Neonatal Abstinence Syndrome?

By The Recovery Village

Editor Nicole LaNeve

Reviewer Benjamin Caleb Williams

Updated on11/25/19

To be born healthy and well, babies rely on the actions of their mothers. Almost everything expectant women consume affects their unborn babies, and drug use during pregnancy can be extremely detrimental to a fetus. Babies whose mothers misused drugs or alcohol during pregnancy may face a unique set of short-term and long-term developmental challenges, including neonatal abstinence syndrome.

Understanding Neonatal Abstinence Syndrome

Vital nutrients and dangerous substances alike can pass through the placenta to a fetus, meaning that whatever a mother consumes, the baby ingests, also.

If an expectant mother faces a drug or alcohol addiction, her unborn baby also feels the effects of substance abuse in the womb, and the baby may experience withdrawal symptoms upon birth.

Using prescription drugs or illicit substances (especially opioids) during pregnancy can lead to neonatal abstinence syndrome (NAS), a group of conditions that include drug withdrawal symptoms in newborns and can lead to a variety of physical complications.

What Causes Neonatal Abstinence Syndrome?

Typically, the neonatal abstinence syndrome definition involves the difficulties infants face from exposure to several kinds of drugs while in utero.

For a NAS baby, this condition develops mainly from the prenatal use of:

• Prescription and illicit opioids, like OxyContin and heroin, respectively
• Antidepressants such as Zoloft
• Benzodiazepines, including Xanax and Valium

Mothers may use these drugs during pregnancy for a variety of reasons. For example, they may take opioids for post-surgical pain, or use antidepressants and benzodiazepines to ease the symptoms of mental health conditions.

Regardless of why prescription or illicit drugs were consumed, their use must be ceased before pregnancy to avoid NAS completely. It’s imperative for expectant mothers to consult with medical professionals as a part of family planning so that they can transition to safer medications before conceiving a child.

Signs and Symptoms of Neonatal Abstinence Syndrome

Regardless of which drug a baby is exposed to in the womb, NAS can result in a variety of issues upon birth. Typically, NAS affects various areas of a newborn’s body, including the respiratory system, central nervous system, gastrointestinal tract and autonomic nervous system, causing a range of uncomfortable side effects.

Common symptoms of NAS include:

Neurological Excitability

• Hyperirritability
• High-pitched and excessive crying
• Agitation and restlessness
• Sleeping difficulties
• Tremors (body shaking) and seizures (convulsions)

Metabolic and Respiratory Disturbance

• Fever or blotchy skin
• Nasal flaring, stuffiness and sneezing
• Irregular body temperature
• Excessive sweating
• Excessive yawning

Gastrointestinal Dysfunction

• Diarrhea
• Dehydration
• Vomiting
• Poor feeding ability
• Excessive sucking
• Slow weight gain

In addition to these symptoms, NAS can cause complications such as low birth-weight (defined as a birth weight less than five pounds, eight ounces) and jaundice, which is a yellowing of the skin and eyes often due to a weak liver. These conditions are indicative of developmental difficulties as prenatal opioid use can stunt an infant’s growth.

The severity of NAS symptoms and developmental issues depends on factors including:

• If the baby was born prematurely (prior to 37 weeks of pregnancy)
• Which drugs were used during pregnancy
• The quantity and length of use of each drug during pregnancy
• The efficiency of the mother’s metabolism
• Whether the mother smoked cigarettes or used sedatives or stimulants (like cocaine)

Clarifying Language: What Happens to Babies Born Addicted to Drugs?

The term “Born addicted,” is frequently used to describe babies who are born with alcohol- and drug-related conditions like fetal alcohol spectrum disorders (FASD) and neonatal abstinence syndrome (NAS). However, this language is inaccurate as babies are not born addicted to the drugs their mother used, and usually recover from their symptoms with treatment.

