Neonatal Abstinence Syndrome

Medically reviewed by Drugs.com. Last updated on May 6, 2024.

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Neonatal abstinence syndrome (NAS)

develops when a baby is no longer exposed to a substance his or her mother used during pregnancy. Examples include heroin, codeine, and oxycodone. Other substances such as alcohol, nicotine, amphetamines, and benzodiazepines may also cause NAS. The baby is affected by the substance while in the womb and becomes dependent on it. When the baby is born, he or she is still dependent on the substance. The baby may also become dependent on medicines given for sedation or pain after he or she is born. The sudden lack of the substance causes withdrawal symptoms.

Signs and symptoms of NAS

depend on the amount and kind of substance involved. Substance use during pregnancy may cause your baby to be born sooner than is recommended (preterm). It may also prevent your baby from growing properly in the womb. The following may begin when your baby is born, or several days later:

• Irritability or high-pitched crying that cannot be consoled
• Diarrhea or vomiting
• Trouble feeding, constant sucking, or poor weight gain
• Tremors, rigid muscles, jerking movements, or seizures
• Sleeping problems
• A fever, trouble keeping his or her temperature stable, or sweating
• Yawning often, fast breathing, or breathing problems
• Sneezing or a stuffy nose with flaring of the nostrils
• Fast heartbeat
• Mottling (areas of skin that change color) or skin breakdown from constant rubbing

Call your local emergency number (911 in the US) for any of the following:

• Your baby is not breathing or is having trouble breathing.
• Your baby's skin or nails are blue.
• Your baby is limp and does not respond.

Seek care immediately if:

• Your baby stops breathing for short periods of time.

Call your baby's doctor if:

• Your baby is fussy or cries for long periods and cannot be comforted.
• Your baby breastfeeds less often or drinks less formula than usual or has feeding problems.
• You have questions or concerns about your baby's condition or care.

Treatment:

Your baby may need to stay in the hospital for up to a week after birth. He or she may not have symptoms at first.

• Close and quick attention may help comfort your baby as he or she goes through withdrawal. Healthcare providers may recommend that your baby's mother stay in the room with the baby. Your baby may need to be held often or close to someone's chest. Skin-to-skin contact (kangaroo care) may be recommended whenever possible. Healthcare providers will be careful not to wake your baby unless it is necessary. They may swaddle your baby (wrap him or her snugly in a blanket) to help him or her feel comforted and secure. Your baby's room may be kept dim and quiet. Soft music, massage, and rocking can also help comfort him or her.
• Extra calories or IV fluids may be needed. Your baby may be given formula that is thickened or has a high number of calories. Your baby may be able to breastfeed if his or her mother is not taking any substances that can be passed through breast milk. Your baby may need to be fed small amounts often during the day to prevent vomiting. IV fluids may be given if your baby has signs of dehydration.
• Medicines may be needed if other methods do not work or if your baby develops serious medical problems. Your baby may be given a medicine that is close to the substance that he or she became dependent on before birth. The amount may need to be increased at first to manage your baby's symptoms. It will be reduced over time so he or she gets used to being without the substance. This may take days or weeks.

Treatment options

The following list of medications are related to or used in the treatment of this condition.

• morphine

Ask about safe ways to comfort your baby:

Some babies are calmed by movement. Others need to be kept still and quiet. Find out what calms your baby. Your baby may cry for long periods without stopping. This can be frustrating, but never shake a baby to make him or her stop crying. Shaking can cause serious brain damage. The following may help you safely comfort your baby:

• Ask healthcare providers what they did to calm your baby. Talk with them before you take your baby home from the hospital.
• Put your baby in a safe place if you need a break. Ask a family member or friend to hold your baby. If no one can help, gently place your baby in his or her crib and leave the room for 5 or 10 minutes. Then go back to your baby and try to comfort him or her again.
• Use a light blanket to swaddle (wrap) your baby snugly. Your baby's healthcare provider can show you how to swaddle your baby if you do not know how. Do not wrap your baby too tightly.
• Decrease noise or light that may bother or wake your baby. When your baby is trying to go to sleep, play soft music, or sing softly. A fan or humidifier can create a low steady noise that he or she may also find comforting. Dim the lights in the room if your baby is bothered by the light.
• Try movement to calm your baby. Try putting your baby in an automatic swing or sitting with him or her in a rocking chair. Never shake your baby. You may cause brain damage if you shake him or her.

Follow up with your baby's doctor within 48 hours, or as directed:

You will need to bring your baby in for follow-up visits often at first. Your baby's healthcare provider will check that your baby is eating and sleeping well. Your child will need ongoing care and tests as he or she gets older. The provider will check for developmental or physical delays or problems. Write down your questions so you remember to ask them during your visits.

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