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Neonatal Abstinence Syndrome (NAS) Hospital Reporting in Ohio

NAS is a serious withdrawal syndrome that can occur in newborns after exposure to opioids during pregnancy.

Ohio Revised Code 3711.30, which went into effect on July 10, 2014, requires maternity units, newborn care nurseries and maternity homes to report to the Ohio Department of Health (ODH) the number of newborns born to Ohio residents who are diagnosed with opioid dependence, commonly referred to as "NAS," at birth.  

In order to assist hospitals in complying with this law, ODH partners with the Ohio Hospital Association (OHA) to access hospital discharge data associated with NAS. As a result of this partnership, Ohio hospitals that report their discharge data to OHA do not need to report to ODH in order to comply with the law; ODH obtains the required data from OHA’s discharge dataset.  

Facilities that do not report data to OHA should contact ODH at HealthyOhio@odh.ohio.gov for instructions on how to report.  

2017 NAS hospital discharge data summary table

Key findings:

  • From 2006 to 2017, there were approximately 15,441 hospital discharges due to NAS among Ohio residents in Ohio hospitals; 1,935  were in 2017.
  • The hospital discharge rate for NAS in 2017 (140 per 10,000 live hospital births) was approximately 6.3 times the rate in 2006 (20 per 10,000).
  • Approximately 91 percent of hospital discharges for NAS (1,753) were covered by Medicaid in 2017, while 9 percent (182) were non-Medicaid discharges.
  • The average length of stay (LOS) for NAS has fluctuated over the years, with a peak of 20.1 days in 2008; in 2017, the average LOS for NAS was 13.4 days which was approximately 3.5 times the average LOS for all Ohio births (3.8 days).
  • In 2017, there were 2,702 hospitalizations among Ohio resident newborns associated with exposure to opioids and hallucinogens.
  • In 2017, 5,047 mothers were diagnosed with drug abuse or dependence at delivery; of those, 1,961 abused or were dependent on opioids.

*Note: Counts may not reflect unique individuals, as individuals may have been hospitalized multiple times for NAS. 

Other available reports

Ohio NAS Data by County, 2013-2017

Recommendations to Prevent NAS

  • All newborns and at-risk breastfeeding children should be screened for NAS symptoms with standardized instruments like the Finnegan Neonatal Abstinence Scoring Tool.1 Hospital systems should hold mandatory trainings for staff with annual refresher trainings to ensure inter-rater reliability when scoring the instrument.
  • The American Academy of Pediatrics suggests that all infants exposed to opioids be monitored for signs of withdrawal for four to seven days after birth.2,3 Physicians, other healthcare professionals and families should be educated about the signs and symptoms of NAS.  A guide for families has been developed by the Ohio Perinatal Quality Collaborative.4
  • Promising practices in treatment of NAS should be identified and promoted throughout the state. Ohio’s standard of care for NAS follows state and national research and is updated regularly as new information becomes available.5
  • Women delivering NAS infants should be provided with information about the special needs of their newborns.
  • Screening, brief intervention and referral to treatment (SBIRT) should be the standard in all medical practices.6 Healthcare providers should confirm suspicion of alcohol or drug use with questionnaires like the NIDA Drug Screening Tool7 or with a urine drug screen. Pregnant women found to be addicted to or dependent on substances should be referred to behavioral health treatment as soon as possible. The Ohio Department of Mental Health and Addiction Services has a referral gateway to Ohio behavioral health professionals.8
  • Women of childbearing age being treated for substance use disorder should be counseled on the impact of substance use on pregnancy; these women should also be screened for hepatitis C and HIV because of the high comorbidity.
  • All healthcare organizations that treat pregnant women, including those that address behavioral health, should consider establishing a maternal care home like the maternal opiate medical supports (MOMS) program.9 This model emphasizes care coordination and the provision of wrap around services from the prenatal phase through the postpartum phase of care. Results from this project have shown improved uptake of prenatal care, behavioral healthcare and medication-assisted treatment as well as an increase in treatment retention and family stability.
  • Alcohol and drug abuse prevention activities should be targeted to women of child-bearing age.
  • Prescribers should carefully consider whether opioid analgesics and other medications should be used during pregnancy. Physicians and patients should consult resources like the Treating for Two campaign about medication and pregnancy to make informed decisions.10

References:

1 Ohio Perinatal Quality Collaborative (2018). Finnegan neonatal abstinence scoring tool. Retrieved from https://opqc.net/sites/bmidrupalpopqc.chmcres.cchmc.org/files/NAS/Resources/Finnegan%20Neonatal%20Abstinence%20Scoring%20Tool_OPQC%20w%20cc.pdf.

2 Hudak M. L. & Tan R. C. (2012). Committee on drugs committee on fetus and newborn. American Academy of Pediatrics. Clinical Report. Neonatal drug withdrawal. Pediatrics, 129(2), 540-560. doi:10.1542/peds.2011-3212 pmid:22291123.

3 Patrick, S. W., Cooper, W. O., & Davis, M. M. (2017). Prescribing opioids and psychotropic drugs in pregnancy. British Medical Journal, 358, 3616 doi: 10.1136/bmj.j3616.

4 Ohio Perinatal Quality Collaborative (2018). Neonatal abstinence syndrome: A guide for families. Retrieved from https://opqc.net/sites/bmidrupalpopqc.chmcres.cchmc.org/files/Resources/Neonatal%20Abstinence%20Syndrome/opqc_nas_parent_guide_092914.pdf.

5 Ohio Perinatal Quality Collaborative (2017). Updates/changes to the recommended OPQC NAS protocol. Retrieved from https://opqc.net/sites/bmidrupalpopqc.chmcres.cchmc.org/files/NAS/OPQC%20Recommended%20NAS%20Protocol%20Changes%202017.pdf.

6 Ohio Department of Mental Health and Addiction Services (2018). Screening, brief intervention and referral to treatment. Retrieved from http://mha.ohio.gov/Treatment/SBIRT.

7 National Institute on Drug Abuse. (2018). NIDA drug screening tool. Retrieved from https://www.drugabuse.gov/publications/resource-guide-screening-drug-use-in-general-medical-settings/nida-quick-screen.

8 Emerald Jenny Foundation. (2018) This is the first step. Retrieved from https://www.emeraldjennyfoundation.org/.

9 Ohio Department of Mental Health and Addiction Services. (2018). M.O.M.S. Retrieved from http://momsohio.org/moms/.

10 Centers for Disease Control and Prevention. (2018). Treating for two: Medicine and pregnancy.  Retrieved from https://www.cdc.gov/pregnancy/meds/treatingfortwo/index.html.

Current Efforts to Address NAS in Ohio

The Maternal Opiate Medical Supports (MOMS) Program

Ohio Perinatal Quality Collaborative