Fortunately, NAS is rarely fatal, but it can spur severe illness and often results in extended hospital stays. Although symptoms can range in severity, few subside quickly. Infants who are labeled as “Babies born addicted” to opioids or other drugs may require immediate medical assistance, and their persisting symptoms may require weeks or even months of clinical treatment in a neonatal intensive care unit (NICU). However, recovery is possible for these babies with the right care.

Neonatal Abstinence Syndrome Timeline

The onset and duration of NAS depend on several different factors, including the type of substance and amount used during pregnancy, along with its frequency of use and when the last dose was taken.

By far, the greatest predictor of a NAS timeline is which substance was used during pregnancy. As each type of drug (opioids, antidepressants, benzodiazepines, etc.) has a different chemical makeup and the way in which the body uses it, the NAS withdrawal timeline varies significantly by substance.

When Does Neonatal Abstinence Syndrome Start?

Most symptoms of neonatal abstinence syndrome appear within 48-72 hours of birth. In cases where a fetus has been exposed to heroin, antidepressants, methamphetamines or inhalants, the onset of symptoms may start as early as 24 hours after the baby’s delivery. However, some symptoms of drug misuse during pregnancy may not manifest for several weeks and may require months of intensive care treatments to overcome.

NAS Onset, By Drug:

Opioids:

Heroin: 24–48 hours

Buprenorphine: 36–60 hours

Methadone: 48–72 hours

Other prescription opioids: 36–72 hours

Non-Opioids:

Methamphetamines: 24 hours

Inhalants: 24–48 hours

Antidepressants:

Tricyclic antidepressants (TCA): 24–48 hours

Selective serotonin reuptake inhibitors (SSRI): 24–48 hours

How Long Does Neonatal Abstinence Syndrome Last?

The signs and symptoms of NAS can vary from infant to infant, depending on the type and amount of drugs their mother used during pregnancy. Although time estimates are different for each substance, most NAS symptoms last for seven to 10 days.

However, NAS cases that involve the opioids methadone or buprenorphine (long-acting opioids) may require a recovery time of 30 days or more. In more extreme cases, NAS symptoms can linger up to six months. However, most babies who get treatment for NAS can recover from the initial effects within five to 30 days. The long-term effects of substance use, however, can last for years or even throughout the child’s life.

NAS Duration, By Drug:

Opioids:

Heroin: 8–10 days

Buprenorphine: 28+ days

Methadone: 30+ days

Other prescription opioids: 10–30 days

Non-Opioids:

Methamphetamines: 7–10 days

Inhalants: 2–7 days

Antidepressants:

Tricyclic antidepressants (TCA): 2–6 days

Selective serotonin reuptake inhibitors (SSRI): 2–6 days

Neonatal Abstinence Syndrome Facts

As it involves a variety of factors, NAS may be difficult to understand at first. Weeding through misinformation may be difficult, and it’s imperative for women planning families to be aware of what NAS is, and isn’t.

To separate myth from fact, neonatal abstinence syndrome is:

• A group of issues, not a singular disorder: These can include drug withdrawal, impaired development and jaundice, among other conditions.
• Most commonly caused by prenatal opioid use: Opioids include prescription medications such as morphine and oxycodone, as well as illicit substances like heroin. Less frequently, NAS can be caused by an expectant mother’s use of benzodiazepines or antidepressants.
• Possible even if medications are used as prescribed: Even if an expectant mother takes the exact dose of an opioid medication recommended by her doctor, this can lead to the development of NAS in her unborn baby.
• Preventable before pregnancy: Stopping the use of opioids, benzodiazepines and antidepressants prior to conception can help prevent NAS. There are always alternatives to these medications that are safer for the mother and baby.
• Fully treatable with the right care: While NAS can mean extended hospital stays, it can be treated with clinical care, medication assistance plans and holistic remedies.

How Common Is Neonatal Abstinence Syndrome?

When considering the rising number of “babies born addicted to drugs,” (the inaccurate term to describe babies who are born with conditions like NAS) statistics show that neonatal abstinence syndrome is growing more frequent.

