MMWR Morb Mortal Wkly Rep. 2020 Jul 24;69(29):951-955. doi: 10.15585/mmwr.mm6929a2.
Opioid use disorder and neonatal abstinence syndrome (NAS) increased in Massachusetts from 1999 to 2013 (1,2). In response, in 2016, the state passed a law requiring birth hospitals to report the number of newborns who were exposed to controlled substances to the Massachusetts Department of Public Health (MDPH)* by mandating monthly reporting of International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnostic codes related to maternal dependence on opioids (F11.20) or benzodiazepines (F13.20) and to newborns affected by maternal use of drugs of addiction (P04.49) or experiencing withdrawal symptoms from maternal drugs of addiction (P96.1) separately. MDPH uses these same codes for monthly, real-time crude estimates of NAS and uses P96.1 alone for official NAS state reporting. MDPH requested CDC's assistance in evaluating the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of either maternal or newborn codes to identify substance-exposed newborns, and of newborn exposure codes (both exposure [P04.49] or withdrawal [P96.1]) and the newborn code for withdrawal alone (P96.1) to identify infants with NAS cases related to three exposure scenarios: 1) opioids, 2) opioids or benzodiazepines, and 3) any controlled substance. Confirmed diagnoses of substance exposure and NAS abstracted from linked clinical records for 1,123 infants born in 2017 and their birth mothers were considered the diagnostic standard and were compared against hospital-reported ICD-10-CM codes. For identifying substance-exposed newborns across the three exposure scenarios, the newborn exposure codes had higher sensitivity (range = 31%-61%) than did maternal drug dependence codes (range = 16%-41%), but both sets of codes had high PPV (≥74%). For identifying NAS, for all exposure scenarios, the sensitivity for either newborn code (P04.49 or P96.1) was ≥92% and the PPV was ≥64%; for P96.1 alone the sensitivity was ≥79% and the PPV was ≥92% for all scenarios. Whereas ICD-10-CM codes are effective for NAS surveillance in Massachusetts, they should be applied cautiously for substance-exposed newborn surveillance. Surveillance for substance-exposed newborns using ICD-10-CM codes might be improved by increasing the use of validated substance-use screening tools and standardized facility protocols and improving communication between patients and maternal health and infant health care providers.
1999 年至 2013 年期间，马萨诸塞州的阿片类药物使用障碍和新生儿戒断综合征（NAS）有所增加（1,2）。因此，为应对这一情况，2016 年，该州通过一项法律，要求分娩医院每月向马萨诸塞州公共卫生部（MDPH）报告接触受控物质的新生儿数量*，并规定分别报告与产妇对阿片类药物（F11.20）或苯二氮䓬类药物（F13.20）依赖相关的国际疾病分类，第十次修订，临床修正（ICD-10-CM）诊断代码，以及与产妇使用成瘾药物（P04.49）或新生儿出现戒断症状（P96.1）有关的诊断代码。MDPH 每月使用这些相同的代码对 NAS 进行实时粗略估计，并单独使用 P96.1 对 NAS 进行官方州级报告。MDPH 请求 CDC 协助评估产妇或新生儿代码识别接触物质的新生儿的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV），以及新生儿暴露代码（暴露[P04.49]或戒断[P96.1]）和单独的新生儿戒断代码（P96.1），以识别与三种暴露情况相关的 NAS 病例的婴儿：1）阿片类药物，2）阿片类药物或苯二氮䓬类药物，以及 3）任何受控物质。对 2017 年出生的 1123 名婴儿及其产妇的链接临床记录中确认的物质暴露和 NAS 诊断进行了分析，作为诊断标准，并与医院报告的 ICD-10-CM 代码进行了比较。对于三种暴露情况下的物质暴露新生儿的识别，新生儿暴露代码的敏感性（范围为 31%-61%）高于产妇药物依赖代码（范围为 16%-41%），但这两组代码的阳性预测值（PPV）均较高（≥74%）。对于 NAS 的识别，对于所有暴露情况，新生儿代码（P04.49 或 P96.1）的敏感性均≥92%，PPV 均≥64%；单独使用 P96.1，所有情况下的敏感性均≥79%，PPV 均≥92%。虽然 ICD-10-CM 代码可有效用于马萨诸塞州的 NAS 监测，但在监测物质暴露新生儿时应谨慎使用。使用 ICD-10-CM 代码监测物质暴露新生儿的敏感性可能会通过增加使用经过验证的药物使用筛查工具和标准化的机构协议，以及改善患者与产妇健康和婴儿保健提供者之间的沟通来提高。
