Neonatal Abstinence Syndrome (NAS)

What Is Neonatal Abstinence Syndrome?

Neonatal abstinence syndrome (NAS) is a treatable condition that occurs when babies are exposed to drugs in the womb before birth.

Drugs taken during pregnancy can pass through the placenta, which supplies the baby with food and oxygen through the umbilical cord. Even in the womb, these drugs can pose a serious risk to the pregnancy.

After the mother gives birth, the baby undergoes drug withdrawal and displays several common withdrawal symptoms. Some of these symptoms may range from severe to life-threatening if left untreated.

What Causes Neonatal Abstinence Syndrome?

Any substance that impacts the mother’s central nervous system will also affect the baby.

NAS happens most often when the mother takes opioids during pregnancy, but antidepressants, barbiturates, and benzodiazepines have also been linked to the development of NAS.

The term NOWS (neonatal opioid withdrawal syndrome) also gets used in cases of opioid exposure during pregnancy.

Common substances known to cause neonatal abstinence syndrome include:

• Codeine
• Hydrocodone (name brand Vicodin®)
• Morphine (name brands Kadian®, Avinza®)
• Oxycodone (name brands OxyContin®, Percocet®)
• Tramadol
• Heroin
• Amphetamines
• Cocaine
• Some anti-depressants (selective serotonin reuptake inhibitors, a.k.a. SSRIs)
• Alcohol
• Cannabis
• Nicotine

Symptoms of Neonatal Abstinence Syndrome

Signs of NAS typically begin to appear within 3 days or 72 hours of birth, but others take a few weeks to manifest. Neonatal abstinence syndrome symptoms may last from 1 week to 6 months after birth.

The timeframes of when NAS symptoms appear will depend on these factors:

• What drug you used during pregnancy
• How much of the drug you used while pregnant
• How long you took the drug during your pregnancy
• How your own body breaks down the drug
• Your baby’s gestational age at birth (number of weeks of pregnancy)

Symptoms of NAS can vary depending on the baby, so this isn’t an exhaustive list. 

If you suspect your child may be showing NAS symptoms, take them to a healthcare provider immediately.

Symptoms of withdrawal in full-term babies may include:

• Birth defects such as head and face deformities, heart defects, and mental retardation
• Body shakes (tremors), seizures (convulsions), overactive reflexes (twitching), and tight muscle tone
• Fussiness, excessive crying, or having a high-pitched cry
• Poor feeding or sucking or slow weight gain
• Breathing problems, including breathing fast
• Fever, sweating, or blotchy skin
• Trouble sleeping and lots of yawning
• Diarrhea or throwing up
• Stuffy nose or sneezing

Development of Neonatal Abstinence Syndrome

Neonatal abstinence syndrome can be caused by chronic in-utero exposure to opioids, benzodiazepines, antidepressants, and other sedating substances.

It’s critical to note that not all cases of NAS are because the mother has a substance use disorder or uses illegal drugs.

In many cases of NAS, the mother was prescribed medications (such as opioids after surgery) and was unaware of the drug’s impact on the baby.

Pregnant women with opioid dependence face heightened risks for their babies developing NAS. Considering the opioid crisis facing the United States, more and more women battling opioid addiction find it difficult to abstain while pregnant.

Risk Factors for Neonatal Abstinence Syndrome

You can prevent NAS by stopping drug use before becoming pregnant. However, planning so far ahead may be incredibly difficult unless a mother is actively trying to conceive.

Many women don’t know they’re pregnant until a few weeks or even months into their pregnancy, leaving a tiny window for any attempt to stop the drug.

To make matters worse, women living in poverty and facing drug addiction often lack access to prenatal care. As a result, some women may never learn about the risk of NAS in the first place.

Long-Term Effects of Neonatal Abstinence Syndrome

Babies with NAS often have health conditions that need treatment in the newborn intensive care unit (a.k.a., the NICU) after birth.

In addition to having withdrawal signs, babies with NAS have an increased risk of: 

• Low birthweight (less than 5 pounds, 8 ounces)
• Jaundice
• Seizures
• Sudden infant death syndrome (SIDS usually occurs when a baby sleeps)

While not much is known about the long-term effects of NAS on a baby, research shows a grim outlook.

Long-term issues linked with NAS include:

• Developmental delays
• Behavior and learning problems
• Speech and language problems
• Motor problems
• Sleep problems
• Ear infections
• Vision problems

How Common Is Neonatal Abstinence Syndrome?

Data shows that not only is neonatal abstinence syndrome somewhat common, but it is also increasing in prevalence.

The Centers for Disease Control and Prevention (CDC) reports that the number of women with opioid use disorders documented at delivery increased by 131% from 2010 to 2017.

Data from the 2018 Healthcare Cost and Utilization Project (HCUP) showed that roughly 7 out of every 1,000 newborns were diagnosed with NAS.

This data also shows that approximately 1 baby is diagnosed with NAS every 19 minutes in the United States. That total equates to 80 newborns diagnosed during hospital stays every day.

The number of U.S. babies born with NAS increased by 82% nationally from 2010 to 2017.

Neonatal Abstinence Syndrome Diagnosis and Treatment

Luckily, NAS is treatable if addressed immediately. Diagnosis and treatment of NAS require testing from a pediatric physician or neonatal specialist.

After obtaining a diagnosis, most infants will be placed in the newborn intensive care unit (NICU) for treatment.

Diagnosis of Neonatal Abstinence Syndrome

The most common and traditional way of testing for NAS utilizes the Finnegan scoring system, which physicians use to evaluate babies and make management decisions.

To ensure an accurate diagnosis, you must be honest with your doctor about your history of medicine or substance abuse.

Your healthcare provider typically first checks meconium (baby’s bowel movement), urine, or umbilical cord blood. Because of the high incidence of NAS, some birth centers routinely screen all babies for withdrawal symptoms.

After testing, Finnegan scoring points are assigned for certain signs and symptoms and the seriousness of each to help plan treatment.

Treatment of Neonatal Abstinence Syndrome

The best treatment will depend on your baby’s age, symptoms, general health, and severity of the condition. Because babies suffering from withdrawal are irritable, they often have a difficult time being comforted.

Common NAS treatments include:

• Skin-to-skin care
• Swaddling
• Keeping noises low and lights dim
• Being gentle
• Breastfeeding
• Using a pacifier
• Sharing a room with the baby
• Increasing calories
• IV fluids (in cases of dehydration from vomiting or diarrhea)

Your doctor may recommend medication-assisted treatment (i.e., methadone, buprenorphine, phenobarbital, and clonidine) to treat and manage severe withdrawal symptoms.

Your doctor will likely schedule follow-up appointments to monitor your baby’s recovery progress.

Find Help for Neonatal Abstinence Syndrome

If you took any medications or drugs during pregnancy and suspect your infant has NAS, see your doctor immediately to begin treatment and avoid long-term side effects.

For mothers still actively struggling with substance abuse, treatment centers are ready to help you find sobriety as a new mother. Find a treatment center near you with SAMHSA’s online treatment locator, or call (800) 662-4357 to find a treatment center that fits your needs.