Neonatal Abstinence Syndrome (NAS) | Symptoms & Causes
What are the symptoms of NAS?
Symptoms of NAS may vary depending on the type of substance used, the last time it was used, and whether your baby is full-term or premature. Symptoms of withdrawal may begin as early as 24 to 48 hours after birth, or as late as five to 10 days. Alcohol withdrawal may begin within a few hours after birth.
Symptoms of withdrawal in full-term babies may include:
- tremors (trembling)
- irritability (excessive crying)
- sleep problems
- high-pitched crying
- tight muscle tone
- hyperactive reflexes
- seizures
- yawning, stuffy nose, and sneezing
- poor feeding and suck
- vomiting
- diarrhea
- dehydration
- sweating
- fever or unstable temperature
- rapid breathing
An accurate report of the mother's drug usage is important in order for doctors to properly treat the baby. A neonatal abstinence scoring system may be used to help diagnose and grade the severity of the withdrawal. Using the scoring system, points are assigned for certain signs and symptoms and the severity of each. This scoring may also help in planning treatment.
What causes neonatal abstinence syndrome?
Almost every drug passes from the mother's blood stream through the placenta to the fetus. Illicit substances that cause drug dependence and addiction in the mother also cause the fetus to become addicted. At birth, your baby's dependence on the substance continues. However, since the drug is no longer available, your baby's central nervous system becomes overstimulated causing the symptoms of withdrawal.
Some drugs are more likely to cause NAS than others, but nearly all have some effect on your baby. Opiates, such as heroin and methadone, cause withdrawal in about half of babies exposed prenatally.
- Cocaine may cause some withdrawal, but the main symptoms in your baby are due to the toxic effects of the drug itself.
- Other drugs, such as amphetamines, barbiturates, and narcotics, can also cause withdrawal.
- Alcohol use causes withdrawal in your baby, as well as a group of problems including fetal alcohol syndrome.
Neonatal Abstinence Syndrome (NAS) | Diagnosis & Treatments
How do we treat neonatal abstinence syndrome?
Babies suffering from withdrawal are irritable and often have a difficult time being comforted.
- Swaddling, or snugly wrapping your baby in a blanket, may help comfort your baby.
- Babies also may need extra calories because of their increased activity and may need a higher calorie formula. Intravenous (IV) fluids are sometimes needed if your baby becomes dehydrated or has severe vomiting or diarrhea.
Some babies may need medications to treat severe withdrawal symptoms, especially for seizures. Specific drugs for treating withdrawal are:
- methadone for heroin and other opiate withdrawal
- benzodiazepines (for alcohol withdrawal)
Other drugs are also being used to help relieve the discomfort and problems of withdrawal. The treatment drug is usually in the same class as the substance your baby is withdrawing from. Once the signs of withdrawal are controlled, the dosage is gradually decreased to help wean your baby off the drug.
How we care for NAS
Boston Children's is devoted to addressing the needs of high-risk babies and their families. One such program is our Young Parents Program (YPP), which provides quality medical care and health education to teen or at-risk parents and their children in low-income and at-risk environments.
YPP is part of the Children's Hospital Primary Care Center (CHPCC), which is dedicated to helping young parents learn positive parenting skills, attitudes, and behaviors so their child experiences healthy development and growth in the critical first years.
