Neonatal Abstinence Syndrome

Neonatal abstinence syndrome (NAS)
is what happens after babies are exposed to drugs in the uterus before birth. Babies
can
then go through drug withdrawal after birth. The syndrome most often applies to opioid
medicines.

Almost every drug and medicine
passes from the mother’s bloodstream through the placenta to her unborn baby. If the
mother uses substances that affect her nervous system, they will also affect the baby’s.
At birth, the baby has become used to getting the drug. But because the drug is no
longer available, the baby may have withdrawal symptoms.

Some drugs and medicines are more
likely to cause the syndrome than others. In general, anything that affects a mom’s
central nervous system can affect her baby’s. When more than one substance has been
used, the symptoms are often worse. These include:

  • Opioids such as heroin and prescribed
    medicines such as codeine and oxycodone
  • Stimulants such as amphetamines or
    cocaine. For these drugs, the effects on a baby are more likely from the drug itself
    instead of withdrawal.
  • Antidepressant medicines such as
    selective serotonin reuptake inhibitors (SSRIs)
  • Depressants such as barbiturates, or
    alcohol, or marijuana
  • Nicotine from cigarette smoking

Alcohol use can also cause another
group of problems called fetal alcohol spectrum disorders.

Pregnant women who use psychoactive
drugs, smoke, or drink alcohol put their unborn babies at risk for NAS and other
problems. Women who use drugs also may be less likely to get prenatal care. This can
also increase the risks for both mother and baby.

Pregnant women who take opioid pain medicine under medical care may
also have babies who are at risk. It’s important to discuss all medicines and their
possible risks with your healthcare provider and your baby’s provider.

Symptoms of NAS may vary depending
on:

  • The type of drug used
  • The last time it was used
  • If the baby is full-term or
    premature

Withdrawal symptoms may start as
soon as 24 to 48 hours after birth. Or they may start as late as 5 to 10 days after
birth. Symptoms may be slightly different for each baby.

Symptoms of withdrawal in full-term
babies may include:

  • Trembling
  • Too much crying or high-pitched
    crying
  • Sleep problems
  • Tight muscle tone
  • Overactive reflexes
  • Seizures
  • Yawning, stuffy nose, and
    sneezing
  • Poor feeding and sucking
  • Vomiting or diarrhea
  • Sweating
  • Fever or unstable temperature

Premature babies may have a lower
risk for withdrawal symptoms or have less severe symptoms. They may also get better
faster because they were exposed to less of the drug than full-term babies.

The symptoms of this problem may
look like other health conditions. Make sure your child sees their healthcare provider
for a diagnosis.

The diagnosis is made based on a
history of medicine or substance use in the mother, or on a baby’s symptoms. An accurate
report of the mother’s drug use is important. This includes the time the last
drug was taken. The healthcare provider may use a scoring system to help diagnose
and
pinpoint how serious the baby’s withdrawal is. Points are given for certain signs
and
symptoms and the seriousness of each. This scoring may also help in planning
treatment.

If the provider thinks that the
mother was using drugs, they may check meconium, urine, or umbilical cord blood or
tissue. This should also be done if the baby shows symptoms of the syndrome even without
a history. Some birth centers routinely screen all babies.

Treatment will depend on your
child’s symptoms, age, and general health. It will also depend on how severe the
condition is.

Babies suffering from withdrawal
are grouchy (irritable). They often have a hard time being comforted. Kangaroo
(skin-to-skin) care or wrapping the baby snugly in an adult’s arms or a blanket may
help
give comfort. Rocking, quiet, and darkness are other ways to help with calming and
comforting babies with NAS. Babies with NAS also may need extra calories added to
their
feedings because of their increased activity. They may need IV (intravenous) fluids
if
they are dehydrated or have severe vomiting or diarrhea.

Some babies will need medicines to
treat severe withdrawal symptoms and prevent complications such as seizures. Medicines
may also help ease the discomfort and problems of withdrawal. If medicine is needed,
babies will often be given a medicine that’s in the same family of drugs as the drug
the
baby was exposed to before birth. Once the signs of withdrawal are controlled, the
amount of the medicine is slowly decreased. This helps wean the baby off the drug.
Talk
with your baby’s healthcare provider to learn which treatments might work for your
baby.

In addition to the problems of
withdrawal after birth, complications in the baby may include:

  • Poor growth in the uterus
  • Being born too soon (preterm or
    premature)
  • Seizures
  • Yellowing of the skin or eyes
    (jaundice)
  • Birth defects

Even without NAS, prenatal drug
exposure can be linked to later developmental delay. This may be affected by the
environment in which the baby grows up as well. 

Certain drugs have been linked to
specific problems in the baby. These problems may include:

  • Heroin and
    other opioids.
    These drugs, including methadone, can cause serious withdrawal
    in the baby. Some symptoms can last as long as 4 to 6 months. Seizures may also occur
    in babies born to opioid users.
  • Amphetamines. These can lead to low birth weight and premature birth.
  • Cocaine.
    This can cause poor growth. It also makes complications such as placental abruption
    more likely.
  • Marijuana.
    This may cause lower birth weight, as well as later learning and behavior
    problems.
  • Alcohol.

    This can have major effects on babies before and after birth. Growth during
    pregnancy and after birth is slowed. It can also cause certain problems of the head
    and face, heart defects, learning problems, and mental problems.

  • Cigarette
    smoking.
    This may cause low birth weight. It may also put babies at higher
    risk for premature birth and stillbirth.

It may be possible to prevent NAS.
But it can only be prevented if the mother stops using substances that could cause
NAS
before pregnancy or as soon as she learns she is pregnant. In some cases, this can’t
be
done safely. In all cases it needs close medical supervision.

  • Neonatal abstinence syndrome (NAS)
    happens when babies are exposed to certain substances or medicines in the uterus
    before birth. Babies can then go through drug withdrawal after birth.
  • Symptoms of NAS may begin as soon as
    24 to 48 hours after birth. Or they may start as late as 5 to 10 days after
    birth.
  • Some babies may need medicines to
    treat severe symptoms. The medicines help ease the discomfort and problems of
    withdrawal.
  • It may be possible to prevent NAS. But
    it can only be prevented if the mother stops using drugs before pregnancy or as soon
    as she learns she is pregnant. In some cases, this can’t be done safely. In all cases
    it needs close medical supervision.

Tips to help you get the most from
a visit to your child’s healthcare provider:

  • Know the reason for the visit and what
    you want to happen.
  • Before your visit, write down
    questions you want answered.
  • At the visit, write down the name of a
    new diagnosis, and any new medicines, treatments, or tests. Also write down any new
    instructions your provider gives you for your child.
  • Know why a new medicine or treatment
    is prescribed and how it will help your child. Also know what the side effects
    are.
  • Ask if your child’s condition can be
    treated in other ways.
  • Know why a test or procedure is
    recommended and what the results could mean.
  • Know what to expect if your child does
    not take the medicine or have the test or procedure.
  • If your child has a follow-up
    appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your child’s
    provider after office hours. This is important if your child becomes ill and you have
    questions or need advice.