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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 illegal or prescription drugs while in the mother’s womb.

Alternative Names

NAS

Causes, incidence, and risk factors

Neonatal abstinence syndrome occurs because a pregnant woman takes addictive illicit or prescription drugs such as:

• Amphetamines
• Barbiturates
• Cocaine
• Diazepam
• Marijuana
• Opiates (heroin, methadone, codeine)

These and other drugs pass through the placenta – the organ that connects the baby to its mother in the womb – and reach the baby. 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 occur.

Alcohol use during pregnancy can also cause problems in the baby. See: Fetal alcohol syndrome

Symptoms

The symptoms of neonatal abstinence syndrome depend on:

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

Symptoms can begin within 1 - 3 days after birth, or they may take 5 - 10 days to appear. They 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

Signs and tests

It is important to have your baby checked out by a pediatrician. Many other conditions can produce the same symptoms as neonatal abstinence syndrome.

The doctor will ask questions about the mother's drug use, such as what 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 infant’s overall health and 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 (intravenous).

Some babies need medicine to treat withdrawal symptoms. Medicines may include:

• Benzodiazepines for alcohol withdrawal
• Methadone for heroin and other opiate withdrawal

The doctor may 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 relieve some withdrawal symptoms.

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

Babies with this condition often have poor feeding. Such babies may need:

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

Expectations (prognosis)

Treatment helps relieve symptoms of withdrawal. How well the baby does depends in part on whether the mother (and father) continues to use drugs.

Complications

Exposure to drugs in the womb can lead to many health problems, including:

• Birth defects
• Low birth weight
• Premature birth
• Small head circumference
• Sudden infant death syndrome (SIDS)

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

Calling your health care provider

Contact your health care provider if you are pregnant and have taken any type of drugs. Also call if your baby shows symptoms of neonatal abstinence syndrome.

Prevention

You can prevent this condition by avoiding drugs during pregnancy. Discuss all drug use with your health care provider. If you use drugs, stop using them before you get pregnant or as soon as possible after you find out that you are pregnant.

References

Ford MD, Delaney KA, Ling L, Erickson T, eds. Clinical Toxicology. 1st ed. Philadelphia, Pa: Saunders Elsevier; 2001.

Ebner N. Management of neonatal abstinence syndrome in neonates born to opioid maintained women. Drug Alcohol Depend. 2007;87:131-138.