NAS Surveillance Program


Promising Practice

NAS Surveillance Program

State/JurisdictionSettingPopulationTopic AreaNPMs
TennesseeClinicalPerinatal/Infant Health, Women/Maternal HealthMental Health, Substance Use14.1

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.

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.


contact information

Tennessee Department of Health
Alice Nyakeriga
alice.nyakeriga@tn.gov
(615) 253-2655

Project Website