Neonatal Abstinence Syndrome (NAS)

Neonatal Abstinence Syndrome (NAS) is the set of withdrawal symptoms that a newborn can experience when the mother used or abused drugs during pregnancy.  Because the mother and baby share blood circulation through the placenta during pregnancy, almost every drug that the mother used passes to the baby. When the baby is born, it is still physically dependent on the drug and may begin to show symptoms of withdrawal, called NAS. Symptoms can include tremors, excessive crying, excessive sucking, poor feeding, sweating, vomiting, diarrhea, blotchy skin, hyperactive reflexes, and occasionally, seizures. NAS most often is caused when a woman takes narcotics (e.g. morphine, methadone, oxycodone) during pregnancy, but can also occur with antidepressants and benzodiazepines. It also can also occur when a woman is abusing illegal drugs, such as heroin, amphetamines, and barbiturates.

NAS is legally reportable to the Georgia Department of Public Health as of January 1, 2016. Gathering information about NAS will help DPH to develop policies and programs aimed at reducing the number of babies who are born with NAS.

FAQs - Reporting NAS for Healthcare Providers

What is the reporting criteria for NAS?

A report should be made when:

  1. A newborn is identified to have symptoms consistent with NAS and/or
  2. A newborn is identified to have a positive drug screen result

A positive maternal history only (drug screen result or reported drug use/abuse) does not meet criteria for reporting.

Who is responsible for reporting?

The baby’s physician of record at the facility where NAS is diagnosed is responsible for reporting.  This can be delegated to other staff within the facility. NAS is usually diagnosed in the hospital following birth but can be diagnosed on readmission.

How do I report a case of NAS?

NAS is reported in the same manner as other infectious notifiable diseases, through the State Electronic Notifiable Disease Surveillance System (SendSS). You can access SendSS at https://sendss.state.ga.us/.

When do I make a report?

Reports should be made to DPH within 7 days of identification. 

What type of laboratory testing can be done to confirm the diagnosis?

A urine screen is the most common and cost effective method; a positive result can be helpful in understanding the causative agent. A meconium screen or cord testing are more sensitive methods and may detect minor, remote exposures, however may require reference laboratories. A negative screen in any test is considered an inconclusive result; it does not rule out drug exposure. Kocherlakota. P (2014). Neonatal Abstinence Syndrome, Pediatrics, (134) 2.

If the mother has a history of substance abuse but the baby is born with no withdrawal symptoms AND a negative laboratory test for substances, do I still report?

No.  Reporting is based on the baby only.

Does a diagnosis of NAS mean a delay in discharge from the hospital?

Every baby with NAS is different depending on many factors, but in general, babies with a diagnosis of NAS have a longer length of stay due to the need for symptom management. Symptoms can last from one week to six months. Most commonly, babies with NAS are hospitalized for two to four weeks.

Do I also need to make a report to the Division of Family and Children Services (DFCS)?

A NAS report to DPH does NOT satisfy “mandatory reporter” obligations of child abuse under Code Section 19-7-5. A DFCS report should be made by the facility if there is reasonable cause to believe that the mother is abusing substances.

Do I need to go back and report cases since January 1, 2016?

Ideally, the surveillance goal is to capture all cases of NAS. However, DPH understands there is a learning curve in the reporting process.  At a minimum, please report all cases of NAS moving forward. Since reporting began January 1, 2016, the reporting form has been updated based on provider feedback to improve ease of reporting. 

What is the law requiring mandated reporting of NAS and when was it passed?

Georgia law, Code Section 31-12-2 was passed in 1964.  The addition of NAS to the reporting panel was effective January 1, 2016.

Will the information reported be passed along to law enforcement?

No. The reporting procedure is for public health surveillance purposes only. Like all personal health information collected by DPH, it is confidential and subject to HIPAA, which means it will be available to law enforcement only through court order or subpoena.

 


Please direct any questions related to NAS to:

Grace Kang, RN
Perinatal Health Clinical Coordinator
Maternal and Child Health Section
Georgia Department of Public Health
2 Peachtree Street, NW; 11th
Atlanta, GA 30303
 
 
 
 
 
 
 
 
 

Page last updated 04/26/2017