Neonatal Abstinence Syndrome (NAS)
Neonatal Abstinence Syndrome is a condition in which a baby has withdrawal symptoms after being exposed to certain substances. Many times, the baby is exposed when the mother uses substances such as medications or illicit drugs during pregnancy, and after the baby is born (and separated from the mother’s body), the baby goes through withdrawal because it is no longer receiving the substances. Less commonly, very sick babies may receive medications after birth to help control pain or agitation, and once those medications are stopped, the baby may go through withdrawal.
The kinds of medications that may cause withdrawal include those known as opioids (painkillers) or benzodiazepines (which help with anxiety or sleep). Illicit drugs such as cocaine may also cause withdrawal. Withdrawal can occur when a mother is using a medication as prescribed, such as a mother who is receiving treatment for pain or addiction; when a mother is using a prescription medication inappropriately (such as when she uses too much of a medication, takes the medication too often, or takes someone else’s prescription); or when a mother is using an illegal drug.
Sometimes mothers who are addicted to illegal drugs like heroin will receive treatment with another drug such as methadone or buprenorphine to help treat their addiction. Even in these cases, if the mother is treated during pregnancy, the baby can go through withdrawal after birth.
Over the past decade, we have seen a nearly ten-fold rise in the incidence of babies born with NAS in Tennessee. Infants with NAS stay in the hospital longer than other babies and they may have serious medical and social problems.
Effective January 1, 2013, all cases of NAS diagnosed among Tennessee resident births should be reported to the Tennessee Department of Health at the time of diagnosis.
- NAS Reporting Portal (Use this to report cases. The NAS Reporting portal now requires a username and password. Please email Dr. Alice Nyakeriga (Alice.Nyakeriga@tn.gov) to gain access)
- Letter from Commissioners of TDH and DCS regarding reporting of child abuse and NAS affected infants (10/16/2017
- Additional Guidance on Reporting Cases from Border States (6/24/2014)
- Frequently Asked Questions Regarding Public Chapter 820 (PC 820) and Other Requirements Related to NAS in Tennessee (6/24/2014)
- Frequently Asked Questions about reporting cases of NAS to the Tennessee Department of Health (11/28/2012)
- Letter from TDH Commissioner Dr. John Dreyzehner regarding reporting requirement (11/29/2012)
Additional Reporting Resources
- June 2014 Webinar for Hospitals
- March 2013 Webinar for Hospitals
- Update on NAS Reporting Webinar (March 19, 2013)
- Questions and Answers from the NAS Reporting Webinar (March 19, 2013)
- Slides from NAS Reporting Webinar (March 19, 2013)
Reports and Publications Related to NAS
- National Library of Medicine:
- American Academy of Pediatrics:
- American College of Obstetrics and Gynecology:
- Tennessee Initiative for Perinatal Quality Care:
- National Association of State Alcohol and Drug Abuse Directors:
- Tennessee Department of Health Brochures
The Tennessee Department of Health was recently awarded short-term funding through the Council of State and Territorial Epidemiologists (CSTE) to implement a new standardized case definition for Neonatal Abstinence Syndrome (NAS). Currently, the use of diagnostic criteria and diagnostic codes for NAS varies between states, hospitals and providers. The implementation of a new standardized case definition will result in a better understanding of NAS and allow for more reliable comparisons between states. Detailed information about the CSTE standardized case definition can be found here. Infants will be classified as confirmed, probable, or suspect cases. To meet the requirements of the case definition, new questions were added to the REDCap survey.
A webinar about the changes to the REDCap reporting portal can be found here: https://tngov.webex.com/recordingservice/sites/tngov/recording/play/e263c6d5c02b453cb6389c6066d2bcb6