What’s Neonatal Abstinence Syndrome?
When a pregnant woman uses substances while she is pregnant, she places her baby at high risk for many issues, including neonatal abstinence syndrome (NAS). What’s neonatal abstinence syndrome? NAS is a group of conditions caused when a newborn baby is experiencing withdrawal from a certain type of drug they were exposed to while in the womb. In most cases, it is opioids.
NAS is also referred to as newborn withdrawal syndrome, infant drug withdrawal or when opioids are the focus, neonatal opioid withdrawal syndrome. NAS can lead to long-term health and developmental issues in the baby, including problems with learning, behavior, hearing, and vision.
What is Neonatal Abstinence Syndrome?
Neonatal abstinence syndrome (NAS) is a group of withdrawal signs that appear after birth when a baby is no longer receiving a substance that it has become dependent on while in the womb. When a mother uses drugs while she is pregnant, the substance can be passed onto the baby through the placenta. And if a mother continues to use the drug within the weeks before the birth, the baby will be born dependent on that substance.
When the baby’s body has adapted to the exposure in the womb, the delivery creates a sudden change that can impact sleep, feeding, digestion, temperature control, movement and comfort. When this happens, the baby will need careful observation, gentle care, and even medication depending on the symptom severity.
NAS not only occurs when the baby is exposed to opioids in the womb. It can also occur with other drugs such as prescription opioids oxycodone or hydrocodone, antidepressants, barbiturates, benzos or cocaine. Most babies with NAS are treated in the hospital after birth to help improve symptoms because these babies are often fussy and difficult to soothe.
Core signs that define Neonatal Abstinence Syndrome
NAS can be identified as a pattern rather than a single symptom. The baby may mainly have issues with feeding difficulty, irritability and struggling to sleep. But health care teams will look at how the symptoms impact the baby’s ability to eat, sleep, gain weight and be comforted. NAS care is individualized and treatment decisions are based on the newborn’s current condition.
- A known or suspected prenatal exposure. The baby was exposed to a substance before birth. It is most commonly opioids, but other substances can also contribute.
- Symptoms after delivery. These symptoms can include shakes and tremors, fever, seizures, difficulty gaining weight, diarrhea, vomiting, difficulty breathing, difficulty feeding, high-pitched crying and being unable to calm down.
- Effects across the body systems. NAS can impact the nervous system, digestive system, breathing, skin, and feeding.
- Severity. Symptoms can appear at different times depending on the substance, duration of drug exposure, the baby’s overall health and other factors.
- The need for structured assessment. Clinicians may use scoring tools or functional assessments to decide whether supportive care is enough or medication for the baby is needed.
What are the Symptoms to look for?
Neonatal abstinence syndrome symptoms are both physical and behavioral signs in a newborn baby that is experiencing withdrawal from an addictive substance it was exposed to in the womb. Symptoms can exist on a spectrum. Mild symptoms can improve with quiet, low stimulation care and frequent feeding support. More severe symptoms can interfere with hydration, nutrition and growth, which is why hospital care is critical.
The nervous system. A baby can experience tremors, jitteriness, irritability, poor sleep and high-pitched crying. This means the baby is having difficulty calming and conserving energy.
Feeding and digestion. The baby has difficulty latching, uncoordinated sucking, and is vomiting and having diarrhea. This means the baby can lose weight or struggle to gain weight.
Autonomic signs. The baby is sweating, has a fever and has frequent sneezing and a stuffy nose. This means the baby’s body may have difficulty regulating itself.
Movement and comfort. The baby has tight muscles, frantic sucking and sensitivity to light or sound. This means the baby might need extra soothing and a calmer environment.
If a baby displays any of these typical signs, caregivers should seek a prompt medical evaluation.
Causes and Contributing Factors
Opioid exposure during pregnancy is one of the most recognized causes of neonatal abstinence syndrome. Substances such as prescribed pain medications, heroin, fentanyl, methadone or buprenorphine are all opioids that can cause NAS.
Other substances can also induce withdrawal symptoms. These include certain sedatives, benzos, antidepressants, nicotine, cocaine and other drugs. Alcohol exposure is different and can lead to fetal alcohol effects as well as possible newborn symptoms. This will require its own medical assessment.
Factors that influence how NAS appears:
- The type of substance that was used by the mother and how long it stays in the body
- Whether more than one substance was used
- Timing, dose and duration of the exposure to the drug during pregnancy
- Whether the baby was born full term or prematurely
- Feeding ability, weight gain and other medical complications
- The care environment after the baby is born, including the room and soothing support
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How different drugs appear in NAS
Heroin and other opioids can cause significant withdrawal in a baby with some symptoms that can last for as long as four to six months. Symptoms of withdrawal can begin as early as 24 to 48 hours after birth. In other cases, it can begin as late as 5 to 10 days after birth.
Babies can experience a high risk for seizures, which is more likely in babies who are exposed to methadone.
Prenatal use of amphetamines is often associated with low birth weight and premature birth.
Prenatal cocaine use puts a baby at higher risk for sudden infant death syndrome.
Marijuana use is also linked to babies with lower birth weight and overall smaller size of the baby. Smokers often have smaller babies and are at risk for delivering stillborn babies.
The long-term impact of NAS
NAS can have a huge impact on a baby. If the mother is actively using while pregnant, it can cause slower-than-expected growth in the uterus. It could also trigger the baby to be born too early and prematurely. It can also lead to birth defects, seizures and jaundice in the baby after birth.
NAS not only causes withdrawal after birth, but it can also lead to some long-term impacts on the baby. NAS puts a baby at risk of sudden infant death syndrome. Later on, they may experience developmental delays, motor skills problems, learning and behavior problems, speech and language problems, sleep disorders as well as hearing and vision problems. All of these are important in growing babies.
What are treatments for Neonatal Abstinence Syndrome?
Treatment for NAS usually starts with non-medication care. This can include putting the baby in a quiet environment, gently rocking, swaddling and skin-to-skin contact. The baby may be put on frequent small high-calorie feedings and close monitoring. If symptoms are severe and the baby cannot be consoled, is not eating and cannot sleep, healthcare providers may prescribe medications and gradually reduce the dose as withdrawal symptoms improve.
Non-medication strategies are the first line because, often, many babies improve with consistent soothing and feeding support. Medication can be used when these supportive measures are not enough or the withdrawal is so severe.
An example of a care plan can include:
- Close observation after birth to watch for developing signs of withdrawal
- Standardized assessments to track severity and response to care
- Careful feeding support to hydrate, increase calories and weight gain
- Low stimulation setting to reduce stress and induce sleep
- Medication when needed for persistent symptoms
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Treatment for Substance Use Disorder
Neonatal abstinence syndrome is newborn withdrawal after exposure to drugs in the womb. Mothers who use drugs and other substances while pregnant can put themselves as well as their unborn babies at risk. Hotel California by the Sea provides treatment for substance addiction.
We offer treatment at all levels of care including detox, residential, PHP and IOP. We utilize evidence-based methods such as CBT, DBT and family therapy. Hotel California by the Sea is dedicated to helping clients reach their goals in sobriety and overcome their addiction.
References:
https://www.marchofdimes.org/find-support/topics/planning-baby/neonatal-abstinence-syndrome-nas
https://medlineplus.gov/ency/article/007313.htm
https://www.cdc.gov/opioid-use-during-pregnancy/treatment/infants-opioid.html
https://www.childrenshospital.org/conditions-treatments/neonatal-abstinence-syndrome-nas
https://www.stanfordchildrens.org/en/topic/default?id=neonatal-abstinence-syndrome-90-P02387
