Neonatal forbearance syndrome (NAS)

KEY POINTS

  • NAS is a grouping of conditions caused when a infant withdraws from certain drugs (most often opioids) he's exposed to in the womb before birth.

  • Most babies with NAS become treatment in the hospital after birth. Most babies who get treatment become meliorate in a few days or weeks.

  • During treatment, your baby may be fussy and hard to soothe. Pare-to-skin care, swaddling, being gentle and breastfeeding can help calm your baby.

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

  • If y'all're meaning and taking opioids, tell your provider right away. Don't end taking the opioid without talking to your provider outset.

What is neonatal abstinence syndrome?

Neonatal abstinence syndrome (also called NAS) is a group of weather condition acquired when a baby withdraws from sure drugs he'south exposed to in the womb earlier birth. NAS is most often acquired when a adult female takes drugs chosen opioids during pregnancy. Simply it as well tin exist caused past antidepressants (used to care for depression), barbiturates or benzodiazepines (sleeping pills). When y'all take these drugs during pregnancy, they can pass through the placenta and cause serious bug for your baby. The placenta grows in your uterus (womb) and supplies your babe with food and oxygen through the umbilical cord.

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

  • Codeine
  • Hydrocodone (name brand Vicodin®)
  • Morphine (name brands Kadian®, Avinza®)
  • Oxycodone (name brands OxyContin®, Percocet®)
  • Tramadol

The street drug heroin likewise 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's caused only by opioids.

If you're pregnant or trying to go pregnant and taking any of these drugs, tell your health intendance provider right away.

What are signs of NAS?

Signs of a condition are things someone else tin run across or know near y'all, like you lot accept a rash or you're coughing. Signs of NAS can exist different for every baby. Nigh happen within 3 days (72 hours) of nativity, but some may happen correct subsequently nascency or not until a few weeks after birth. They can last from 1 week to half dozen months after birth.

If your baby 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 loftier-pitched cry
  • Poor feeding or sucking or deadening weight gain
  • Breathing issues, including breathing actually fast
  • Fever, sweating or blotchy skin
  • Trouble sleeping and lots of yawning
  • Diarrhea or throwing up
  • Stuffy nose or sneezing

Signs of NAS depend on:

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

What complications can NAS cause for your baby?

Babies with NAS may have health atmospheric condition that demand treatment in the newborn intensive care unit (likewise called NICU) after birth. The NICU is the nursery in a hospital where sick newborns get medical care. In addition to having withdrawal signs, babies with NAS are at increased risk of:

  • Low birthweight. This means your infant is built-in weighing less than 5 pounds, eight ounces.
  • Jaundice. This is when your baby'southward skin and eyes look yellow. It'southward caused when your infant's liver isn't fully developed or working.
  • Seizures
  • Sudden infant expiry syndrome (also called SIDS). This is the unexplained death of a infant younger than one year old. SIDS normally happens when a baby is sleeping.

We don't know a lot most long-term furnishings of NAS on a baby. We demand more research to see how NAS affects a kid in the outset few years of life and longer. We think that NAS may cause long-term issues for your baby, like:

  • Developmental delays. Developmental delays are when your kid doesn't achieve developmental milestones when expected. Developmental milestones are skills and activities that about children can do at a sure age, similar sitting, walking, talking, having social skills and having thinking skills.
  • Motor bug. These are problems with your infant's bones, muscles and motility.
  • 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 pedagogy services in school.
  • Voice communication and linguistic communication problems
  • Sleep problems
  • Ear infections
  • Vision bug

How is your baby tested for NAS?

Your infant's provider tin use these tests to run into if your infant has NAS:

  • NAS scoring system. With this arrangement, your baby'due south provider uses points to course how severe your infant'due south withdrawal is. Your infant'southward provider uses the score to decide what kind of handling your infant needs.
  • Urine and meconium tests to check for drugs. Meconium is your baby's starting time bowel movement.

Your baby'south provider besides needs to know about what drugs or medicine yous've used and when yous last took them. You may get a urine test.

How is NAS treated?

