What Is Neonatal Abstinence Syndrome?

Medically Reviewed by Dany Paul Baby, MD on April 27, 2022
5 min read

With so many advances in modern medicine, we now know that during pregnancy, it’s important for mothers-to-be to take care of their health to protect not only themselves but their babies, too. Even so, complications can arise when mothers ingest or use unhealthy substances. Neonatal abstinence syndrome (NAS) is something that can happen to babies whose mothers took opioid drugs while pregnant.

Neonatal abstinence syndrome refers to a series of problems that your baby might face if they’ve been exposed to certain drugs while in the womb. It’s estimated that anywhere from 3 to 50 percent of babies born in the US were exposed to some kind of drug use while still in the uterus. These numbers vary depending on location and population.

Most drugs or medicines that pregnant women take move through their bloodstream and then are passed on to their baby through the placenta. When a pregnant woman takes a drug that affects the central nervous system, though, like opioids, the baby’s central nervous system is also affected. Once the baby is born, it may show signs of withdrawal since it is no longer getting the drug.

Opioids, or narcotics, are drugs that doctors can prescribe for pain. Some examples are:

  • Morphine
  • Oxycodone
  • Codeine
  • Hydrocodone
  • Fentanyl
  • Meperidine

Methadone is an opioid drug that helps people wean off of opioids, including heroin.

Certain drugs and medicines are more likely to have some effect on your baby while in the womb. Taking multiple drugs at once has an even worse effect on your baby. Some drugs or substances that are known to cause NAS are:

  • Illicit opioids, like heroin
  • Prescription drugs like codeine and oxycodone
  • Stimulants, like cocaine or amphetamines
  • Nicotine
  • Anti-depressants like selective serotonin reuptake inhibitors (SSRIs)
  • Depressants, including marijuana, alcohol, and barbiturates

Using alcohol while you are pregnant can cause another set of problems for your baby, which is called fetal alcohol spectrum disorder.

Neonatal abstinence syndrome risk factors. Studies suggest that moms-to-be who use drugs or alcohol while pregnant are less likely to seek out proper prenatal care. This can raise risks within the pregnancy for both you and your baby. Women who regularly use drugs are more likely to use more than one kind. Those who use intravenous drugs with needles are also at a higher risk of contracting HIV and AIDS.

Once your baby is delivered, the umbilical cord is cut, and the newborn baby will no longer be getting any of the drugs or substances that you were taking during your pregnancy. It’s after this that babies may begin to show signs of neonatal abstinence syndrome. The symptoms are close to those that adults may experience while going through drug withdrawal.

The signs and symptoms that a baby experiencing NAS will show depend on several factors, including which drugs are in their system, the amount, and how much was used throughout the mother’s pregnancy. The most common symptoms include:

  • Tremors or shaking
  • High-pitched crying
  • Fever
  • Vomiting
  • Crankiness or restlessness
  • Diarrhea
  • Sweating
  • Feeding problems
  • Trouble gaining weight
  • Skin irritations or serious diaper rash
  • Dehydration
  • Sneezing and stuffy nose

Symptoms of NAS can start as soon as 24 hours after birth or up to 10 days afterward. Babies who are born prematurely have lower chances of developing serious symptoms and may even get better quicker since they were exposed to drugs in the womb for less time than most babies who are born at full term.

If a baby is born with neonatal abstinence syndrome, it may have symptoms for up to six months. While most babies are able to manage their symptoms with therapeutic care from their parents or a nurse, some may need medical care and treatment.

Diagnosis. To diagnose babies with neonatal abstinence syndrome, doctors need to know about the mother’s history of drug use, along with the newborn’s symptoms. Having an accurate report is really important, so your doctor or nurse may ask you questions about the drugs you use and the last time you used them. Your doctor may also check your urine or umbilical cord tissue for traces of drugs.

Babies born with NAS need to stay in the hospital for a minimum of three days for observation and to see if their symptoms are lessening. Some may need to stay longer than three days depending on the severity of their symptoms.

During observation, a nurse will use a scoring sheet that monitors the symptoms of NAS. If your baby has a high score for some time, a doctor may decide that medication is necessary to help with the baby’s symptoms. If the doctor does decide to give medication, the dose will gradually be lowered as NAS symptoms subside.

Treatment. Babies born with NAS tend to be cranky and irritable. You will want to try to comfort them as much as you can during this time. Skin-to-skin contact or swaddling can provide some comfort to your baby, especially as you rock them gently or cuddle them. Be careful not to bundle the swaddle up too tightly, though.

During this time, try to keep your baby away from bright lights or startling, loud noises. Quiet, dark spaces can be soothing for your baby and help them calm down to get some sleep. Some gentle music or humming can be comforting to them.

You should talk to your doctor about feeding options. Moms who continue to use opioids should not breastfeed their babies. If you give your baby formula, make sure to follow the instructions of your doctor on the amount needed per feeding. Some babies born with NAS may need extra calories. Feeding your baby takes a lot of their energy, so when they’re hungry, take them to a calm, quiet place that facilitates resting if they need it.

If your doctor decides that your baby needs medication, they will be given one that’s in the same family as the drug they were exposed to in the womb. As your baby’s symptoms decrease, so will their dosage. Soon, they will be able to stop taking the medication altogether.