What is Neonatal Abstinence Syndrome?
According to the National Center on Substance Abuse and Child Welfare, Neonatal abstinence syndrome (NAS) is a treatable condition that newborns may experience as a result of prenatal exposure to certain substances, most often opioids. Neonatal opioid withdrawal syndrome (NOWS) is a related term that refers to the symptoms that infants may experience as a result of exposure to opioids specifically.
Symptoms of NAS and NOWS may include severe irritability, difficulty feeding, respiratory problems, and seizures. Infants with NAS and NOWS are treated through non-pharmacological methods (such as rooming-in with mothers after birth, breastfeeding, swaddling, skin-to-skin time, and minimizing stimuli in the environment), as well as pharmacologic methods (medication) when warranted.
Before birth, engaging pregnant women with opioid and other substance use disorders in substance use treatment and other services as a component of prenatal care can also mitigate or prevent negative birth outcomes associated with Neonatal Abstinence Syndrome and NOWS. [1] If you’ve been injured or had surgery, your provider may give you a prescription for opioids to help relieve pain. Prescription opioids include:
- Codeine
- Hydrocodone (name brand Vicodin®)
- Morphine (name brands Kadian®, Avinza®)
- Oxycodone (name brands OxyContin®, Percocet®)
- Tramadol
- The street drug ‘heroin’ also is an opioid
If you’re pregnant or trying to get pregnant and taking any of these drugs, tell your health care provider right away.
Signs of Neonatal Abstinence Syndrome
Signs of a condition are things someone else can see or know about you like you have a rash or you’re coughing. Signs of Neonatal Abstinence Syndrome can be different for every baby. Most happen within 3 days (72 hours) of birth, but some may happen right after birth or not until a few weeks after birth. They can last from 1 week to 6 months after birth. Signs may include:
- Body shakes (tremors), seizures (convulsions), overactive reflexes (twitching) and tight muscle tone
- Fussiness, excessive crying or having a high-pitched cry
- Poor feeding or sucking or slow weight gain
- Breathing problems, including breathing really fast
- Fever, sweating or blotchy skin
- Trouble sleeping and lots of yawning
- Diarrhea or throwing up
- Stuffy nose or sneezing
Signs of Neonatal Abstinence Syndrome depend on:
- What drug you used during pregnancy, how much you used and how long you took it
- How your own body breaks down the drug
- Your baby’s gestational age at birth (number of weeks of pregnancy)
Complications Neonatal Abstinence Syndrome can cause for babies
Babies with Neonatal Abstinence Syndrome may have health conditions that need treatment in the newborn intensive care unit (also called NICU) after birth. The NICU is the nursery in a hospital where sick newborns get medical care. In addition to having withdrawal signs, babies with NAS are at increased risk of:
- Low birthweight: This means your baby is born weighing less than 5 pounds, 8 ounces.
- Jaundice: This is when your baby’s skin and eyes look yellow. It’s caused when your baby’s liver isn’t fully developed or working.
- Seizures
- Sudden infant death syndrome (also called SIDS): This is the unexplained death of a baby younger than 1 year old. SIDS usually happens when a baby is sleeping.
Neonatal Abstinence Syndrome may cause long-term problems for your baby, like:
- Developmental delays: Developmental delays are when your child doesn’t reach developmental milestones when expected. Developmental milestones are skills and activities that most children can do at a certain age, like sitting, walking, talking, having social skills and having thinking skills.
- Motor problems: These are problems with your baby’s bones, muscles and movement.
- Behavior and learning problems: Babies with Neonatal Abstinence Syndrome are more likely than babies who don’t have NAS to be checked for learning problems and to get special education services in school.
- Speech and language problems
- Sleep problems
- Ear infections
- Vision problems
How is a baby tested for Neonatal Abstinence Syndrome?
Your baby’s provider can use these tests to see if your baby has NAS:
- NAS scoring system. With this system, your baby’s provider uses points to grade how severe your baby’s withdrawal is. Your baby’s provider uses the score to decide what kind of treatment your baby needs.
- Urine and meconium tests to check for drugs. Meconium is your baby’s first bowel movement.
- Your baby’s provider also needs to know about what drugs or medicine you’ve used and when you last took them. You may get a urine test.
Neonatal Abstinence Syndrome Treatment
Your baby’s treatment may include:
- Taking medicines to treat or manage severe withdrawal symptoms. Once withdrawal is under control, your baby gets smaller doses of the medicine over time so their body can adjust to being off the medicine. Medicines used to treat severe withdrawal include morphine, methadone and buprenorphine.
- Getting fluids through a needle into a vein (also called intravenous or IV) to prevent your baby from getting dehydrated. Dehydrated means not having enough water in the body. Babies with Neonatal Abstinence Syndrome can get dehydrated from having diarrhea or throwing up a lot.