Your babe'south treatment may include:

  • Taking medicines to care for or manage severe withdrawal symptoms. Once withdrawal is nether command, your baby gets smaller doses of the medicine over time so her trunk tin adjust to being off the medicine. Medicines used to treat severe withdrawal include morphine, methadone and buprenorphine.
  • Getting fluids through a needle into a vein (too chosen intravenous or Iv) to prevent your baby from getting dehydrated. Dehydrated means not having enough h2o in the body. Babies with NAS tin can become dehydrated from having diarrhea or throwing upward a lot.
  • Existence fed higher-calorie baby formula. Some babies with NAS demand extra calories to help them grow because they have problem feeding or slow growth.

Most babies with NAS who get treatment become amend in 5 to thirty days.

During treatment, your infant may be fussy and hard to soothe. Doing these things tin help at-home your baby:

  • Room in with your baby. This means yous and your baby stay in the same room together at the hospital before you lot take your baby home.
  • Requite your babe skin-to-skin intendance (also called kangaroo intendance). This is when you put your infant, dressed merely in a diaper, on your bare chest.
  • Exist gentle with your baby. Stone your babe gently. If she's sleeping, don't wake her upward.
  • Swaddle your baby (wrap him snuggly) in a coating.
  • Go along your baby's room serenity and the lights dim.
  • Breastfeed your baby. Feed your baby on demand. This means you feed your infant when he'due south hungry.
  • Requite your babe a pacifier.

Your infant's provider checks your babe often in the NICU after birth to make sure he's getting better and having fewer and less severe withdrawal signs. Your babe can become home from the infirmary when she:

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

Later your baby is dwelling, take her to all of her follow-upwards and well-infant checkups, even if she'southward doing well. Your provider checks your babe at these visits for problems that may exist linked to NAS, like:
•    Developmental delays and problems with motor and learning skills and behavior
•    Problems with diet and growth
•    Issues with hearing and vision
•    Problems at dwelling, including using harmful substances. This can include misusing prescription drugs and using illegal drugs.

If your baby has developmental delays, talk to her provider nigh early intervention services. These services tin help children from birth through 3 years sometime learn important skills. Services include therapy to help a child talk, walk, acquire self-help skills and interact with others. Getting services as early on as possible can help improve your child'due south evolution. The Centers for Disease Control and Prevention has information to assist you become early intervention services for your child and how to detect services in your state or territory.  What tin you exercise to help preclude NAS in your infant?

Here'due south what you can do:

  • If you're pregnant and you use any of the drugs that can cause NAS, tell your provider right away, but don't stop taking the drug without getting handling from your provider starting time. Quitting suddenly (sometimes called cold turkey) can crusade severe issues for your baby, including death. If yous need assistance to quit using these drugs, talk to your provider most handling. Getting treatment can aid you stop using drugs and is safer for your babe than getting no handling at all.
  • If you lot're pregnant and can't terminate using opioids without bug, ask your provider about medication-assisted treatment (also called MAT). NAS in babies may be easier to care for for babies whose moms get MAT during pregnancy. Medicines used in MAT include methadone and buprenorphine.
  • If yous're pregnant and you become to a provider who prescribes medicine to treat a health condition, brand sure that provider knows you're pregnant. You may demand to end taking certain medicines or modify to medicine that's safer for your baby. Inquire all your health intendance providers if the medicine you have—even prescription drugs—tin can cause NAS in your baby. Even if you use a prescription drug exactly as your provider tells yous to, information technology may cause NAS in your infant.
  • If you're pregnant or thinking near getting significant, tell your provider about whatsoever drugs or medicine yous take. Your provider can make certain that what you're taking is safe for you lot and your baby. She as well can help you get treatment for using street drugs or abusing prescription drugs if you lot need it. If you abuse prescription drugs, information technology ways you have more than has been prescribed for y'all, you accept someone else's prescription drug, or you lot get the drug from someone without a prescription.
  • If you're not pregnant and you use whatever drug that tin cause NAS: Employ nativity control until you're ready to get pregnant. Birth control (too called contraception or family planning) helps keep you from getting pregnant. Examples include intrauterine devices (also chosen IUDs), implants, the pill and condoms.

More information

  • Female parent to Babe
  • Substance Abuse Treatment Facility Locator

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

Last reviewed: June, 2019