The condition Neonatal Abstinence Syndrome (NAS) affects newborns exposed to certain substances during pregnancy, such as opioids. It is through the placenta, which provides oxygen and nutrients to the baby, that these substances can pass from the mother's bloodstream to the baby's. As the body adjusts to not having these substances anymore after birth, the baby may experience withdrawal symptoms. The baby may experience various health problems as a result of NAS, which requires medical attention and monitoring.
NAS is caused by different types of substances that affect the mother's and baby's nervous systems.
Heroin, codeine, oxycodone, methadone, or buprenorphine are opioids that relieve pain and produce euphoria. They are often prescribed for chronic pain, but can also be misused.
Drugs that increase alertness and energy, as well as heart rate, blood pressure, and body temperature, such as amphetamines and cocaine.
Drugs that slow down brain activity, such as barbiturates, benzodiazepines, alcohol, or marijuana. They can also cause drowsiness, relaxation, and reduced anxiety.
In addition to treating depression and other mood disorders, antidepressants can also affect the levels of certain brain chemicals, such as serotonin, that regulate mood and behavior.
Cigarette smoking produces nicotine, a substance that stimulates the nervous system and increases the release of dopamine, a chemical that causes pleasure and reward.
NAS is affected by several factors, including:
Mother's substance use and amount
Mother's substance use duration and frequency
Before delivery, the mother's last substance use
Mother's metabolism and baby's genetics
Baby's gestational age and health
There are a variety of symptoms associated with NAS, depending on the substance involved, the dose, and the baby's response. The symptoms may start 24 to 48 hours after birth, or as late as 5 to 10 days after birth. Symptoms may last from a few days to several weeks.
NAS is characterized by the following symptoms:
Seizures, tremors, or shaking
Crying that is excessive or high-pitched
A tendency to be irritable or fussy
Problems settling down or sleeping
Feeding or sucking problems
Diarrhea or vomiting
Weight loss or dehydration
Sweating or fever
Problems breathing or fast breathing
Sneezing or stuffy nose
Rashes or blotchy skin
Overactive reflexes or increased muscle tone
It is possible for some babies to have mild symptoms that can be managed at home with supportive care and close monitoring, while other babies may have more severe symptoms that require hospitalization and medication.
The diagnosis of NAS is based on the history of substance abuse by the mother, the clinical signs and symptoms of the baby, and the results of urine or meconium tests. During the early days of childbirth, the baby passes meconium, the first stool he or she passes. It can contain traces of substances that the baby was exposed to while in the womb.
Health care providers may use a scoring system to assess the baby's withdrawal severity. The scoring system assigns points to different signs and symptoms of NAS, such as crying, feeding, sleeping, and breathing. The total score determines whether the baby needs medication or not.
NAS is treated based on the type and severity of symptoms, the substance involved, and the baby's overall health. The main goals of treatment are:
Provide relief to the baby's discomfort and distress
Infections or complications should be prevented or treated
Ensure the baby's growth and development
Encourage mother-baby bonding and attachment
Provide a safe and nurturing environment for the baby while helping the mother overcome substance use disorder
NAS may be treated with the following options:
Swaddling, rocking, soothing, breastfeeding, skin-to-skin contact, and a quiet, dimly lit room can help calm the baby and reduce the need for medication.
A medication such as morphine, methadone, or buprenorphine can relieve withdrawal symptoms and prevent seizures. It is administered in small doses and tapered off gradually as the baby improves. Usually, the medication is taken orally, but it is sometimes administered intravenously or through a tube into the stomach.
If the baby has dehydration, breathing problems, infections, or another medical condition, specialized care may be needed.
A baby's health and progress can be monitored and addressed with follow-up care, such as regular check-ups, developmental screenings, immunizations, and referrals to other services.
NAS can be treated by a team of health care providers, such as pediatricians, neonatologists, nurses, pharmacists, social workers, and counselors. The family, particularly the mother, may also be involved in the treatment process.
In order to prevent NAS, it is important to avoid substances that can harm the baby during pregnancy. It is important for the mother to seek help from a health care provider or a substance abuse treatment program as soon as possible if she has a substance abuse disorder. It is possible for the health care provider to help the mother and baby find the right treatment options, such as:
The mother can stop using illicit opioids with medication-assisted treatment (MAT), including methadone or buprenorphine. MAT reduces withdrawal, overdose, and relapse risks for the mother. MAT can also improve the outcomes for the baby, such as reducing the severity and duration of NAS, and increasing the chances of a full-term and healthy birth.
The mother can change her thoughts, feelings, and behaviors regarding substance use with behavioral therapy, such as cognitive-behavioral therapy (CBT) or contingency management. In addition, it can help the mother deal with stress, cravings, triggers, and relapse prevention.
A support group such as Narcotics Anonymous (NA) or Alcoholics Anonymous (AA) can provide the mother with peer support, encouragement, and guidance from other people who have had similar experiences.
There are also services available to help mothers address the social and economic factors that may affect their health and well-being, and their ability to care for their babies, such as prenatal care, nutrition, housing, transportation, child care, education, or employment.
