Neonatal abstinence syndrome (NAS)

KEY POINTS

  • NAS is a grouping of weather caused when a baby withdraws from certain drugs (most ofttimes opioids) he's exposed to in the womb before birth.

  • Most babies with NAS get treatment in the hospital subsequently birth. Most babies who go handling get better in a few days or weeks.

  • During handling, your baby may be fussy and hard to soothe. Skin-to-skin care, swaddling, being gentle and breastfeeding can help calm your baby.

  • NAS may lead to long-term wellness and evolution problems, including hearing and vision issues and issues with learning and behavior.

  • If you're pregnant and taking opioids, tell your provider correct away. Don't stop taking the opioid without talking to your provider get-go.

What is neonatal abstinence syndrome?

Neonatal forbearance syndrome (also chosen NAS) is a group of weather condition acquired when a babe withdraws from certain drugs he'due south exposed to in the womb before nascency. NAS is nigh often caused when a woman takes drugs called opioids during pregnancy. Simply information technology likewise can be caused past antidepressants (used to treat depression), barbiturates or benzodiazepines (sleeping pills). When you take these drugs during pregnancy, they can pass through the placenta and cause serious issues for your infant. The placenta grows in your uterus (womb) and supplies your baby with food and oxygen through the umbilical cord.

If yous've been injured or had surgery, your provider may give you a prescription for opioids to assistance relieve pain. Prescription opioids include:

  • Codeine
  • Hydrocodone (name make Vicodin®)
  • Morphine (name brands Kadian®, Avinza®)
  • Oxycodone (name brands OxyContin®, Percocet®)
  • Tramadol

The street drug heroin also is an opioid.

You may hear NAS likewise called NOWS. NOWS stands for neonatal opioid withdrawal syndrome. NOWS is the same equally NAS except it's caused but by opioids.

If you're meaning or trying to get pregnant and taking any of these drugs, tell your health care provider right away.

What are signs of NAS?

Signs of a status are things someone else can see or know about you, like you have a rash or yous're coughing. Signs of NAS tin can exist unlike for every baby. Almost happen within three days (72 hours) of birth, but some may happen correct later birth or non until a few weeks after birth. They can last from 1 week to 6 months later birth.

If your infant has signs of NAS, call her provider right away. Signs may include:

  • Body shakes (tremors), seizures (convulsions), overactive reflexes (twitching) and tight musculus tone
  • Fussiness, excessive crying or having a high-pitched cry
  • Poor feeding or sucking or slow weight gain
  • Breathing problems, including breathing really fast
  • Fever, sweating or blotchy peel
  • Trouble sleeping and lots of yawning
  • Diarrhea or throwing upwardly
  • Stuffy nose or sneezing

Signs of NAS depend on:

  • What drug you used during pregnancy, how much you used and how long you took information technology
  • How your own torso breaks down the drug
  • Your baby's gestational age at birth (number of weeks of pregnancy)

What complications tin NAS cause for your baby?

Babies with NAS may accept health conditions that demand treatment in the newborn intensive care unit (also called NICU) afterwards birth. The NICU is the nursery in a hospital where sick newborns get medical intendance. In improver to having withdrawal signs, babies with NAS are at increased risk of:

  • Depression birthweight. This means your baby is built-in weighing less than 5 pounds, viii ounces.
  • Jaundice. This is when your baby'due south skin and eyes expect yellow. It'due south caused when your babe'due south liver isn't fully adult or working.
  • Seizures
  • Sudden infant death syndrome (also chosen SIDS). This is the unexplained death of a baby younger than 1 year one-time. SIDS usually happens when a baby is sleeping.

We don't know a lot about long-term effects of NAS on a baby. We need more research to encounter how NAS affects a kid in the first few years of life and longer. We think that NAS may cause long-term problems for your baby, similar:

  • Developmental delays. Developmental delays are when your child doesn't reach developmental milestones when expected. Developmental milestones are skills and activities that most children tin do at a sure age, like sitting, walking, talking, having social skills and having thinking skills.
  • Motor problems. These are issues with your baby'southward basic, muscles and move.
  • Behavior and learning bug. Babies with NAS are more likely than babies who don't have NAS to be checked for learning problems and to get special education services in school.
  • Speech communication and language problems
  • Slumber problems
  • Ear infections
  • Vision problems

How is your baby tested for NAS?

Your baby's provider can employ these tests to meet if your baby has NAS:

  • NAS scoring organisation. With this system, your baby's provider uses points to grade how severe your baby's withdrawal is. Your baby's provider uses the score to make up one's mind what kind of treatment your babe needs.
  • Urine and meconium tests to check for drugs. Meconium is your baby's beginning bowel motion.

