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Neonatal Abstinence Syndrome


What is neonatal abstinence syndrome?

Neonatal abstinence syndrome (NAS) develops when a baby is no longer exposed to a drug his mother used during pregnancy. Examples include heroin, codeine, and oxycodone. The baby is affected by the drug while he is in the womb and becomes dependent on it. When he is born, he is still dependent on the drug. He may also become dependent on medicines he is given for sedation or pain after he 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 arms or legs, or making his muscles rigid
  • Sleeping problems
  • Trouble keeping his temperature stable, or sweating
  • Sneezing or yawning often, or breathing problems
  • 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 mother used any drugs during pregnancy, and how often she used them. He will ask when she 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, even if he does not have symptoms at first.

  • Close and quick attention may help comfort your baby as he goes through withdrawal. His healthcare provider may recommend that his mother stay in the room with him. He 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 him (wrap him snugly in a blanket) to help him feel comforted and secure. His room may be kept dim and quiet to prevent him from becoming irritable. Soft music, massage, and rocking can also help comfort him.
  • Extra calories may be needed. Your baby may be given formula that is thickened or has a high number of calories. He may be able to breastfeed if his mother is not taking any drugs or medicines that can be passed through breast milk. He 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 became addicted to before he was born. The amount may need to be increased at first to manage your baby's symptoms. It will be reduced over time so he gets used to being without the drug. This may take weeks or months.

What are the risks of NAS?

Your baby may be born smaller or weigh less than expected. His risk for apnea (periods of not breathing) or sudden infant death syndrome (SIDS) may be increased. As he gets older, he may have trouble in school or have attention or behavior problems.

Call 911 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 contact my baby's healthcare provider?

  • Your baby is fussy or cries for long periods, and he cannot be comforted.
  • Your baby breastfeeds less often or drinks less formula than usual, or he 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.

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