Neonatal Abstinence Syndrome (NAS) - Crozer-Keystone Health System - PA

Neonatal Abstinence Syndrome

Neonatal Abstinence Syndrome (NAS) occurs when a baby who was exposed to addictive drugs in the womb experiences withdrawal after birth.Neonatal Abstinence Syndrome (NAS) occurs when a baby who was exposed to addictive drugs in the womb experiences withdrawal after birth. For some infants that experience withdrawal, symptoms are bad enough that they require hospitalization and treatment.

It is important for families to be honest with their doctors about the medications they take during their pregnancy in an effort to prepare a family for the possibility of NAS.

What Causes Neonatal Abstinence Syndrome?

Almost every drug and medicine an expectant mother uses passes from her bloodstream through the placenta to her unborn baby. If the mother uses addictive opiate or narcotic drugs (whether by prescription or not) the unborn baby can become dependent on the drug. At birth, the baby continues to need the drug. However, because the drug is no longer available, the baby goes through withdrawal.

The drugs and medicines most likely to cause the syndrome include:

  • Opiates like heroin and prescribed medicines such as codeine, oxycodone, methadone, subutex and suboxone 
  • Benzodiazepines such as Valium, Xanax and Klonopin
  • Other substances that can cause physical dependence

Withdrawal Symptoms

Initial signs and symptoms of withdrawal can include tremors, crankiness, difficulty feeding, rashes, sneezing and diarrhea as well as other symptoms. Most worrisome is that withdrawing infants can experience seizures.

Symptoms of the syndrome may vary depending on the type of drug used, the last time it was used and whether the baby is full-term or premature.

Symptoms may start as soon as 24 to 48 hours after birth, or they may start as late as 5 to 10 days after birth.

Treating Neonatal Abstinence Syndrome

All babies with NAS symptoms will receive specialized supportive treatment throughout the withdrawal process that is proven to help with symptoms. Despite this support, most babies will also require treatment for NAS symptoms with morphine or other medications.

If your child requires treatment or prolonged observation for signs of withdrawal, he or she will be transferred to the pediatric unit and receive care there. In certain instances, infants may require more intensive care in the neonatal intensive care unit (NICU). The aim will always be to do what is best for your baby.

Your child will be monitored for signs of withdrawal or Neonatal Abstinence Syndrome (NAS) based on nursing assessment, your history or a positive screen of their urine or stool. The nurses and doctors use a validated scoring system to determine if your child will require longer monitoring and/or treatment with morphine given by mouth.

If your child requires morphine, they will continue to be scored during their treatment. Morphine starts at a set dose and is weaned based on your child’s behaviors and scores. Some babies may require additional medications to help with their withdrawal symptoms. A child will not be able to go home until they are off of morphine and are able to cope with symptoms without medication. The time it takes for this to occur varies from patient to patient.

Once your baby is off morphine and the team and the family have met the discharge requirements, your child will be cleared to go home.

It is important for all those involved in your child’s care to be on the same page and knowledgeable about the care of your infant. Please feel free to ask us questions as we all work together in this process

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