What is Neonatal Abstinence Syndrome (NAS)?

Neonatal Abstinence Syndrome (NAS) is a group of withdrawal symptoms that some newborns develop after being exposed in the womb to certain substances, most commonly opioids (e.g., heroin, oxycodone, methadone, buprenorphine). The term is sometimes used broadly for multiple drug exposures; when it’s specifically opioid-related, you’ll also see Neonatal Opioid Withdrawal Syndrome (NOWS).

How it’s diagnosed

• Maternal history and/or toxicology (maternal and/or infant)
• Clinical scoring/assessment tools: classic Finnegan score or newer Eat-Sleep-Console (ESC) approach focused on functional well-being.

How Does a Baby Get NAS?

Unborn babies are sponges for their mothers’ nutritional and medicinal intake, regardless of safety. When a mother is using the most powerful prescription painkillers available, her baby will be affected. And when a baby is born and its supply of opioids is cut off, it will experience drug withdrawal just like an adult — except to far worse effect. Drugs that a mother has taken during pregnancy can take months to leave her newborn’s body.

While opioids are the most difficult drugs for a newborn to withdraw from, all drug use during pregnancy can lead to NAS. When more than one drug has been used, the symptoms are often worse.

The following drugs used during pregnancy have been correlated to damaging effects in children:

• Opioids: NAS resulting from opioid use can produce symptoms that last as long as 4 to 6 months.
• Amphetamines: Can lead to low birth weight and premature birth.
• Cocaine: Can cause poor growth in a fetus, and birth injuries such as placental abruption.
• Marijuana: Is correlated with lower birth weight, as well as learning and behavioral problems later in life.
• Alcohol: Alcohol abuse during pregnancy can slow growth and lead to heart defects, learning problems and mental disorders.
• Tobacco: Is correlated with low birth weight and may put babies at higher risk for premature birth and stillbirth.

What Are the Symptoms of NAS?

According to Stanford Children’s Health, NAS usually manifests between 24 hours and 10 days after birth. The symptoms will differ for each baby and are also affected by its mother’s drug usage. Pre-term births are also less likely to manifest the worst symptoms of NAS, due to their reduced exposure to their mothers’ drug intake.

Signs of NAS include:

• Trembling
• Too much crying or high-pitched crying
• Sleep problems
• Tight muscle tone
• Overactive reflexes
• Seizures
• Yawning, stuffy nose and sneezing
• Poor feeding and sucking
• Vomiting or diarrhea
• Sweating
• Fever or unstable temperature

What Are the Long-Term Effects of NAS?

So much is unknown about the long-term ramifications of NAS, but the condition has been linked to the following complications:

• Low birth weight
• Poor feeding and slow weight gain
• Vision, hearing and speech problems
• Delayed motor skills
• Behavioral issues
• Heart problems
• Spina bifida (a spinal defect which often causes paralysis)
• Sudden Infant Death Syndrome