Neonatal Opioid Withdrawal Syndrome (formerly known as Neonatal Abstinence Syndrome)

What is neonatal abstinence syndrome?

Neonatal abstinence syndrome (NAS) is a condition that affects your newborn when they have exposure to opioid drugs or other addictive substances while in your womb. Your baby receives these drugs through your placenta, which is an organ that provides oxygen and nutrients from your body to your baby’s body in your uterus.

What drugs cause neonatal abstinence syndrome?

A newborn could experience neonatal abstinence syndrome (NAS) if their birthing parent took drugs (opioids) or addictive substances during their pregnancy. The most common drugs include:

• Amphetamines.
• Buprenorphine.
• Codeine.
• Heroin.
• Oxycodone.
• Hydrocodone.
• Morphine.
• Methadone.

Additional substances that cause NAS include:

• Alcohol.
• Barbiturates.
• Benzodiazepines.
• Nicotine.
• Some antidepressants (selective serotonin reuptake inhibitors).

Who does neonatal abstinence syndrome affect?

Neonatal abstinence syndrome affects newborns whose birthing parent took or has an addiction to opioid drugs or addictive substances during pregnancy. Drug addiction is a common condition that affects an estimated 20 million people in the United States.

How common is neonatal abstinence syndrome?

Neonatal abstinence syndrome (NAS) can be difficult to quantify since the number of cases continues to increase each year. One study suggests there is one newborn diagnosed with NAS every 25 minutes, which equals between 2 to 7 newborns out of every 1,000 births.

How does neonatal abstinence syndrome affect my newborn’s body?

Your newborn will experience withdrawal symptoms until the drug or substance is out of their system. This could create symptoms that cause your child to cry often, be excessively fussy or ill. As a new parent, it could be alarming to see your child in distress. During their withdrawal period, your newborn will be hard to calm. Depending on the severity of your newborn’s symptoms, your child might need to stay in the newborn intensive care unit (NICU) until their body gets rid of the drug or substance that causes their symptoms.

What are the symptoms of neonatal abstinence syndrome?

Symptoms of neonatal abstinence syndrome include:

• Vomiting and/or diarrhea.
• Fever and sweating.
• Breathing quickly.
• Loud, high-pitched and excessive crying.
• Frequent sucking.
• Shaking (tremors).
• Diaper rash.

Additional symptoms could include:

• Hypertonia and overactive reflexes.
• Difficulty gaining weight.
• Trouble falling asleep and staying asleep.
• Feeding problems.
• Skin has a blotchy, marbled pattern (mottling).

Symptoms range in severity for each newborn. The severity of your child’s symptoms vary based on:

• What drug is in your baby’s body.
• How much of that drug is in your baby’s body.
• How long your baby had exposure to the drug while in your womb.

Severe symptoms

If your child has a large number of drugs in their system when they’re born, they could be at risk of having severe, life-threatening symptoms. These symptoms include:

• Being born too soon (premature).
• Growth and birth defects.
• Seizures.
• Sudden infant death syndrome (SIDS).

When do symptoms of neonatal abstinence syndrome appear?

Your baby could experience symptoms of neonatal abstinence syndrome between one to three days after they’re born. Sometimes, it could take up to a week for symptoms to appear. During this time, your newborn will likely stay in your hospital’s newborn intensive care unit (NICU) until the drug leaves their body and they’re healthy enough to go home.

Will my child have long-term symptoms of neonatal abstinence syndrome?

Long-term symptoms vary depending on the severity of their diagnosis but neonatal abstinence syndrome (NAS) could affect your child as they get older by causing:

• Developmental delays and difficulty using their cognitive, social and motor skills.
• Behavioral issues in school.
• Problems with short-term memory.
• Growth problems.
• Difficulty gaining weight.
• Hearing and vision problems.

Stay up to date with your baby’s wellness checkups to make sure your child reaches developmental milestones according to their age.

Studies suggest that children diagnosed with NAS are more likely to develop the following conditions as they grow:

• Attention-deficit/hyperactivity disorder.
• Anxiety.
• Depression.

What causes neonatal abstinence syndrome?

Drugs or addictive substances that your newborn received through your placenta during pregnancy cause neonatal abstinence syndrome.

Your baby gets oxygen and nutrients from you via their umbilical cord that attaches to your placenta. The placenta is an organ that develops in your uterus during pregnancy. Similar to oxygen and nutrients, drugs that you take can pass through your placenta and reach your baby. Your baby becomes dependent on opioid drugs that they receive in the womb.

If you take opioids before you deliver your baby, your newborn will experience withdrawal symptoms when they’re born until the drug passes through their body.

How is neonatal abstinence syndrome diagnosed?

Since symptoms of neonatal abstinence syndrome (NAS) relate to other conditions for newborns, your provider will diagnose NAS after learning more about your drug intake before your baby was born and by performing a drug screen.

Drug screenings help your provider detect the type and amount of a drug that’s within your newborn’s body. A drug screen takes a sample of the umbilical cord, urine or blood from your newborn. Your provider might also run a meconium test that examines a sample of your newborn’s first bowel movement. You might need to take a drug screening as well to help verify a diagnosis for your baby.

What tests diagnose neonatal abstinence syndrome?

In addition to a drug test, your newborn’s provider will use the NAS scoring system, which is a test where your provider designates points to identify the severity of your baby’s symptoms. The score (results) from this test help your provider offer treatment to alleviate your baby’s symptoms.

How is neonatal abstinence syndrome treated?

