Evaluation of the Web-Based Neonatal Abstinence Syndrome Surveillance System in Tennessee

BACKGROUND:   Neonatal Abstinence Syndrome (NAS) occurs when an infant experiences withdrawal symptoms after birth because of in-utero exposure to an addictive substance.  The syndrome is associated with both prescription and illicit maternal drug use. Over the past decade, the United States has seen a three-fold increase in NAS incidence, however Tennessee has seen a ten-fold increase.  Due to the epidemic proportions of NAS in Tennessee, the condition was designated as a reportable condition effective January 1, 2013, and a web-based surveillance system was established to monitor cases.  Before this, NAS incidence was abstracted from hospital discharge and Medicaid claims data.  However, there is a nine to eighteen month delay between the collection and release of this data.  This time lag drastically decreased the Department of Health’s ability to make timely public health decisions regarding NAS.  The new surveillance system was designed to allow a more real-time estimation of incidence.  The goal of this new system is to inform policy making and aid in program efforts.

METHODS:   Infants with a clinical diagnosis of NAS are to be reported within thirty days of diagnosis.  Cases are reported through an online, publicly available survey subscription service.  Data elements collected include infant’s age and gender, maternal county of residence, confirmatory tests performed on infant, presence of clinical signs of NAS, and maternal source of exposure.  Each week, a report is generated and made available on the Tennessee Department of Health’s website.  This report includes the number of cases by gender, the number of unique reporting hospitals, maternal county of residence aggregated by region, and source of maternal substance.

RESULTS:   Positive attributes of the system are that it is simple, flexible, timely, and stable.  During the first year of reporting, there were 852 cases at 50 hospitals.  Of these cases 58% (n=497) were male and most (64%, n=545) occurred in eastern Tennessee.  Mutually exclusive categories of drug exposure were prescribed drugs (42%), illicit and diverted drugs (33%), prescription and illicit drugs (21%), and unknown exposure (4%).

CONCLUSIONS:   The web-based reporting system has two major benefits over the previous data collection methods.  First, it provides real-time estimates of NAS incidence, and second it provides data on supervised versus unsupervised maternal prescription drug use that was previously unavailable.  However, improvements can be made to reduce duplicate reports.  Overall, this system provides crucial data needed to address the growing problem of NAS.