What Is Neonatal Abstinence Syndrome?

Neonatal abstinence syndrome (NAS) occurs when a baby is exposed to opioid narcotics like Percocet or heroin while in the womb. Narcotics easily cross the placenta through the blood since the mother’s body shares all nutrients with the growing baby through the bloodstream.

Opioids, whether prescribed or abused, can lead to NAS in 55 percent to 94 percent of babies exposed to opioid drugs in utero. As the number of people who struggle with opioid addiction and overdose rises in the United States, instances of NAS have also risen. Along with opioid overdose, NAS is an epidemic that can lead to long-term problems.

Neonatal abstinence syndrome is essentially a set of intense withdrawal symptoms experienced by the infant after they are born because the baby no longer receives drugs through the mother’s bloodstream. Opioid withdrawal is not deadly in adults although it can be seriously uncomfortable; however, in newborns, the condition can be life-threatening.

The Centers for Disease Control and Prevention (CDC) lists symptoms of NAS after birth as autonomic over-reactivity, central nervous system irritability, and gastrointestinal system dysfunction. The CDC reports that between 1999 and 2013, incidents of NAS increased more than 300 percent in 28 states – from 1.5 out of every 1,000 hospital births in 1999 to 6 out of every 1,000. In 2012, there were reportedly 21,732 instances of babies born with NAS in the United States.

During the heroin epidemic in the 1970s, when this serious infant condition was first described as a medical problem, NAS occurred in association with maternal heroin or morphine addiction. In this current epidemic, mothers are more likely to struggle with heroin due to previous prescription painkiller abuse, including abuse of hydrocodone, oxycodone, codeine, morphine, or methadone. Other drugs can also cause NAS in newborns, including antidepressants, benzodiazepines, and alcohol.

Symptoms of Neonatal Abstinence Syndrome

Children who develop neonatal abstinence syndrome will experience the onset of withdrawal symptoms within 24-72 hours after birth – a similar rate of time to adults who develop withdrawal symptoms after they stop taking the drug. Also like adults, infants who develop NAS can experience symptoms for five days. A baby born with NAS may experience:

• Mottling or blotchiness in the skin
• Diarrhea
• High-pitched crying
• Excessive crying and irritability
• Excessive suckling
• Poor feeding
• Hyperactive reflexes
• Fever
• Sweating
• Increased muscle tone
• Rapid breathing
• Sleep problems
• Trouble gaining weight
• Stuffy nose and sneezing
• Trembling or shaking
• Vomiting
• Seizures

Symptoms and severity of NAS in infants can depend on:

• Which opioid the mother abused
• How much of the drug the mother abused
• How long the mother struggled with opioid addiction
• Genetic factors influencing the body’s ability to break down and clear the opioid
• When the baby was born, with prematurity resulting in more severe withdrawal symptoms

Treatment for NAS

Ultimately, treatment of neonatal abstinence syndrome involves comfort. The physical discomfort and pain experienced by infants with NAS requires lots of loving care. Gentle rocking, low noise levels and dim lights, and swaddling the child in a warm blanket can all help the baby feel more comforted and secure. Some studies have shown that infants with NAS who are allowed to room with their mothers for consistent physical touch and breastfeeding have shorter hospital stays compared to infants who remain in neonatal wings.

More intense withdrawal symptoms may require IV fluids; excessive vomiting not only prevents the child from gaining weight but may also lead to dehydration. The infant may even need low levels of buprenorphine, methadone, or morphine, just like adults easing off opioid dependence. Phenobarbital or clonidine may also be used in very small doses to relax the muscles and lessen some of the panic associated with the infant’s withdrawal. Between 60 percent and 80 percent of infants with severe NAS do not respond to nonmedical interventions and require supervised pharmacological treatment. Another study found that 50-70 percent of babies with NAS require pharmacological interventions.

Unfortunately, long-term health complications may occur in children who struggle with NAS. These include:

• Birth defects
• Sudden infant death syndrome (SIDS)
• Low body weight
• Small head circumference
• Trouble with physical and emotional development
• Behavioral disorders

Women who are pregnant or want to become pregnant and struggle with opioid addiction can get help from addiction specialists. Buprenorphine was approved by the Food and Drug Administration (FDA) in 2002 as a prescription treatment to manage opioid withdrawal, and it has been found effective in pregnant women, although neither buprenorphine nor methadone have been approved as a detox treatment during pregnancy. Because these drugs are both opioid agonists to an extent, they can still lead to NAS.

Treatment focused on women’s needs, including issues related to pregnancy and medical care for children who suffer long-term effects of NAS, is crucial to helping more women recover from opioid addiction.