Neonatal Abstinence Syndrome (NAS)
Background Information
Neonatal Abstinence Syndrome (NAS) is a condition in which an infant undergoes withdrawal from a substance to which he or she was exposed in-utero. Different classes of substances, including opioids, antidepressants and barbiturates, may cause NAS when used during pregnancy. The most common substances causing NAS are opioids. This can include legally prescribed opioids (such as pain relievers like morphine and medication assisted treatment opioids such as buprenorphine and methadone) or illegally obtained opioids, e.g., heroin. In addition, a pregnant woman may obtain a substance through drug diversion, i.e. transfer of legally prescribed controlled substance from the individual for whom it was prescribed to another person for any illicit use.
Since the early 2000s, the incidence of NAS in Tennessee increased by 10-fold, far exceeding the national 3-fold increase over the same time period. A sub-cabinet working group focused on NAS and consisting of Commissioner-level representation from the Departments of Health, Children’s Services, Mental Health and Substance Abuse Services, Medicaid (TennCare), Safety and the Children’s Cabinet convened from 2012 to 2019. This group aligned efforts across state agencies, with a focus on upstream (primary) prevention strategies.
In 2013, Tennessee became the first state in the nation to require reporting of NAS for public health surveillance purposes. Providers are required to report all diagnoses of NAS within 30 days of diagnosis. Since 2013, Tennessee had seen annual increases in the number of cases of NAS until CY2018, which marked the first decrease in the number of cases.
Reporting Cases of NAS to the Tennessee Department of Health
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)
- Additional Guidance on Reporting Cases from Border States (6/24/2014)
Updates to NAS REDCap Reporting Portal (Effective 5/29/2020)
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.
Tennessee Department of Health NAS Reports and Publications
Additional Resources
- Tennessee Department of Health Brochures
NAS Educational Material for Medication-Assisted Treatment (MAT) Providers
- National Library of Medicine:
- American Academy of Pediatrics:
Clinical Report — Neonatal Drug Withdrawal Syndrome
- American College of Obstetrics and Gynecology:
Committee Opinion — Opioid Abuse, Dependence, and Addiction in Pregnancy
- Tennessee Initiative for Perinatal Quality Care:
- Association of State and Territorial Health Officials
Programs and Resources for Families in Tennessee
Several programs in Tennessee offer support and services for parents and families of infants exposed to substances in-utero, including infants with NAS.
Community Health Access and Navigation in Tennessee (CHANT)
Navigating the complex system of health and social services can be challenging for many individuals and families, and depending on individual needs and medical diagnoses, care may involve several programs, providers, and personnel. To overcome these challenges, the Tennessee Department of Health developed a care coordination program, CHANT. CHANT teams provide enhanced patient-centered engagement and navigation of medical and social services referrals. Additional information about the CHANT program is available here .
Tennessee Early Intervention System (TEIS)
TEIS is a program that provides services to children from birth to age three who have disabilities or other developmental delays. TEIS is a critically important program to support young children and their families. TEIS helps families navigate available resources for their child to reach their optimal development.
Information for parents can be found here. Children can be referred to TEIS by completing an online referral form or calling (800) 852-7157.
Family Voices of Tennessee
Programs offered through Family Voices of Tennessee provide support, information and resources from someone who is on a similar journey caring for a child with a special health care need, chronic illness or disability. Family Voices of TN can help by: problem-solving; providing emotional support; connecting parents/caregivers to community resources; sharing first-hand experience and tips; making referrals to other agencies who can provide additional support; providing assistance in navigating the healthcare system; and connecting parents/caregivers with other parents through the PEARS Program, Parent to Parent Mentorship or a Parents Reaching Out Session. Families can get connected by visiting the Family Voices of Tennessee website and filling out the “Get Connected” form.
Evidence Based Home Visiting Programs
Evidence Based Home Visiting (EBHV) programs can be an effective early-intervention strategy to improve the health and well-being of children and parents. Research demonstrates that young children of families enrolled in EBHV programs show improvements in health and development outcomes and increased school readiness. Families participate on a voluntary basis and are provided with ongoing support in times of need.
The Tennessee Department of Health funds eleven (11) agencies to deliver EBHV services in 51 counties. Contact information for Evidence Based Home Visiting programs by county can be found here .
Head Start and Early Head Start
Head Start and Early Head Start are federally funded programs that promote school readiness of children ages 0-5 from eligible families through education, health, social and other supports and services. Tennessee's Head Start programs serve approximately 20,000 children and their families every year with comprehensive education, social and health programs for children, and programs for family and community engagement with the goal of facilitating school readiness. Head Start classrooms are operated by government, private, faith-based and community-based organizations in nearly every county in the state directly or through Child Care partnerships or other collaborative arrangements. More information is available here .
For More Information
For General Information:
Call: 615-741-7353
Email: FHW.Health@tn.gov
For Media Inquiries:
Call: 615-741-3111