Addiction and Neonatal Abstinence Syndrome

If you use drugs while pregnant, you expose your unborn baby to neonatal abstinence syndrome or other drug-related side effects.

What Is Neonatal Abstinence Syndrome?

When babies withdraw from drugs in the womb due to mothers using substances while being pregnant, they can develop physical and behavioral conditions. This group of disorders is called neonatal abstinence syndrome (NAS). There are two types of NAS: prenatal NAS and postnatal NAS.

Prenatal NAS is when substance abuse during pregnancy causes withdrawal symptoms in newborns when stopped. Prenatal NAS is more common and a leading cause of children and infants’ physical, mental, and psychological problems. Postnatal NAS is what happens when medications, like fentanyl or morphine, are discontinued for newborns admitted to the Neonatal Intensive Care Unit (NICU).1

Neonatal Abstinence Syndrome


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Neonatal Abstinence Syndrome Statistics

According to the Centers for Disease Control and Prevention in their 2019 report:

  • 7% of women reported using prescription opioids to relieve pain during pregnancy.
  • 1 in 5 women that used prescription opioids during pregnancy obtained the drugs from a non-healthcare provider
  • Among the women who reported using prescription opioids to relieve pain during pregnancy, 21.1% reported misusing the drugs, while 31.9% reported not getting counseling advice about how opioid use could affect the unborn baby.2

Addiction And Neonatal Abstinence Syndrome

Addiction to opioids, medicines, or other substances can quickly lead to neonatal abstinence syndrome for an unborn baby. Various factors, such as environment or genetics, can cause this addiction as well. In cases of alcohol, drugs, or nicotine, they affect how people feel both mentally and physically. These enjoyable feelings create a strong urge to continue using the drugs. Once the body adapts to a substance, oftentimes many people:

  • Continue using the drug even when it causes harm.
  • Lose interest in doing other daily activities.
  • Develop withdrawal symptoms when drug usage has stopped.
  • See changes in sleeping habits, weight, or eating habits.
  • Become moody, violent, angry, or depressed.

Neonatal abstinence syndrome means that many of these symptoms also impact the newborn, even though the mother is the one using.

What Causes Neonatal Abstinence Syndrome?

Almost all medicines or substances that pass from the mother’s bloodstream to the child’s placenta will cause neonatal abstinence syndrome. If someone is using a drug that affects the nervous system, this means that it will also affect the baby’s nervous system. Since the substance or medicine is no longer available to the child after the birth, the child develops withdrawal symptoms.

Substances that Can Lead to Neonatal Abstinence Syndrome

Opioids like methadone and heroin have been linked to most NAS cases. When the mother uses different or multiple drugs, it can worsen the symptoms of NAS for the baby. NAS can also result from other substances or medications such as:

  • Stimulants
  • Antidepressant medicines like
  • SSRIs and barbiturates
  • Depressants
  • Nicotine
  • Benzodiazepines
  • Alcohol use

Signs And Symptoms of Neonatal Abstinence Syndrome

Signs and symptoms of neonatal abstinence syndrome (NAS) differ from one baby to the other. While most NAS can last between seven to ten days, others can go on for up to six months or more after birth. Neonatal abstinence syndrome signs occur as either metabolic, gastrointestinal, neurological, or respiratory withdrawal symptoms. These signs can range from being mildly discomforting, to directly impeding on health and wellness. Those symptoms will be detailed below.

Neurological Excitability and Neonatal Abstinence Syndrome

Neurological Excitability symptoms include:

  • Agitation and restlessness
  • Sleep difficulties
  • Hyper-irritability
  • Tremors and a possibility of seizures
  • Excessive and high-pitched crying
  • Hyperactive tendon reflexes
  • Frequent yawning

Respiratory and Metabolic Disturbances and Neonatal Abstinence Syndrome

Respiratory And Metabolic Disturbance signs are:

  • Irregular body temperature
  • Problems breathing
  • Excessive sweating
  • Blotchy skin
  • Fever
  • Nasal flaring, sneezing, and stuffiness
  • Mottling of the skin

Gastrointestinal Dysfunction and Neonatal Abstinence Syndrome

Gastrointestinal Dysfunction examples include:

