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Neonatal abstinence syndrome

Definition

Neonatal abstinence syndrome (NAS) is a group of problems that occur in a newborn who was exposed to addictive opiate drugs while in the mother’s womb.

Alternative Names

NAS

Causes

Neonatal abstinence syndrome occurs because a pregnant woman takes opiate or narcotic drugs such as heroin, codeine, oxycodone (Oxycontin) methadone or buprenorphine.

These and other substances pass through the placenta that connects the baby to its mother in the womb. The baby becomes addicted along with the mother.

At birth, the baby is still dependent on the drug. Because the baby is no longer getting the drug after birth, symptoms of withdrawal may occur.

Alcohol and other drugs use during pregnancy can also cause problems in the baby.

Babies of mothers who use other addictive drugs (nicotine, amphetamines, barbiturates, cocaine, marijuana,) may have long-term problems. However, there is no clear evidence of a neonatal abstinence syndrome for these drugs.

Symptoms

The symptoms of neonatal abstinence syndrome depend on:

  • The type of drug the mother used
  • How the body breaks down the drug
  • How much of the drug she was taking
  • How long she used the drug
  • Whether the baby was born full-term or early (premature)

Symptoms often begin within 1 - 3 days after birth, but may take up to a week to appear. Symptoms may include:

  • Blotchy skin coloring (mottling)
  • Diarrhea
  • Excessive crying or high-pitched crying
  • Excessive sucking
  • Fever
  • Hyperactive reflexes
  • Increased muscle tone
  • Irritability
  • Poor feeding
  • Rapid breathing
  • Seizures
  • Sleep problems
  • Slow weight gain
  • Stuffy nose, sneezing
  • Sweating
  • Trembling (tremors)
  • Vomiting

Exams and Tests

Many other conditions can produce the same symptoms as neonatal abstinence syndrome. To help make a diagnosis, the doctor will ask questions about the mother's drug use. The mother may be asked about which drugs she took during pregnancy, and when she last took them.

Tests that may be done to diagnose withdrawal in a newborn include:

  • Neonatal abstinence syndrome scoring system, which assigns points based on each symptom and its severity. The infant's score can help determine treatment.
  • Toxicology screen of first bowel movements (meconium)
  • Urine test (urinalysis)

Treatment

Treatment depends on:

  • The drug involved
  • The infant's overall health
  • Whether the baby was born full-term or premature

The health care team will watch the newborn carefully for signs of withdrawal, feeding problems, and weight gain. Babies who vomit or who are very dehydrated may need to get fluids through a vein (IV).

Infants with neonatal abstinence syndrome are often fussy and hard to calm. Tips to calm the infant down include:

  • Gently rocking the child
  • Reducing noise and lights
  • Swaddling the baby in a blanket

Some babies with severe symptoms need medicines such as methadone and morphine to treat withdrawal symptoms.

The goal of treatment is to prescribe the infant a drug similar to the one the mother used during pregnancy and slowly decrease the dose over time. This helps wean the baby off the drug and relieves some withdrawal symptoms. Breastfeeding may also be helpful.

Babies with this condition often have poor feeding or slow growth. These babies may need:

  • A higher-calorie formula that provides greater nutrition
  • Smaller portions given more often

Outlook (Prognosis)

Treatment helps relieve symptoms of withdrawal.

Possible Complications

Drug and alcohol use during pregnancy can lead to many health problems in the baby besides NAS. These may include:

Neonatal abstinence syndrome can last from 1 week to 6 months.

When to Contact a Medical Professional

Make sure your doctor or nurse knows about all the drugs you take during pregnancy.

Call your doctor or nurse if your baby has symptoms of neonatal abstinence syndrome.

Prevention

Discuss all medications, and alcohol and tobacco use with your health care provider. If you are using drugs, including alcohol or tobacco, ask your health care provider for help with stopping as soon as possible. If you are already pregnant, talk to your health care provider about the best way to stop using and keep you and the baby safe.

References

Wong S, Ordean A, Kahan M; Maternal Fetal Medicine Committee; Family Physicians Advisory Committee; Medico-Legal Committee; Society of Obstetricians and Gynaecologists of Canada. Substance use in pregnancy. J Obstet Gynaecol Can. 2011 Apr;33(4):367-84.

Jansson LM, Velez M. Neonatal abstinence syndrome. Curr Opin Pediatr. 2012 Jan 5. [Epub ahead of print]

Bio LL, Siu A, Poon CY. Update on the pharmacologic management of neonatal abstinence syndrome. J Perinatol. 2011 Nov;31(11):692-701.

McQueen KA, Murphy-Oikonen J, Gerlach K, Montelpare W. The impact of infant feeding method on neonatal abstinence scores of methadone-exposed infants. Adv Neonatal Care. 2011 Aug;11(4):282-90.

Bencke M, Smith VC, Committee on Substance Abuse, Committee on Fetus and Newborn. American Academy of Pediatrics. Prenatal substance abuse: short- and long-term effects on the exposed fetus (technical report). Pediatrics. 2013 Mar;131(3):e1009-24. doi: 10.1542/peds.2012-3931. Epub 2013 Feb 25.


Review Date: 1/31/2014
Reviewed By: Kimberly G Lee, MD, MSc, IBCLC, Associate Professor of Pediatrics, Division of Neonatology, Medical University of South Carolina, Charleston, SC. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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