Neonatal Abstinence Syndrome (NAS) is a diagnostic term used to describe withdrawal in neonates following in-utero exposure to substances. However, the term broadly encompasses both opioid and non-opioid etiologies, leading to diagnostic ambiguity and potential mismanagement. This conflation poses significant risks to patient care, data accuracy, and healthcare policy. An exploratory literature review was conducted to assess the consequences of using NAS as an umbrella term. The review included peer-reviewed publications, health policy documents, and an in-depth analysis of ICD-10 Clinical Modification (ICD-10-CM) codes related to neonatal withdrawal. Diagnostic criteria and definitions were compared across U.S. states and organizations. Findings revealed frequent conflation of NAS with Neonatal Opioid Withdrawal Syndrome (NOWS), with limited acknowledgment of non-opioid causes (noNAS). ICD-10-CM coding lacks granularity in neonates, unlike adult withdrawal codes that include causative agents. Inconsistencies across U.S. state definitions further complicate surveillance, treatment standardization, and research reliability. Literature on noNAS demonstrates that such misdiagnoses can lead to inappropriate treatment and patient safety risks. The broad and imprecise use of NAS contributes to misclassification, flawed data, and clinical mismanagement. Clear differentiation between opioid and non-opioid withdrawal in neonates is necessary to improve diagnostic accuracy, coding practices, and ultimately, patient outcomes. Recommendations for improving terminology, ICD-10 coding, and clinical awareness are presented.
Chandawarkar et al. (Sun,) studied this question.