What is Neonatal Abstinence Syndrome (NAS)?

What is Neonatal Abstinence Syndrome (NAS)?

  • Neonatal abstinence syndrome (NAS) is a description of symptoms of drug withdrawal that can occur in a newborn who was exposed to opiate drugs while in the mother's womb.

What Complications Can Drug Use During Pregnancy Cause?

  • Drug use during pregnancy can cause a lot of health problems in a baby, such as:
    • Withdrawal (Neonatal Abstinence Syndrome is just one type)
    • Birth defects
    • Low birth weight
    • Premature birth
    • Small head
    • Sudden infant death syndrome (SIDS)
    • Developmental or behavioral problems
  • Genetic studies are also sent to confirm the diagnosis.

What is Withdrawal?

  • Withdrawal is caused by drug exposure during pregnancy
    • Almost every drug (prescribed and illegal) passes from the mother's blood to the baby's blood.
    • Exposure can lead to the baby being physically dependent on/addicted to the substance.
    • After birth, when the baby is no longer getting the drug from the mother's system, the baby can go through withdrawal.

Which Drugs Cause NAS?

  • Opiate drugs (narcotics):
    • Heroin
    • Methadone
    • Subutex/Suboxone/Buprenorphine
    • Codeine
    • Oxycodone/Oxycontin

What Are the Symptoms of NAS?

  • Diarrhea
  • High-pitched cry
  • Lots of crying
  • Excessive sucking
  • Fever
  • Increased muscle tone: the baby may be very "stiff"
  • Fussiness
  • Difficulty eating
  • Seizures
  • Sleep problems
  • Stuffy nose, sneezing
  • Sweating
  • Trembling (tremors)
  • Vomiting

What Complications Can NAS Cause in Infants?

  • NAS can cause seizures or death if not treated
  • Babies suffering from NAS can be very fussy and hard to calm. They like to be held even more than the typical baby.
  • Babies often have trouble gaining weight and may need to be fed more often. This is because the baby has diarrhea, is stiff, and fussy; their bodies use more calories than the average baby.

How Are Babies at Risk for NAS Identified?

  • Maternal drug screens are ordered at the time of delivery according to risk factors such as:
    • Illegal substance use either currently or in the last 12 months
    • Enrolled in methadone treatment program currently or in the last 12 months
    • Opiate use for chronic pain currently or in the last 12 months
    • Exhibited physical/behavioral signs of drug or alcohol use or withdrawal
    • Prenatal Care: Either none, late (after 27 weeks of pregnancy), or limited (4 or fewer prenatal visits)
    • Placental abruption with no other obvious medical explanation
    • Admitted drug or alcohol use
    • Recommendation by outpatient clinic social worker
  • Urine drug screen is ordered on the baby

What Complications Can NAS Cause in Infants?

  • Babies are watched in the hospital for at least 5-7 days to see if the child has any signs and/or symptoms of withdrawal. Some babies go through withdrawal early, and others take more time to show signs of withdrawal.
  • A "Finnegan score" is a formal assessment of signs and symptoms of withdrawal. The higher the score, the worse the withdrawal.
  • If a baby's Finnegan scores are high enough, the baby will be treated with medicine to help ease the symptoms of withdrawal, and to prevent bad complications such as seizures or death. The medicine given is usually morphine by mouth.
  • Whether or not a child goes through withdrawal, needs to be treated, and how long the process last depends on a number of factors such as the type of drugs the mother took and how quickly the baby's body breaks down the drugs (metabolizes).
  • A baby is kept in the hospital for the whole time the withdrawal is being treated because it is risky to send the baby home with an opiate drug if the child's parents have an addiction to opiates.

When Must NAS Be Reported to Childline in Pennsylvania?

  • Reporting by health care providers involved in the delivery or care of a child less than one year old is mandatory when the child is identified as being affected by:
    • Illegal substance abuse by the child's mother
    • Withdrawal symptoms resulting from prenatal drug exposure
    • A fetal alcohol spectrum disorder
  • Urine drug screen is ordered on the baby

How Can A CPS Caseworker Help?

  • Recognize the stress that comes from caring from such fussy infants. These children are at risk for maltreatment due to parental addiction and the baby's own withdrawal symptoms.
  • Help to ensure that the child goes to routine well child checks.
  • Help to ensure that the child is evaluated by Early Intervention (Alliance for Infants) services due to risk of developmental problems due to prenatal drug exposure.

Jennifer E. Wolford, DO, MPH, FAAP
Children's Hospital of Pittsburgh,
Division of Child Advocacy

Rachel P. Berger, MD, MPH
Children's Hospital of Pittsburgh,
Division of Child Advocacy

Adelaide L. Eichman, MD
Children's Hospital of Pittsburgh,
Division of Child Advocacy

Content Sources:
Stanford Children's Health. "Neonatal abstinence syndrome.": www.stanfordchildrens.org
U.S. National Library of Medicine. "Neonatal abstinence syndrome." Medline Plus.: www.nlm.nih.gov

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