Neonatal Abstinence Syndrome (NAS) is the medical term for the set of symptoms experienced by a newborn that is going through drug withdrawal. Exposure to many drugs in utero can lead to NAS, including nicotine, alcohol, cocaine, LSD and opioids.
In particular, opioid exposure to the unborn fetus can result in NAS. Opioids are taken both legally, in the form of prescription medication and illegally as street drugs. They readily cross the placenta, and babies born to mothers who take opioids are at risk for NAS.
NAS can include one of nearly two dozen symptoms. Doctors and nurses will treat opioid addiction according to the severity of the symptom the baby is experiencing. For example, while a jittery baby may be swaddled for comfort with the lights lowered and sounds kept to a minimum, a baby experiencing seizures will require an anti-seizure medication. A baby having diarrhea may require additional fluids such as with an IV, and many opioid exposed babies require frequent feedings with a higher-than-normal calorie formula just to maintain their weight.
Whenever possible, doctors avoid giving opioid-exposed newborns experiencing NAS more opioids as this has been shown to increase length of hospitalization. If the baby is failing to thrive, cannot eat, cannot maintain normal vital signs, cannot sleep, and cannot tolerate routine care by nurses, medication may be indicated. The most common medications used are oral morphine and oral methadone. The medication is given with close monitoring of their vital signs (respiratory rate, heart rate and blood pressure), sleeping and eating patterns and overall behavior. The medication is slowly weaned (decreased) until it can be discontinued entirely without disrupting these patterns.
Breastfeeding and rooming-in with the mother have shown to be beneficial for babies with NAS. Breastfeeding is encouraged when the mother is undergoing treatment for her addiction, free from acute infection and HIV, and willing. Because mothers are frequently discharged before their babies with NAS, rooming-in is rarely possible.
Setting up social supports for the family of a baby with NAS is also part of treatment. Helping the mother receive drug treatment and making sure both she and the newborn will leave the hospital to a safe, supportive environment are important to the success or failure of the treatment. Consultation with a pediatrician who will follow the child after discharge as well as a child developmental specialist can help a family know what to expect when they take home their baby.
Reviewed by Sara Connolly, March 2020
- Opioids cross the placenta barrier easily.
- Newborns exposed to opioids are at risk for Neonatal Abstinence Syndrome.
- Treatment depends on the severity of symptoms.
- Doctors usually try to avoid giving more opiates to a newborn.
- Support for the mom is critical.