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. Babies of mothers who drink during pregnancy may have a similar condition.
Causes, incidence, and risk factors
Neonatal abstinence syndrome occurs because a pregnant woman takes addictive illicit or prescription drugs such as:
Benzodiazepines (diazepam, clonazepam)
Opiates/Narcotics (heroin, methadone, codeine)
These and other substances pass through the placenta to the baby during pregnancy. The placenta is the organ 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.
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 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 (intravenously).
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 medicine to treat withdrawal symptoms. Medicines may include:
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. Breastfeeding may also be helpful.
Babies with this condition often have poor feeding or slow growth. Such babies may need:
A higher-calorie formula that provides greater nutrition
Smaller portions given more often
Treatment helps relieve symptoms of withdrawal.
Drug and alcohol use during pregnancy can lead to many health problems in the baby, including:
Neonatal abstinence syndrome can last from 1 week to 6 months.
Calling your health care provider
Make sure your doctor or nurse know about all the drugs you take during pregnancy.
Call your doctor or nurse if your baby has symptoms of neonatal abstinence syndrome.
Discuss all medications, alcohol and tobacco 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 yourself and the baby safe.
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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, Medical Director, A.D.A.M., Inc.