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Neonatal Abstinence Syndrome

Medically reviewed by Last updated on Jul 4, 2022.

What is neonatal abstinence syndrome (NAS)?

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

What are the signs and symptoms of NAS?

Signs and symptoms depend on the amount and kind of drug involved. 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 in his or her arms or legs, or making his or her muscles rigid
  • 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
  • Seizures
  • Mottling (areas of skin that change color) or skin breakdown from rubbing constantly against clothing

How is NAS diagnosed?

Your baby's healthcare provider will ask if his or her mother used any drugs during pregnancy. The provider will ask how often she used them. He or she will ask when the mother last used the drugs, and how much she used. The following may also be needed:

  • A neonatal abstinence syndrome score is used to evaluate your baby's signs of dependence and withdrawal. The score will be done several times each day. It will also be used to help plan your baby's treatment.
  • Blood, urine, or meconium samples may be tested for drugs. Meconium is a baby's first bowel movement.

How is NAS treated?

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 him or her. 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. His or her room may be kept dim and quiet. Soft music, massage, and rocking can also help comfort him or her.
  • Extra calories may be needed. Your baby may be given formula that is thickened or has a high number of calories. He or she may be able to breastfeed if his or her mother is not taking any drugs or medicines that can be passed through breast milk. He or she may need to be fed small amounts often during the day to prevent vomiting.
  • 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 drug that he or she became addicted to 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 drug. This may take weeks or months.

Treatment options

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

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.

When should I seek immediate care?

  • Your baby stops breathing for short periods of time.

When should I call my baby's doctor?

  • Your baby is fussy or cries for long periods, and he or she 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.

Care Agreement

You have the right to help plan your baby's care. Learn about your baby's health condition and how it may be treated. Discuss treatment options with your baby's healthcare providers to decide what care you want for your baby. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.