Your baby’s treatment for neonatal abstinence syndrome depends on the type of drug and how much of that drug is in their system, as well as their overall health and the severity of their symptoms. Treatment could include:

• Taking medicine to make symptoms less severe over time.
• Receiving fluids through an IV (intravenous) in their vein if they’re dehydrated.
• Using a cream or ointment to soothe diaper rash and skin irritation.
• Adjusting feeding times where your baby will have smaller feedings more often with a high-calorie formula to help them gain weight.

Treatment typically lasts between five days to six months or until your newborn feels well and doesn’t have any drugs in their body. Treatment to help reduce long-term symptoms could continue throughout your child’s life, which could include cognitive behavioral therapy and medicine to treat conditions that appear as a side effect.

What medications treat neonatal abstinence syndrome?

If your newborn has severe symptoms of neonatal abstinence syndrome (NAS), your provider might treat your baby with different types of medicine to alleviate withdrawal symptoms that help them eat and sleep. The goal of prescribed medicine gives your baby small doses of the medicine that is similar to what they received in your womb to wean your baby off of the drug slowly over time instead of letting their body do it all at once (cold turkey), which causes severe symptoms.

Types of medicine to treat NAS includes:

• Methadone.
• Morphine.
• Buprenorphine.
• Phenobarbital.
• Clonidine.

Your newborn may spend several weeks to months in the hospital if they need to take medicine. This helps providers make sure your baby is healthy enough to go home when the drug is out of their body completely.

How do I take help my newborn manage their symptoms?

Your newborn will be fussy and it can be difficult to calm them down while they experience symptoms of withdrawal. You can help your newborn by:

• Being with your baby as much as possible.
• Reducing your newborn’s exposure to loud noises and bright lights.
• Rocking your baby gently.
• Holding your baby close to your chest (skin-to-skin contact).
• Swaddling your newborn in a soft blanket.

Can I breastfeed my newborn if I take drugs?

Drugs, like opioids, can pass through your breastmilk (chestmilk) and into your baby’s body if you breastfeed (chestfeed) your newborn. This can cause dangerous side effects for your child. If you’re actively taking drugs that aren’t approved by your healthcare provider, don’t feed your baby your breastmilk. Instead, use formula or donor milk to feed your baby. If you’re in a program and taking a prescribed opioid to prevent you from withdrawal symptoms during or after your delivery, you may give your baby breastmilk if your healthcare providers consider it safe for your baby.

If you have a substance abuse problem or an addiction, talk to your provider about ways to treat your addiction. It’s important to keep yourself healthy so you can be there for your child when they need you most.

How can I prevent neonatal abstinence syndrome?

You can take steps to prevent severe symptoms of neonatal abstinence syndrome from affecting your baby by:

• Telling your provider what drugs or substances you take if you become pregnant. If you quit taking drugs that you’ve taken for a long time, you could experience severe withdrawal symptoms that could harm your developing baby. Your provider will recommend treatment options to keep you and your baby safe.
• Telling your provider about the prescription medicine and supplements you’re taking to make sure they’re safe for both you and your baby. Don’t stop taking a prescribed medicine unless your provider tells you to do so.
• Taking birth control (contraception) until you’re ready to have a baby. If you’re sexually active and have substance use disorder or you’re undergoing treatment for it, use safe sex practices until you’re healthy enough to become pregnant.

What can I expect if my newborn has neonatal abstinence syndrome?

Your newborn, diagnosed with neonatal abstinence syndrome (NAS), will spend an average of 20 days in the hospital after they’re born to make sure they’re healthy enough to go home. Sometimes treatment for NAS lasts up to six months. Your provider will closely monitor their symptoms to make sure they’re safe and that the drug or substance that is in their system clears before they leave.

Your provider will discuss feeding options on how you can care for your child. If you’re actively taking drugs, don’t breastfeed (chestfeed) your newborn since the drug can pass through your breastmilk, which could cause them to experience symptoms of NAS that affect their health.

When your baby leaves the hospital with you, your newborn will need extra love and support for a few weeks to a few months, as well as through their childhood. Monitor your baby’s growth and development to make sure they don’t miss any milestones. If you notice your child isn’t thriving or misses milestones, talk to your healthcare provider.

How long does neonatal abstinence syndrome last?

Babies born with neonatal abstinence syndrome may experience withdrawal symptoms that last up to six months depending on how much of a drug or substance is in their body. Most babies experience symptoms for an average of 20 days. Your baby will most likely stay in the hospital while they experience symptoms to monitor their health.

When should I see my healthcare provider?

If your newborn experiences any symptoms of neonatal abstinence syndrome, visit your healthcare provider. Monitor your child’s development after treatment to make sure they’re on track to meet milestones for their age. If you notice your child misses developmental milestones, contact your provider.

When should I go to ER?

Visit the emergency room or call 911 if your child experiences severe symptoms, especially if your baby:

• Has a high fever that lasts for more than 24 hours.
• Isn’t eating or can’t keep milk or formula down (vomiting) after feedings.
• Has a seizure.
• Has an abnormal heartbeat.
• Has trouble breathing.

What questions should I ask my doctor?

• What drugs are safe to take if I’m pregnant?
• How do I quit taking an addictive drug or substance?
• Will my baby’s symptoms affect them long term?
• How do I comfort my child during treatment?

A note from Cleveland Clinic

Addictions and substance abuse problems can be challenging and overwhelming. These feelings might escalate if you become pregnant and don’t know what to do. Know that treatment is available to help you and your baby live happy and healthy lives. It’s important to be honest with your healthcare provider about the drugs you’re taking during your pregnancy. This is important for your provider to offer treatment unique to you and your situation. It’s always safer to get help than not get any at all.