Patient education: Neonatal abstinence syndrome (The Basics)

What is neonatal abstinence syndrome? — Neonatal abstinence syndrome, or "NAS," is a problem that can affect a baby born to a person who used drugs during pregnancy. Babies with NAS usually have trouble sleeping and feeding and are hard to soothe.

Doctors also use the term "neonatal opioid withdrawal syndrome," or "NOWS," when the parent used drugs called "opioids" during pregnancy. NOWS is the most common form of NAS, but the terms generally mean the same thing.

What causes NAS? — It happens when a baby was exposed to a drug before birth.

When a person uses drugs during pregnancy, the drugs can get into their baby's blood, too. Then, after the baby is born, they are suddenly no longer exposed to the drug. This can cause "withdrawal" symptoms.

●Opioids – The most common cause of withdrawal in babies is exposure to an "opioid" drug. It can happen if a pregnant person uses heroin or fentanyl or if they misuse prescription opioids, like oxycodone. It can also happen if they take certain prescription medicines, like methadone or buprenorphine, for treatment of opioid use disorder.

●Other drugs – Exposure to other substances can also cause withdrawal symptoms in babies. This can be 1 drug or multiple drugs. Sometimes, it's not known exactly which drug caused the withdrawal symptoms. Babies who were exposed to more than 1 drug during pregnancy (for example, opioids and cannabis) often have more severe NAS symptoms.

What are the symptoms of NAS? — Symptoms usually start within a day of birth. In some cases, it can take a few days for symptoms to start.

Symptoms can include:

●Trouble sleeping

●Irritability

●Stiff muscles, tremors, or twitching

●Sweating

●Fever

●Breathing fast or yawning a lot

●Stuffy nose

●Mottled skin

●High-pitched cry

●Problems with feeding

●Vomiting

●Diarrhea

Symptoms can depend on how much of the drug, or drugs, the baby was exposed to.

Exposure to drugs can also cause other problems besides withdrawal signs. For example, babies who were exposed to opioids before birth can sometimes have low birth weight and small head size.

Is there a test for NAS? — Doctors can usually tell if a baby has NAS based on their symptoms and whether they were exposed to a drug before birth. They can use different scoring systems to measure how severe the baby's symptoms are.

The doctor will also order tests. These might include:

●Drug testing on the baby – This can show if the baby has drugs in their system. Testing is usually done on a urine sample. Sometimes, doctors also test the baby's first bowel movement.

●Tests on the baby's blood – These can help the doctor figure out if something else is causing the baby's symptoms.

The doctor will also do a physical exam soon after the baby is born. This is to check for problems with growth or development.

How is NAS treated? — Babies are treated in the hospital. You and your baby will probably stay there for at least 4 to 5 days.

The main goals of treatment are:

●Bonding with your baby – It can help to keep your baby in the room with you after birth. Try to keep the room as quiet and peaceful as possible. You can soothe your baby by holding them, rocking them, and using "skin-to-skin contact." Giving them a pacifier can also help.

●Treating the baby's symptoms – There are different ways to do this. For babies with severe symptoms, treatment usually involves giving morphine or a related medicine. Once the baby's symptoms improve, the dose is gradually reduced.

It helps to have support from your health care team. This might include your doctor and your baby's doctor, but also others like therapists and social workers. Their goal should be caring for you and your baby in a non-judgmental way. They can also help make sure that you have the support you need when you go home.

What else should I do? — You should:

●Follow your treatment plan for substance use disorder. This usually involves counseling, and sometimes medicines.

●Talk to your doctor or nurse if you want to breastfeed. This might be an option. It depends on your situation and when you last used drugs.

●Go to your baby's follow-up appointment. The doctor will want to see them again soon after you go home.

●Try to be gentle with yourself. Caring for a baby that cries a lot can be difficult and tiring. As you spend more time with your baby, you will learn what calms them.

●Tell your doctor or nurse if you are having trouble coping or caring for your baby. They can help connect you with resources that can help.

Can NAS be prevented? — Yes. You can prevent NAS by not using drugs if you are pregnant or trying to get pregnant.

If you are already pregnant and use drugs, it's not too late to make changes. A good first step is to talk to your doctor or nurse. They can give you advice on the best and safest ways to quit for your and your baby's health. They can also make sure that you have the support you need.

More on this topic

Patient education: Alcohol and drug use in pregnancy (The Basics)
Patient education: Taking medicines during pregnancy (The Basics)
Patient education: How to plan and prepare for a healthy pregnancy (The Basics)
Patient education: Substance use disorder (The Basics)
Patient education: Opioid use disorder (The Basics)
Patient education: Prescription drug misuse (The Basics)