What is Neonatal Abstinence Syndrome?

Neonatal abstinence syndrome (NAS) refers to issues that can occur when a fetus is exposed to drugs while still in the mother’s uterus. When a mother uses substances, they pass through the blood stream and placenta and to the fetus. After the baby is born and is no longer receiving the substance, it can experience symptoms of withdrawal, which can be severe and lead to complications. Many substances can cause neonatal abstinence syndrome, including barbiturates, amphetamines, opiates, cocaine, marijuana and alcohol.

The symptoms of this syndrome depend on the substance the mother was using. Symptoms also depend on the frequency and amount of substance use. A baby’s symptoms might manifest anywhere from one to 10 days after birth. Some common symptoms include difficulty sleeping, trembling, fever or sweating, diarrhea and vomiting, dehydration, feeding problems, excessive and high-pitched crying, seizures, blotchy skin and hyperactive reflexes or muscle tone. In premature babies, the most common symptoms are feeding difficulties, high-pitched cries, trembling and rapid breathing.

Physicians have developed a neonatal abstinence syndrome scoring system for diagnosis and to help assess severity. Doctors might also screen a baby’s urine or early stool samples. Determining the substance and syndrome severity can help a doctor plan the course of treatment.

Treatment for this syndrome depends on a child's health and whether the baby was born at full term. In cases of severe withdrawal, a doctor might prescribe methadone, benzodiazepines or other drugs to help control withdrawal symptoms. An infant might need intravenous fluids or a high-calorie formula to help with weight gain. Babies suffering from neonatal abstinence syndrome are difficult to comfort, so very basic treatment will include swaddling and rocking the child as well as reducing environmental disruptions such as bright lights.

If a baby receives treatment for neonatal abstinence syndrome, it can help manage the withdrawal symptoms, but drug exposure in the womb still can lead to numerous complications. Some babies could be born with birth defects or low birth weight. Drug use during pregnancy also can lead to premature birth or sudden infant death syndrome (SIDS). The most important factor for prognosis is whether or not the mother continues using substances.

With neonatal abstinence syndrome, prevention is key. A woman should stop using substances before she becomes pregnant, or at least as soon as she finds out that she is pregnant. The syndrome can be avoided by not using drugs or alcohol during pregnancy.