  • Diarrhea
  • Dehydration
  • Vomiting
  • Excessive sucking
  • Poor feeding
  • Slow weight gain

Factors That Affect the Symptoms of Neonatal Abstinence Syndrome

Many factors influence the symptoms of neonatal abstinence syndrome, including social, family, genetic, and individual factors. An environment with easy access to drugs leads to a higher intake of drugs for the mother. Also, people living in a stressful environment can resort to taking medications to help cope with daily living. Once the mother begins taking drugs, the unborn baby is at risk of developing NAS and other complications very quickly.3

Risks And Complications of Neonatal Abstinence Syndrome

Apart from the above signs and symptoms, neonatal abstinence syndrome can also cause even more complications for the newborn. These complications indicate developmental difficulties that usually require medication under the supervision of medical professionals.

Complications Ensuing from Neonatal Abstinence Syndrome

Complications from neonatal abstinence syndrome include:

  • Congenital disabilities
  • Seizures
  • Jaundice
  • Premature birth
  • Low birth weight
  • Sudden Infant Death Syndrome (SIDS)
  • Vision problems
  • Problems with behaviors and development
  • Ear infections
  • Motor problems

Neonatal Abstinence Syndrome Diagnosis

There are several tests that medical professionals use when diagnosing NAS.

NAS Scoring System

Many medical providers grade NAS symptoms using the NAS scoring system. The doctor will diagnose the severity of the condition from the reports and tests done by the medical team and then create a treatment plan and follow-up care for the mother and baby after discharge.

The most used NAS scoring system is the Finnegan Neonatal Abstinence Scoring System. This system gives points to specific signs and symptoms and then tracks them over seven days. The doctor begins scoring about a day after the birth and continues to monitor the symptoms every three to four hours while adjusting the scores as needed.

ESC Evaluation

Eating, Sleeping, Consoling for Neonatal Withdrawal (ESC-NOW) is a management approach and function-based assessment for drug-addicted babies. The approach monitors the baby’s body functions before the doctor administers morphine as needed in order to help with the symptoms.4

Drug, Urine, or Meconium Screen

A medical provider may test your baby’s urine, blood, or meconium samples in order to help diagnose neonatal abstinence syndrome. A meconium sample is the baby’s first bowel movement.

Treatment For Neonatal Abstinence Syndrome

NAS baby  

Treatment for NAS involves both medications from medical professionals as well as some other ways to help them recover.

Neonatal Abstinence Syndrome Treatment Options

In infants, the standard treatments for NAS involve using medicine and receiving intravenous (IV) fluids or higher calorie baby formula. Babies with NAS can experience severe symptoms like seizures that often need drugs to manage. Common medicines that treat NAS withdrawal symptoms include methadone, morphine, and buprenorphine.

IV fluids prevent babies with NAS from dehydration, as NAS and withdrawal causes excessive vomiting and diarrhea. Higher calorie baby formula helps give the babies the extra calories they need since babies battling NAS have troubled feeding and increased activity.

While most babies recover from NAS within five to thirty days after treatment, the long-term effects of substance use can last for years and impact their growth as well.

Some Tips to Help Calm the Baby

Calming a crying or agitated baby affected by NAS can be challenging. While the following techniques can help calm down the baby, take note of the child’s cues as well, since all babies are different. Some of these tips include:

  • Movement: Hold the baby in your arms and move around the room. Accompany the movement with soothing whispers, caresses, and gentle patting on the back. You can also walk with them around the room or outside to try and help as well.
  • Massages: These help alleviate the pains of colic in the baby and soothe crying. You can add creams or oils to increase the child’s well-being and enhance its benefits.
  • Sound: The parents’ voices can often calm babies. Your voice brings a primitive sense of protection to your child.
  • Bath time: Hot water relaxes the baby’s muscles and releases tension. Accompany the bath with a quiet environment and caresses.

Get Treatment for Addiction and Neonatal Abstinence at Concise Recovery

Neonatal abstinence syndrome is easy to treat when parents and babies alike can get medication-assisted training (MAT) during pregnancy. Concise Recovery ensures a safe detox space and a healing environment for both you and your unborn baby. Reach out today and talk to one of our medical professionals if you are struggling with substance use disorder.