Neonatal forbearance syndrome (NAS)

KEY POINTS

  • NAS is a grouping of weather condition acquired when a baby withdraws from sure drugs (most often opioids) he'southward exposed to in the womb earlier birth.

  • Most babies with NAS get treatment in the hospital after nativity. Most babies who get treatment get better in a few days or weeks.

  • During treatment, your baby may be fussy and hard to soothe. Skin-to-skin care, swaddling, beingness gentle and breastfeeding can help at-home your babe.

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

  • If y'all're pregnant and taking opioids, tell your provider correct away. Don't end taking the opioid without talking to your provider offset.

What is neonatal abstinence syndrome?

Neonatal abstinence syndrome (also called NAS) is a grouping of weather condition caused when a baby withdraws from certain drugs he's exposed to in the womb before nascency. NAS is nigh often acquired when a woman takes drugs called opioids during pregnancy. Just information technology also can be acquired 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 problems for your baby. The placenta grows in your uterus (womb) and supplies your baby with food and oxygen through the umbilical cord.

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

  • Codeine
  • Hydrocodone (proper 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 also called NOWS. NOWS stands for neonatal opioid withdrawal syndrome. NOWS is the same equally NAS except it'south acquired but by opioids.

If you're pregnant or trying to get significant 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 well-nigh you, like you accept a rash or yous're cough. Signs of NAS can exist dissimilar for every baby. Most happen within 3 days (72 hours) of nascency, but some may happen right after birth or not until a few weeks after birth. They tin final from 1 week to 6 months after 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 muscle 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 skin
  • Problem sleeping and lots of yawning
  • Diarrhea or throwing up
  • Stuffy nose or sneezing

Signs of NAS depend on:

  • What drug yous used during pregnancy, how much you used and how long you took it
  • How your own body breaks down the drug
  • Your baby'south gestational historic period at birth (number of weeks of pregnancy)

What complications tin can NAS cause for your baby?

Babies with NAS may have health weather that need treatment in the newborn intensive care unit (as well called NICU) after birth. The NICU is the nursery in a infirmary where ill newborns get medical intendance. In addition to having withdrawal signs, babies with NAS are at increased take a chance of:

  • Low birthweight. This ways your baby is born weighing less than 5 pounds, 8 ounces.
  • Jaundice. This is when your baby's peel and eyes look yellow. It's caused when your baby's liver isn't fully adult or working.
  • Seizures
  • Sudden infant decease syndrome (also called SIDS). This is the unexplained death of a baby younger than i year sometime. SIDS normally happens when a babe is sleeping.

Nosotros don't know a lot most long-term effects of NAS on a baby. We need more research to run across how NAS affects a child in the first few years of life and longer. We recollect that NAS may cause long-term problems for your babe, similar:

  • Developmental delays. Developmental delays are when your child doesn't accomplish developmental milestones when expected. Developmental milestones are skills and activities that well-nigh children can do at a certain age, like sitting, walking, talking, having social skills and having thinking skills.
  • Motor bug. These are bug with your babe'southward bones, muscles and movement.
  • Behavior and learning problems. Babies with NAS are more likely than babies who don't have NAS to be checked for learning issues and to get special education services in school.
  • Speech and linguistic communication problems
  • Sleep problems
  • Ear infections
  • Vision problems

How is your baby tested for NAS?

Your baby's provider tin can use these tests to run across if your baby has NAS:

  • NAS scoring system. With this system, your babe's provider uses points to grade how severe your baby's withdrawal is. Your baby's provider uses the score to decide what kind of treatment your infant needs.
  • Urine and meconium tests to cheque for drugs. Meconium is your baby's first bowel move.

Your babe'southward provider also needs to know about what drugs or medicine you've used and when you last took them. Yous may go a urine exam.

How is NAS treated?

Your baby's treatment may include:

  • Taking medicines to treat or manage severe withdrawal symptoms. Once withdrawal is under command, your baby gets smaller doses of the medicine over fourth dimension so her body can adjust to being off the medicine. Medicines used to care for severe withdrawal include morphine, methadone and buprenorphine.
  • Getting fluids through a needle into a vein (too called intravenous or IV) to prevent your baby from getting dehydrated. Dehydrated means not having plenty water in the trunk. Babies with NAS can go dehydrated from having diarrhea or throwing upward a lot.
  • Existence fed higher-calorie baby formula. Some babies with NAS need extra calories to assistance them grow because they have trouble feeding or slow growth.

Near babies with NAS who become treatment become improve in five to 30 days.

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

  • Room in with your baby. This means you and your infant stay in the same room together at the infirmary before you have your infant habitation.
  • Give your baby skin-to-skin intendance (besides called kangaroo intendance). This is when y'all put your baby, dressed only in a diaper, on your bare chest.
  • Be gentle with your babe. Stone your infant gently. If she's sleeping, don't wake her up.
  • Swaddle your baby (wrap him snuggly) in a blanket.
  • Keep your baby's room serenity and the lights dim.
  • Breastfeed your baby. Feed your baby on demand. This means you feed your baby when he's hungry.
  • Give your infant a pacifier.

Your baby'southward provider checks your babe oft in the NICU after nascence to brand certain he'southward getting improve and having fewer and less severe withdrawal signs. Your baby tin go abode from the hospital when she:

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

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

If your baby has developmental delays, talk to her provider about early on intervention services. These services tin can help children from birth through 3 years erstwhile learn important skills. Services include therapy to help a child talk, walk, acquire self-help skills and interact with others. Getting services as early as possible can help meliorate your child's development. The Centers for Illness Control and Prevention has information to assist you get early intervention services for your child and how to find services in your state or territory.  What can you practise to assistance prevent NAS in your infant?

Here'due south what you can do:

  • If you're pregnant and you utilize any of the drugs that tin cause NAS, tell your provider correct away, but don't stop taking the drug without getting treatment from your provider kickoff. Quitting suddenly (sometimes chosen cold turkey) tin cause astringent issues for your baby, including death. If you need assist to quit using these drugs, talk to your provider about treatment. Getting treatment can assist you stop using drugs and is safer for your baby than getting no handling at all.
  • If you're significant and can't stop using opioids without problems, ask your provider about medication-assisted treatment (likewise called MAT). NAS in babies may be easier to treat for babies whose moms get MAT during pregnancy. Medicines used in MAT include methadone and buprenorphine.
  • If you lot're pregnant and you get to a provider who prescribes medicine to care for a health condition, make sure that provider knows you're pregnant. You may demand to end taking certain medicines or change to medicine that's safer for your babe. Enquire all your health intendance providers if the medicine you accept—fifty-fifty prescription drugs—can cause NAS in your baby. Fifty-fifty if you use a prescription drug exactly as your provider tells you to, it may cause NAS in your baby.
  • If you're meaning or thinking about getting pregnant, tell your provider most any drugs or medicine you take. Your provider tin make certain that what you lot're taking is safe for you and your infant. She as well can assistance you lot get treatment for using street drugs or abusing prescription drugs if you need information technology. If yous abuse prescription drugs, it means you take more than has been prescribed for you, you take someone else'due south prescription drug, or yous get the drug from someone without a prescription.
  • If you're not significant and you utilise any drug that tin can cause NAS: Employ nascence command until y'all're prepare to get meaning. Nascence control (too chosen contraception or family planning) helps go on you lot from getting pregnant. Examples include intrauterine devices (also chosen IUDs), implants, the pill and condoms.

More information

  • Mother to Baby
  • Substance Abuse Handling Facility Locator

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

Final reviewed: June, 2019