In September 2014, WV neonatologists and pediatricians, representing Tertiary care centers, Level II and Level I hospitals met with coders and members of the WV Perinatal Partnership to develop a standardized definition for neonatal withdrawal and guidance on documenting exposure and withdrawal in newborns.

 

NAS Definition

NAS includes neonatal withdrawal from many substances, not just opiates. It is exposure with clinical symptoms, and it is not limited to those cases that require pharmacological treatment.

 

Diagnosing NAS

Neonate has intrauterine exposure to a neuroactive substance, and exhibits clinical signs and symptoms of withdrawal regardless of whether or not pharmacological treatment is required

 

Coding

All newborns with intrauterine exposure, including those diagnosed with NAS, must also be diagnosed with at least one exposure code to indicate newborn is (or suspected to be) affected by maternal use of the substance.

 

Intrauterine Exposure should be recorded in the newborn’s record and coded as exposure when maternal use of neuro-active drugs is known (or suspected) during pregnancy

 

■	toxicology test on mother
■	self-reported or in mother’s prenatal record
■	confirmation of a biological specimen from the baby for any neuro-active drug(s),
■	and/or the newborn exhibits withdrawal symptoms.

 

Using the WV Birth Score to collect surveillance data for substance exposure and NAS:

 

In October 2016, logic-based questions about substance exposure during pregnancy and NAS were added to the electronic Birth Score:

 

1.	Intrauterine Substance Exposure (includes any medication prescribed by a physician during pregnancy).   Yes/No (if No, questions below will not be available)
2.	If yes, then check all that apply
	■	Self-reported
	■	Documented in prenatal record
	■	Positive maternal drug test
	■	Unknown
		Other

 

Infant with clinical signs consistent with NAS diagnosis?

 

Yes/No

Improving the identification of Substance Exposed Infants in WV is presented by Sean Loudin, MD of Cabell Huntington Hospital, Stefan Maxwell, MD of CAMC’s Women and Children’s Hospital, and Collin John, MD of Ruby Memorial, West Virginia University.

 

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