Neonatal Abstinence Syndrome (NAS) in Appalachia: Changing Trends, Clinical Presentation and Management of NAS

Neonatal abstinence syndrome is a significant and rapidly growing public health concern in Appalachia. In 2017, 1090 cases of NAS were reported to the State of Tennessee surveillance program. The incidence of NAS in Tennessee since early 2000s has increased 10-fold, while the national average over the same time period has only increased 3-fold, with the highest rate of increase between 2000-2012. Currently, buprenorphine is a predominant drug of opioid exposure in our region. In this review article, authors describe the incidence of NAS, changing trends, clinical presentation, management protocols and long-term outcomes of infants exposed to buprenorphine. We reviewed the literature, in terms of clinical presentation, changing trends in drug use in pregnancy and choice of drugs available for the management of NAS