Neonatal abstinence syndrome

NAS happens when a woman takes opioids during pregnancy. Almost every drug passes from the mother's bloodstream through the placenta to the fetus, which can cause serious problems for the baby.

Some drugs are more likely to cause NAS than others, but nearly all have some effect on the baby. The following drugs can cause withdrawal:

• Alcohol
• Amphetamines and barbiturates
• Cocaine
• Opiates, such as heroin and methadone

Signs and symptoms can vary for every baby with NAS. Most appear within 3 days of birth, but some can appear immediately or within a few weeks. NAS can last from 1 week to 6 months after birth. Call your doctor if your baby has any of these symptoms of NAS:

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

The baby's doctor may use the following measures to diagnose NAS:

• Neonatal abstinence scoring (a system that gives points for each NAS symptom depending on how severe it is)
• Meconium testing (testing the baby’s first bowel movements)
• Testing the baby’s urine

NAS treatment may include taking prescribed medicines, administering fluids intravenously and/or drinking special baby formula.

Medication for NAS

The baby’s doctor may prescribe a medicine similar to the drug used during pregnancy to relieve withdrawal symptoms. Once these symptoms are under control, the baby receives smaller doses over time so their body can adjust to being off the medicine.

Intravenous fluids for NAS

Babies with NAS can get seriously dehydrated from having diarrhea or frequently throwing up. If a baby is dehydrated, they don't have enough water in their body. Getting fluids through an IV helps keep them hydrated.

Special baby formula for NAS

Some babies with NAS need extra calories to help them grow because they have trouble feeding or slow growth. If your baby has NAS, your doctor may prescribe a special, high-calorie formula to treat the condition.

Comfort measures are an important part of soothing a baby and/or managing symptoms. However, it may not be easy to settle or soothe a baby with NAS because of the effects of withdrawal.

Parents may need to try different comfort measures to see what works best. Watch the baby’s cues and body language to see what makes them uncomfortable. Neonatologists may also provide more specific guidance, including these calming methods:

• Breastfeeding the baby
• Keeping a calm and dimly lit room
• Limiting how much you handle the baby, especially when they are sleeping (quiet time helps them grow and develop)
• Limiting the number of people who visit the baby
• Not overdressing the baby (to properly regulate their body temperature)
• Practicing skin-to-skin care (also called kangaroo care)
• Swaddling the baby
• Using a gentle touch and speaking softly when they are fussy

Breastfeeding is healthy and can be very comforting for babies—including those diagnosed with NAS. Talk to your doctor, neonatologist or lactation consultant about breastfeeding a baby with special needs.

Neonatologists are certified by the American Board of Pediatrics and the Sub-Board of Neonatal-Perinatal Medicine. They are specially trained doctors who care for newborns and infants with serious health problems that are hard to diagnose or treat. If the problem is known before birth, a neonatologist may be needed before or during the baby's delivery and after the child is born.