In recent years, NAS has grown more prevalent in conjunction with the nationwide opioid epidemic. More people are becoming addicted to opiates of all kinds (prescription and illicit), and pregnant women are no exception.

According to the National Institute on Drug Abuse, cases of NAS increased five-fold from 2000 to 2012, when nearly 21,732 infants faced the debilitating condition. In 2012, it was estimated that every 25 minutes, one baby was born with NAS. Today, a NAS baby is born almost every 15 minutes.

Neonatal Abstinence Syndrome Statistics

When planning for a family, expectant mothers and fathers may search online for terms like “How many babies are born addicted to drugs?” Current statistics reveal that NAS is a much larger issue than most people realize, both at the state level and on a national scale.

NAS by the Numbers: Statistics on Neonatal Abstinence Syndrome

The statistics of “babies born addicted to drugs” (babies who are born with drug- or alcohol-related conditions like NAS) paint a grim picture of the reality of NAS.

• Every 15 minutes, a baby is born with opioid withdrawal
• Nearly 50–75 percent of infants exposed to opioids in utero require medical assistance for withdrawal
• From 1999 to 2013, the incidence of NAS rose 300 percent in the United States
• In the U.S., the number of babies born addicted to opioids has tripled in 15 years
• In Ohio, the rate of NAS increased by 800 percent between 2004 and 2013

Neonatal Abstinence Syndrome Rates

Many people wonder, “How many babies are born addicted to drugs each year?” The answer to this question remains unclear, for two reasons: firstly, “born addicted,” is an incorrect term, and secondly, the known data is largely based on estimates and small studies from individual states.

However, in the case of infants born with NAS, the Centers for Disease Control and Prevention (CDC) estimates that nationwide, a shocking six out of every 1,000 babies are born with NAS, as of 2013 data.

The CDC records incidents of NAS through reports from 28 states that track opioid addiction vigilantly. Each state has seen a rise in NAS in recent years, but the states with the highest neonatal abstinence syndrome rates are Maine, Vermont and West Virginia. Two of these are also among the top 10 states with the highest drug overdose rates. The more a region struggles with drug addiction, the more likely its tiniest residents will face NAS.

How Is Neonatal Abstinence Syndrome Diagnosed?

If a pregnant woman is addicted to opioids, benzodiazepines or antidepressants and is taking them in the weeks prior to her due date, her baby will most likely be born with neonatal abstinence syndrome.

A doctor can confirm the presence of NAS in several ways, including:

• Using a neonatal abstinence scoring system: Standardized systems help diagnose the severity of NAS and form a treatment plan.
• Completing a meconium test: Evaluating the baby’s first bowel movement can reveal substance exposure during the final months of pregnancy.
• Urinalysis assessment: Examining the baby’s urine can reveal substance exposure to within the past few days before birth.
• Examining the umbilical cord: Yielding more reliable results than a urinalysis or meconium test, evaluating the umbilical tissue can render a complete image of prenatal drug exposure in the months leading up to labor.

How to Score Neonatal Abstinence Syndrome

A standardized neonatal abstinence syndrome scoring system allows clinicians to diagnose the severity of each case of NAS and develop appropriate treatment plans for each infant. The Finnegan Neonatal Abstinence Scoring System is the most widely used method of scoring NAS.

Using the Finnegan system, points are assigned to specific signs and symptoms and are tracked over time. Medical professionals typically begin scoring around 24 hours after birth and monitor symptoms every three to four hours to adjust the score as needed.

This scoring helps determine the NAS baby’s treatment plan while in the NICU, as well as follow-up care necessary after the mother and baby are discharged from the hospital.

Neonatal Abstinence Syndrome Prognosis

Expectant mothers may wonder, of infants with NAS, how many babies “born addicted” to drugs survive past infancy? This question can be answered through studying a neonatal abstinence syndrome prognosis, or the common outcomes, of the condition.

Most babies born with NAS survive well beyond infancy and grow into healthy children. With proper care, NAS is rarely fatal. A NAS baby’s full recovery is possible when they can overcome drug withdrawal with constant medical supervision in a supportive environment.

