Neonatal abstinence syndrome (also called NAS) happens when a baby is exposed to drugs in the womb before birth. A baby can then go through drug withdrawal after birth.
NAS most often is caused when a woman takes opioids during pregnancy. Opioids are painkillers (used to relieve pain) your provider may prescribe if you’ve been injured or had surgery. Prescription opioids include codeine and hydrocodone (Vicodin®), morphine (Kadian®, Avinza®), and oxycodone (OxyContin®, Percocet®). The street drug heroin is also an opioid. Other prescribed drugs such as antidepressants and sleeping pills can also lead to NAS.
When you take these kinds of drugs during pregnancy, they can pass through the placenta and cause serious problems for your baby. The placenta grows in your uterus (womb) and supplies your baby with food and oxygen through the umbilical cord.
Babies with NAS are more likely than other babies to be born with low birthweight (less than 5 pounds, 8 ounces), have breathing and feeding problems and seizures. They usually have to stay in the hospital longer after birth than babies without NAS (nearly 14 days).
Signs and symptoms can be different for every baby with NAS. Most appear within 3 days (72 hours) of birth, but some can appear right after birth or within a few weeks of birth. Signs and symptoms can include:
- Body shakes (tremors), seizures (convulsions), overactive reflexes (twitching) and tight muscle tone
- Fussiness, excessive crying or having a high-pitched cry
- Poor feeding, poor sucking or slow weight gain
- Breathing really fast
- Fever, sweating or blotchy skin
- Trouble sleeping and lots of yawning
- Diarrhea or throwing up
- Stuffy nose or sneezing
Hospitals and your doctor can and do test for the presence of NAS in newborns. If your health care provider does detect the presences on NAS they may suggest treatment that may include:
- Medications to treat or manage severe withdrawal symptoms. Your baby’s provider may give her a medicine that’s similar to the drug you used during pregnancy. This can help relieve your baby’s withdrawal symptoms. Once these symptoms are under control, your baby gets smaller doses of the medicine over time so her body can adjust to being off the medicine. Medicines used to treat severe withdrawal symptoms include morphine, methadone and buprenorphine.
- Getting fluids through a needle into a vein (also called intravenous or IV). Babies with NAS can get very dehydrated from having diarrhea or throwing up a lot. If a baby’s dehydrated, she doesn’t have enough water in her body. Getting fluids through an IV helps keep your baby from getting dehydrated.
- Drinking higher-calorie baby formula. Some babies with NAS need extra calories to help them grow because they have trouble feeding or slow growth.
- Parental care that includes swaddling your baby in a blanket, skin to skin care (put your baby dressed only in a diaper on your bare chest, keeping your newborn in a quiet, dimly lit room, and breastfeeding.
The long-term effects on infants born dependent on opioids (heroin) or other drugs is at this point unknown.
If you’re pregnant and you use any of the drugs that can cause NAS, tell your health care provider right away. But don’t stop taking the drug without getting treatment from your provider first. Quitting suddenly (sometimes called cold turkey) can cause severe problems for your baby, including death. If you need help to stop using these drugs, talk to your provider about treatment to help you quit. Getting treatment can help you stop using drugs and is safer for your baby than getting no treatment at all.
If you’re addicted to opioids, medication-assisted treatment (also called MAT) during pregnancy can help your baby. NAS in babies may be easier to treat for babies whose moms get MAT during pregnancy. Medicines used in MAT include methadone and buprenorphine.
Even if you use a prescription drug exactly as your provider tells you to, it may cause NAS in your baby. During pregnancy, tell your prenatal care provider about any drug or medicine you take. If you go to a health care provider who prescribes medicine to treat a health condition (like sleep problems or severe pain), make sure that provider knows you’re pregnant. You may need to stop taking certain medicines or change to medicine that’s safer for your baby. Ask all your health care providers if the drugs you take—even prescription drugs—can cause NAS in your baby.
If you’re not pregnant and using any of the drugs that can cause NAS, use birth control until you’re ready to get pregnant. Birth control (also called contraception or family planning) is methods you use to keep from getting pregnant.
If you’re pregnant or thinking about getting pregnant, tell your health care provider right away about any drug or medicine you take. She can make sure that what you’re taking is safe for you and your baby. She also can help you get treatment for using street drugs or abusing prescription drugs if you need it. If you abuse prescription drugs, it means you take more than has been prescribed for you, you take someone else’s prescription drug, or you get the drug from someone without a prescription.
If you’re not pregnant, quit using street drugs or abusing prescription drugs before you get pregnant. This is the best way to prevent NAS.