Neonatal Abstinence Syndrome

What is neonatal abstinence syndrome?

Neonatal abstinence syndrome (NAS) occurs in babies who had drug exposure in the womb. After birth, these babies go through drug withdrawal and need medical care.

Symptoms of neonatal abstinence syndrome

Babies who have NAS can suffer a wide range of symptoms. Other health conditions and problems also can produce the same symptoms. So you should talk to your doctor if you ingested drugs during pregnancy and see one or more of these warning signs:

  • Low birth weight and poor weight gain.
  • Extreme or high-pitched crying.
  • Fever.
  • Fussy or irritable behavior.
  • Trouble sleeping.
  • Extreme yawning.
  • Poor appetite and sucking.
  • Hurried breathing.
  • Stuffy nose or sneezing.
  • Rough or blotchy skin.
  • Sweating.
  • Vomiting.
  • Diarrhea.
  • Tremors, twitches, tight muscles, and/or seizures.

These symptoms usually begin 1 day to 1 week after birth. They can last anywhere from 1 week to 6 months. The presence and severity of symptoms vary based on:

  • The type and amount of drug used.
  • The frequency and duration of drug use.
  • How the mother’s body reacts to the drug (genetics).
  • If your baby was full-term or premature (born 4 weeks early or more).

What causes neonatal abstinence syndrome?

Everything you consume in pregnancy gets passed to the baby. The placenta is an organ attached your uterus wall. It provides food and oxygen to your baby through the umbilical cord. Drugs, alcohol, and other substances also travel through the placenta.

If your baby is exposed to drugs in the womb, they go through withdrawal after birth. NAS usually occurs from using opioids or painkillers. This includes:

  • heroin
  • methadone
  • oxycodone
  • codeine
  • morphine
  • buprenorphine

Babies also can get NAS from other addictive substances, such as:

  • cocaine
  • amphetamines
  • marijuana
  • nicotine
  • alcohol
  • barbiturates
  • benzodiazepines
  • certain antidepressants (such as selective serotonin reuptake inhibitors)

How is neonatal abstinence syndrome diagnosed?

NAS symptoms overlap with those of other health conditions and problems. Alert your doctor or nurse if you notice any symptoms. They will examine your baby and ask questions about your drug use.

Urine screening can check for drugs in you and/or your baby. The doctor also can test your baby’s first bowel movements. The neonatal abstinence syndrome scoring system measures symptoms and severity. Your baby is likely to have NAS if they have a high score.

Can neonatal abstinence syndrome be prevented or avoided?

Neonatal abstinence syndrome can be prevented. Avoid opiates and other drugs during pregnancy. You also should avoid alcohol and tobacco. Talk to your doctor about the medicines you take or if you have an addiction. They can help you quit and provide medical care, if needed. Do not stop taking medicine without talking to your doctor.

If you need opioids for health reasons, do not get pregnant. Use birth control or other preventive measures.

Neonatal abstinence syndrome treatment

If your baby has NAS, the doctor will need to know details of your drug use. This information affects the type(s) of treatment. Factors include the drug, amount, frequency, and length of use. Your baby’s health and birth (full-term or premature) also play a role.

Most likely, your baby will require a hospital stay to treat NAS. Babies who are dehydrated might need IV (intravenous) fluids. High-calorie formula provides added nutrition. You might need to feed your baby more small meals. Also, your baby will need extra attention. Tips to help calm your baby include:

  • Gentle rocking or swinging.
  • Swaddling.
  • Touching skin-on-skin.
  • Reducing lights and noise.
  • Safe breastfeeding.

Babies who have severe cases of withdrawal require medicine. Your doctor will prescribe a drug similar to the one used for mothers in withdrawal during pregnancy. They start with a high dose and slowly decrease it to wean the baby off the drug.

Living with neonatal abstinence syndrome

Treatment should reduce withdrawal symptoms. However, your baby can have lasting effects from NAS and other drug or substance abuse. The following concerns require further observation and care:

  • Birth defects.
  • A small head.
  • Developmental delays or problems.
  • Behavior issues.

Questions to ask your doctor

  • What medicines are okay to take when I’m pregnant?
  • If I’m using an addictive substance, what is the best way to quit?
  • Will my baby have permanent damage from NAS?