Neonatal Abstinence Syndrome: Symptoms and Treatment

What is Neonatal Abstinence Syndrome?

Neonatal Abstinence Syndrome (also called NAS), refers to symptoms of withdrawal that babies may develop after birth if their mothers have taken medications or other substances during their pregnancy that can be addictive.

What causes these symptoms?

Many drugs used by mothers can reach the baby while they are in the womb. Once the baby is born, the baby can no longer receive the drug from the mother's body. The baby's body may begin to react with symptoms known as withdrawal. There are many drugs that can cause this reaction. The most common are listed below.

• Opioids/Analgesics: methadone, morphine, oxycodone, hydromorphone, hydrocodone, Suboxone (buprenorphine)
• Antidepressants/Antianxiety Medications: Valium (diazepam), Ativan (lorazepam), Xanax (alprazolam), Zoloft (sertraline), Celexa (citalopram)
• Other potentially addictive substances:  cocaine, heroin, methamphetamine, ecstasy, kratom

It is very important that you let your nurse and doctor know about any substances or drugs used during your pregnancy. This will help your caregivers to give appropriate medicines, deliver the best care, and safely discharge your baby home.

Will all babies that are exposed to these drugs have NAS?

We cannot predict which babies will have NAS. The amount of drugs or medicines that the baby receives in the womb does not always match the symptoms that each baby can have after they are born.

How is it diagnosed?

Most infants begin to have symptoms of withdrawal between 2-3 days after their birth. However, some infants may have them earlier and others may not have them until up to 10 days of age. These symptoms may be mild and go away quickly or may continue. Some things that can affect how long it takes for symptoms to develop include:

• How long the medication or drug is active in the mother
• What dose was taken by the mother and how recently it was taken before the baby's birth
• Whether other medications or substances were used at the same time

Tests that might be done to measure the presence of the drug in the baby's system include testing drug levels in the first stool (called meconium). Tests might also be done on a sample of the baby's urine.

What are the symptoms of NAS?

Some common withdrawal symptoms you may see in your baby are:

• Irritability
• Jitteriness
• Frequent crying (may be high pitched)
• Vigorous sucking on a pacifier
• Sweating
• Diarrhea
• Stuffy nose
• Difficulty feeding
• Trouble sleeping
• Fever
• Fast breathing
• Vomiting
• Frequent yawning and sneezing
• Stiff arms, legs and back
• Seizures

It is important to remember that infants who have these symptoms usually have a group of the symptoms, not just one symptom. You will notice that some of these symptoms are symptoms of other problems such as colds or infections. For this reason, discussing your baby's symptoms with your doctor or nurse is important.

How will my baby be cared for in the hospital after they are born?

There are different levels of care available in the nurseries within hospitals. Your provider will decide which nursery is best for your baby. Most babies at risk for developing withdrawal symptoms need frequent observations by specially trained staff and may need to go to a special nursery to be watched more closely. Regardless of which nursery your baby is admitted to, our goal is to keep you and your baby together as much as possible.

What treatments will my baby receive while they are in the hospital?

Babies that have withdrawal symptoms use a lot of energy that they need to grow and develop normally. If they need medication treatment but do not receive it, they may not be able to gain weight, sleep, or eat well. Some babies can also have very serious symptoms such as seizures. Our goal for treating your baby is to decrease your baby's symptoms so that they can grow and develop normally, and go home as soon as it is safe.

Some babies stay in the hospital for less than one week. Other babies have more severe withdrawal symptoms and need to stay longer. While your baby is in the hospital, staff will observe your baby frequently to watch their symptoms. When babies have symptoms of withdrawal, a scoring system is used by staff to help them decide how severe the symptoms are. If your baby begins to have high scores and does not respond to comfort measures, your baby's doctor may decide to give them medication to help decrease their withdrawal symptoms so that they remain safe, comfortable, and grow. Medications used to reduce NAS symptoms vary. Common medications used are methadone, morphine, phenobarbital, gabapentin or clonidine.

Babies that need medication in the hospital often need to continue taking it once they go home. Before your baby goes home, staff will teach you how to carefully observe your baby for withdrawal symptoms, how to give medications if needed, and who you can call if you have questions.

What can I do for my baby?

While you are in the hospital, being a part of your baby's care is important. Being near your baby as much as possible will help you to get to know your baby faster and will also be comforting to your baby. During this time, hospital staff will teach you to recognize normal behavior as well as abnormal symptoms or behavior so that you can report them to a doctor if necessary once you go home. In the hospital you will learn some common actions that can be helpful for your baby if they are experiencing withdrawal.

Common ways to comfort a baby that is experiencing withdrawal symptoms can include:

• Keep lights and sound low
• Hold baby skin to skin
• Use gentle touch
• Speak softly
• Swaddle your baby with their hands close to their mouth
• Limit visitors
• Offer breast/bottle feeding and a pacifier often
• Gentle, slow rocking in an upright position

Will I be able to breastfeed my baby?

Every situation is different. While it will be safe for most babies to breastfeed, your doctor and lactation consultants can help to determine whether breastfeeding is safe for your baby. We strongly support breastfeeding and will do everything possible to achieve the feeding goals that you desire!

If you have been told that you can breastfeed your baby safely, it is important that you know that stopping breastfeeding suddenly may increase your baby's withdrawal symptoms. Before you stop, you should discuss with your doctor how to safely wean your baby from breastfeeding.

Care at home

Once your baby is home, symptoms of withdrawal may still continue for several weeks. These symptoms, which should be mild when your baby goes home, will gradually decrease over time. Getting plenty of rest for you and your baby can help to reduce stress for both of you.

A home care nurse will be arranged to come to your house twice a week. The nurse will check your baby's symptoms, weigh your baby, review your baby's medications, and answer any questions you may have. The home care nurse can help give you advice about your baby's care and withdrawal as well as many other topics of caring for your newborn.

Care at the clinic

Clinic appointments will be made before your baby is discharged from the hospital so your baby can be seen regularly by a doctor. These appointments are very important to keep so that your baby remains healthy. It is also a good time for you to be able to ask questions. If your baby is on medications to prevent withdrawal, you will need to take your baby to the clinic every 7-10 days. At the clinic, staff will:

• Complete a well-baby check (to make sure your baby is gaining weight and developing well)
• Observe your baby's symptoms of withdrawal
• Decide if your baby can have his or her medication weaned
• Refill your baby's prescription for more medication, if needed

Resources at Children's Minnesota:

Pediatric Clinics
Minneapolis clinic: 612-813-6107
St. Paul clinic: 651-220-6700

Breastfeeding Resource Center
Minneapolis: 612-813-6250
St. Paul: 651-220-6368

Children’s Home Care
612-813-6246

Questions?

This sheet is not specific to your child, but provides general information. If you have any questions, please call your clinic.

Last reviewed 7/19

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