How Is Neonatal Abstinence Syndrome Treated?

Treatment for neonatal abstinence syndrome depends largely on the results of a Finnegan scoring system, the baby’s medical history and their developmental progress. NAS can be mitigated with both medical care and holistic therapies.

Pharmacological Treatment

Medications can help ease the symptoms of NAS and may be required if the infant develops severe withdrawal. The medications used are usually from the same category of drugs as the substance the infant was affected by, and morphine is one of the most commonly used drugs in the treatment of NAS. Once the painful symptoms of withdrawal are controlled, the dosage can be gradually decreased.

Non-Pharmacological Treatment

Placing babies in low-stimulation environments, such as a dimly-lit room, can be effective in soothing the symptoms of NAS. Swaddling, or snugly wrapping the infant in a blanket, in addition to cuddling, are also recommended. Skin-to-skin contact (also called kangaroo care) between a mother and baby can also prove useful, quieting the baby’s cries and helping forge a lasting bond.

Breastfeeding is encouraged for babies with NAS and may even reduce the need for pharmacologic treatment. To supplement breast milk, babies with NAS may also benefit from a higher calorie formula due to their hyperactivity. In some cases, intravenous fluids may be necessary if the baby is dehydrated or is experiencing vomiting or diarrhea as a result of NAS.

Neonatal Abstinence Syndrome Prevention

For women who are planning to conceive, the most effective way to prevent NAS is not to use opioid medications, antidepressants or benzodiazepines during pregnancy.

Using Alternatives to Prescription Drugs

Alternative prescriptions may be safer for use during pregnancy, and consulting with a medical professional can help determine which medication or holistic therapy will be the most effective.

Using Contraception Until Ready for Conception

Women who are considering family planning but currently take opioids can benefit from using contraception to avoid becoming pregnant until they can safely wean themselves off opioid use. If a woman is planning on getting pregnant, talking with her health care provider about any drugs she currently takes allows her the opportunity to switch out any medications that might cause NAS, before she becomes pregnant.

Medication-Assisted Treatment (MAT)

Avoiding addictive drugs prior to pregnancy may not be a possibility for some expectant mothers. If a woman struggles with opiate or benzodiazepine addiction, abrupt cessation of drug use can do more harm than good and can have dire consequences for her unborn baby.

Medication-assisted treatment (MAT) helps pregnant women manage their substance use disorders safely and effectively. The symptoms of NAS in babies whose mothers engaged in prenatal MAT are often easier to treat. Ultimately, a new mother enrolled in MAT before, during and after her pregnancy will be able to better care for her new infant.

Substance Use Disorder Treatment for New Mothers

An expectant mother’s opioid, antidepressant or benzodiazepine use could stem from:

• An existing treatment plan with prescription opioids
• Recreational drug use
• Drug addiction
• Unresolved trauma (especially during childhood)
• A mental health condition (drug addiction and mental illness often co-occur)

Regardless of its roots, drug use can be difficult to end prior to conception. Pregnancy does not cancel out an existing substance use disorder, and expectant mothers may struggle to stop their use even after getting pregnant.

Medication-Assisted Treatment Works for New Mothers

Because stopping drug use cold turkey can prove life-threatening, new mothers can benefit from drug rehab care that will help them overcome their substance use disorders in a supportive environment.

Medication-assisted treatment plans can ensure a safe detox process, and programs such as partial hospitalization and outpatient care allow mothers to focus on healing so they can better care for their children. For new mothers and their babies, ending the drug use that caused NAS is imperative to a healthy future. A mother’s recovery can lead to her child’s recovery, and only after a mother’s drug use is addressed can she properly care for her new baby.

If you are a new mother in need of drug rehab, don’t wait to seek help. One of the best ways you can take care of your baby is to heal yourself first. The Recovery Village® can guide you toward a center and program that best suits your needs so you can give your child the healthiest future possible.