Your babe'south provider as well needs to know most what drugs or medicine you've used and when you last took them. You may get a urine test.

How is NAS treated?

Your infant'south treatment may include:

  • Taking medicines to treat or manage severe withdrawal symptoms. Once withdrawal is under control, your baby gets smaller doses of the medicine over time and then her body can adjust to beingness off the medicine. Medicines used to treat severe withdrawal include morphine, methadone and buprenorphine.
  • Getting fluids through a needle into a vein (also called intravenous or IV) to prevent your baby from getting dehydrated. Dehydrated means not having plenty water in the trunk. Babies with NAS tin can become dehydrated from having diarrhea or throwing upward a lot.
  • Being fed higher-calorie baby formula. Some babies with NAS need actress calories to help them grow because they have trouble feeding or irksome growth.

Most babies with NAS who go treatment get better in 5 to 30 days.

During treatment, your infant may be fussy and hard to soothe. Doing these things can assist calm your infant:

  • Room in with your baby. This means you and your baby stay in the same room together at the hospital before you take your infant home.
  • Give your baby skin-to-skin care (besides chosen kangaroo intendance). This is when yous put your baby, dressed only in a diaper, on your blank chest.
  • Be gentle with your baby. Rock your baby gently. If she'south sleeping, don't wake her up.
  • Swaddle your baby (wrap him snuggly) in a coating.
  • Proceed your infant'southward room repose and the lights dim.
  • Breastfeed your infant. Feed your infant on demand. This means you feed your infant when he's hungry.
  • Requite your baby a pacifier.

Your baby'due south provider checks your baby often in the NICU afterward birth to make certain he's getting better and having fewer and less astringent withdrawal signs. Your infant can get dwelling from the hospital when she:

  • Is feeding well
  • Is sleeping well
  • Is gaining weight
  • Has a adept NAS score

After your baby is dwelling house, accept her to all of her follow-up and well-baby checkups, even if she'south doing well. Your provider checks your baby at these visits for issues that may be linked to NAS, like:
•    Developmental delays and bug with motor and learning skills and behavior
•    Problems with nutrition and growth
•    Problems with hearing and vision
•    Problems at domicile, including using harmful substances. This can include misusing prescription drugs and using illegal drugs.

If your babe has developmental delays, talk to her provider near early on intervention services. These services tin can help children from nascence through 3 years former learn important skills. Services include therapy to assistance a child talk, walk, acquire self-help skills and collaborate with others. Getting services as early as possible tin help amend your child's development. The Centers for Disease Control and Prevention has information to help you get early intervention services for your child and how to find services in your state or territory.  What can you do to aid preclude NAS in your babe?

Hither's what y'all tin do:

  • If y'all're pregnant and you use any of the drugs that can cause NAS, tell your provider right away, merely don't finish taking the drug without getting treatment from your provider start. Quitting suddenly (sometimes called cold turkey) can crusade astringent problems for your babe, including decease. If y'all need help to quit using these drugs, talk to your provider about treatment. Getting treatment tin can help you end using drugs and is safer for your baby than getting no treatment at all.
  • If you're pregnant and tin't cease using opioids without bug, inquire your provider about medication-assisted handling (besides called MAT). NAS in babies may be easier to care for for babies whose moms get MAT during pregnancy. Medicines used in MAT include methadone and buprenorphine.
  • If you're meaning and y'all go to a provider who prescribes medicine to treat a health condition, make sure that provider knows you're significant. You lot may demand to stop taking certain medicines or change to medicine that's safer for your baby. Ask all your wellness care providers if the medicine you take—even prescription drugs—can cause NAS in your babe. Even if yous use a prescription drug exactly equally your provider tells yous to, it may cause NAS in your babe.
  • If you're pregnant or thinking about getting meaning, tell your provider well-nigh whatsoever drugs or medicine you lot accept. Your provider tin can make certain that what y'all're taking is safe for you and your baby. She also can help you get treatment for using street drugs or abusing prescription drugs if you need information technology. If you abuse prescription drugs, it means you take more than has been prescribed for you lot, yous take someone else's prescription drug, or you get the drug from someone without a prescription.
  • If you're non pregnant and y'all use any drug that tin cause NAS: Apply birth control until you're gear up to become pregnant. Nativity control (as well chosen contraception or family planning) helps proceed you from getting pregnant. Examples include intrauterine devices (also called IUDs), implants, the pill and condoms.

More information

  • Mother to Babe
  • Substance Corruption Treatment Facility Locator

Meet also: Preventing NAS in your babe infographic, Caring for a babe with NAS infographic, Prescription opioids during pregnancy, Prescription medicine during pregnancy

Last reviewed: June, 2019