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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 sometimes develop after birth if their mothers have taken medications or drugs 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.

  • Narcotics: methadone, morphine, Oxycodone, Percocet, Vicodin
  • Muscle relaxants: Valium (diazepam), Ativan (lorazepam), Xanax
  • Other potentially addictive drugs: cocaine, heroin, methamphetamine, ecstasy

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

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 for months. 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 drugs 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 that 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 doctor will decide which nursery is best for your baby. Some babies may be kept in the mother's room after being born. Other infants 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 treatment but do not receive it, they may not be able to gain weight, fail to sleep or eat well, and can become sick. 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 for them to do so.

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 and comfortable. Medications used to reduce NAS symptoms are methadone or morphine.

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 to 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
  • Allow more time for feedings if needed

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 or not for your baby. They can also help you to create a long term plan that is best for your situation. 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.

Questions?

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

Children's Hospitals and Clinics of Minnesota
Patient/Family Education
2525 Chicago Avenue South
Minneapolis, MN 55404

Last Reviewed 7/2015 © Copyright

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This page is not specific to your child, but provides general information on the topic above. If you have any questions, please call your clinic. For more reading material about this and other health topics, please call or visit Children's Family Resource Center library, or visit www.childrensmn.org/educationmaterials.

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