the states found
It works. After implementation, five states reported receiving NAS case reports within 30 days of diagnosis, and mandatory reporting let health departments measure NAS in their states and plan programs and services.
Electronic is better. Every state favored electronic reporting. Arizona and Georgia added NAS to existing electronic disease surveillance systems — an advantage in resources. Tennessee and Virginia built new systems; Kentucky used paper forms and planned to go electronic; Florida's passive reporting through administrative data needed no changes.
Education takes the most effort. Georgia, Kentucky, Tennessee and Virginia said teaching providers and hospital staff about the reporting rules was among the most resource-intensive tasks. Arizona pointed to chasing missing data and training staff. Staff turnover at hospitals and birthing centers can leave gaps, and requiring every facility that treats an infant to report risks duplicates when a baby is transferred.
Definitions differ. All six states count cases diagnosed by a clinician, which misses infants who were exposed but show no symptoms. Only Georgia also counts asymptomatic infants with positive toxicology tests — which also shows whether the exposure came from a prescribed medicine or an illicit drug. The move from ICD-9 to ICD-10 codes may also affect counts drawn from administrative data.
How the data are used
- All six collect infant demographics; Florida, Georgia, Kentucky and Tennessee also collect the mother's.
- Arizona, Georgia, Kentucky and Tennessee publish de-identified data and share it with other agencies for community assessment, planning, programs and intervention.
- Arizona learns how many cases stem from medically supervised opioid treatment in pregnancy — for pain or opioid use disorder — to improve treatment for pregnant women.
- Florida links infant and maternal discharge data to connect women with two or more opioid-exposed pregnancies to treatment.
- Others use the data to build supportive, integrated services for families.
What's next
The absence of a national case definition creates big differences in what gets reported. After this analysis, the Council of State and Territorial Epidemiologists convened a workgroup to propose a standardized NAS case definition to the council in summer 2019. A common definition and consistent reporting would let states be compared and let prevention target the areas of greatest need.
Limitations
- Narrow search terms may have missed states using different wording or laws passed after January 3, 2018.
- Four of the six laws took effect in 2017, leaving little time to judge results.
- Interviews didn't ask about the benefits of using a clinical diagnosis as the case definition.
- The evaluation is qualitative and can't measure the laws' impact.
Sources
Based on Jilani SM, Frey MT, Pepin D, et al., "Evaluation of State-Mandated Reporting of Neonatal Abstinence Syndrome — Six States, 2013–2017," Morbidity and Mortality Weekly Report 68(1), Centers for Disease Control and Prevention; a work of the United States government in the public domain. Original report.
লাইসেন্স: CC0 1.0 (পাবলিক ডোমেইন) · গৃহীত হয়েছে www.cdc.gov
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