- Being fed higher-calorie baby formula. Some babies with NAS need extra calories to help them grow because they have trouble feeding or slow growth.
Most babies with Neonatal Abstinence Syndrome who get treatment get better in 5 to 30 days.
During treatment, your baby may be fussy and hard to soothe. Doing these things can help calm your baby:
- Room in with your baby. This means you and your baby stay in the same room together at the hospital before you take your baby home.
- Give your baby skin-to-skin care (also called kangaroo care). This is when you put your baby, dressed only in a diaper, on your bare chest.
- Be gentle with your baby. Rock your baby gently. If they are sleeping, don’t wake them up.
- Swaddle your baby (wrap him snuggly) in a blanket.
- Keep your baby’s room quiet and the lights dim.
- Breastfeed your baby. Feed your baby on demand. This means you feed your baby when he’s hungry.
- Give your baby a pacifier.
Your baby’s provider checks your baby often in the NICU after birth to make sure he’s getting better and having fewer and less severe withdrawal signs.
Your baby can go home from the hospital when they:
- Are feeding well
- Are sleeping well
- Are gaining weight
- Has a good Neonatal Abstinence Syndrome score
After your baby is home, take them to all of their follow-up and well-baby checkups, even if they are doing well.
Your provider checks your baby at these visits for problems that may be linked to Neonatal Abstinence Syndrome, like:
- Developmental delays and problems with motor and learning skills and behavior
- Problems with nutrition and growth
- Problems with hearing and vision
- Problems at home, including using harmful substances. This can include misusing prescription drugs and using illegal drugs.
If your baby has developmental delays, talk to their provider about early intervention services. These services can help children from birth through 3 years old learn important skills. Services include therapy to help a child talk, walk, learn self-help skills and interact with others. Getting services as early as possible can help improve your child’s development.
Treatment For Opiate Addiction
Seek help if you are suffering from Opioid Addiction and you are currently pregnant or trying to get pregnant. There are many treatment options to choose from, but research suggests the most effective form of treatment for Opiate addiction is inpatient detox followed by inpatient rehab. Inpatient rehab centers have specialized programs for individuals suffering from this type of substance use disorder. These programs help patients dig deep within themselves to uncover the root cause of their drug use. Knowing what caused patients to use drugs or alcohol in the first place will help prevent future triggers while in recovery.
What can you do to help prevent Neonatal Abstinence Syndrome in your baby?
The Centers for Disease Control and Prevention has information to help you get early intervention services for your child and how to find services in your state or territory. [2]
- If you’re pregnant and you use any of the drugs that can cause Neonatal Abstinence Syndrome, tell your provider right away, but don’t stop taking the drug without getting treatment from your provider first. Quitting suddenly (sometimes called cold turkey) can cause severe problems for your baby, including death. If you need help to quit using these drugs, talk to your provider about treatment. Getting treatment can help you stop using drugs and is safer for your baby than getting no treatment at all.
- If you’re pregnant and can’t stop using opioids without problems, ask your provider about medication-assisted treatment (also called MAT). Neonatal Abstinence Syndrome in babies may be easier to treat for babies whose moms get MAT during pregnancy. Medicines used in MAT include methadone and buprenorphine.
- If you’re pregnant and you go to a provider who prescribes medicine to treat a health condition, make sure that provider knows you’re pregnant. You may need to stop taking certain medicines or change to medicine that’s safer for your baby. Ask all your health care providers if the medicine you take—even prescription drugs—can cause Neonatal Abstinence Syndrome in your baby. Even if you use a prescription drug exactly as your provider tells you to, it may cause NAS in your baby.
- If you’re pregnant or thinking about getting pregnant, tell your provider about any drugs or medicine you take. Your provider can make sure that what you’re taking is safe for you and your baby. They also can help you get treatment for using street drugs or abusing prescription drugs if you need it. If you abuse prescription drugs, it means you take more than has been prescribed for you, you take someone else’s prescription drug, or you get the drug from someone without a prescription.
- If you’re not pregnant and you use any drug that can cause NAS: Use birth control until you’re ready to get pregnant. Birth control (also called contraception or family planning) helps keep you from getting pregnant. Examples include intrauterine devices (also called IUDs), implants, the pill and condoms.
- Seek help if you are suffering from Opioid Addiction and you are currently pregnant or trying to get pregnant.
Reclaim your life from opioid addiction and prevent your baby from getting Neonatal Abstinence Syndrome
Opioid Addiction is a chronic disease that can cause major health, social, and economic problems that should not be taken lightly. One of them is Neonatal Abstinence Syndrome. We Level Up Treatment Center can provide you, or someone you love, the tools to recover from Opioid Addiction with professional and safe treatment. Feel free to call us to speak with one of our counselors. We can inform you about this condition by giving you relevant information. Our specialists know what you are going through. Please know that each call is private and confidential.