What Is Neonatal Abstinence Syndrome?


To be born healthy and well, babies’ health is completely reliant 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 born addicted to drugs immediately face a unique set of short- and long-term developmental challenges as they start their lives in the throes of a substance use disorder.
How can a baby be born addicted to drugs? The simple answer is that their mother used, or is dependent on, drugs. Vital nutrients and dangerous substances alike can pass through the placenta to the fetus, meaning that whatever a mother consumes the baby ingests it too. If an expectant mother faces a drug or alcohol addiction, it will pass to the unborn child, who will experience withdrawal upon birth, as the baby no longer receives the drug steadily. Using prescription or illicit drugs (especially opioids) during pregnancy can lead to neonatal abstinence syndrome (NAS) in newborns, a group of conditions that include drug withdrawal symptoms and a variety of physical complications.
The neonatal abstinence syndrome definition considers 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 opioids like OxyContin and heroin, but it can also occur from their mother’s use of antidepressants like Zoloft or benzodiazepines like Xanax.

Mothers may use these drugs for a variety of reasons. Opioids may be prescribed for post-surgical pain, and antidepressants and benzodiazepines may ease the symptoms of mental disorders. Regardless of why these 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 they can transition to safer medications before conceiving a child.

Regardless of which of these substances a baby is exposed to in the womb, neonatal abstinence syndrome can result in a variety of issues upon birth. 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 neonatal abstinence syndrome include:

Neurological Excitability

  • Hyperirritability
  • High-pitched or 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 like low birthweight (less than five pounds, eight ounces) and jaundice, a yellowing of the skin and eyes 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 largely on the circumstances surrounding the birth, including if the baby was born prematurely (prior to 37 weeks of pregnancy).

Symptoms will also vary depending on which drugs were used during pregnancy, the quantity and length of use of each drug and the efficiency of the mother’s metabolism. Smoking cigarettes and using sedatives or stimulants (like cocaine) can also influence the severity of NAS.

What Happens to Babies Born Addicted to Drugs?

Neonatal abstinence syndrome 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. 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 neonatal intensive care units (NICU).

The onset and duration of neonatal abstinence syndrome 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 the substance that was used during pregnancy. As each type of drug (opioids, antidepressants, benzodiazepines, etc.) has a different chemical makeup and abuse potential, the NAS withdrawal timeline varies significantly by substance.

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 may not manifest for several weeks, and may require months-worth of intensive care 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

The signs and symptoms of NAS can vary from infant to infant, depending on the type of drug their mother struggles with. Although time estimates are different for exposure to different substances, most NAS symptoms last for seven to 10 days. 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 within five to 30 days.

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

As it involves a variety of factors, neonatal abstinence syndrome 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 like 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.
When considering the rising number of babies born addicted to drugs, 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.
When planning for a family, vigilant, expectant mothers and fathers may wonder how many babies are born addicted to drugs. Current statistics reveal 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 paint a grim picture of the reality of neonatal abstinence syndrome.

  • 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
How many babies are born addicted to drugs each year? The answer to this question remains unclear, as the known data is largely based on estimates and small studies from individual states. However, in the case of infants born with neonatal abstinence syndrome, the Centers for Disease Control (CDC) estimates that nationwide, a shocking six out of every 1,000 babies are born with NAS.

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 neonatal abstinence syndrome.

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 are helpful for diagnosing the severity of NAS and forming 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 more complete image of prenatal drug exposure in the months leading up to labor.
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 3–4 hours to adjust the score as needed. This scoring will help 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.
Of infants with neonatal abstinence syndrome, 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.
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 by using holistic therapies.

Pharmacological Treatment

This may be required if the infant develops severe withdrawal and can help ease the symptoms of NAS. The medications used are usually from the same category of drugs as the substance the infant is withdrawing from, 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.

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

Women who are considering family planning but currently take opiates can benefit from using contraception to avoid becoming pregnant until they can safely wean themselves off opiate 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.   

Avoiding these 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.

Neonatal abstinence syndrome doesn’t happen in isolation, it’s a result of a mother’s prenatal drug use. An expectant mother’s opioid, antidepressant or benzodiazepine use could stem from an existing treatment plan, recreational use or an addiction. Oftentimes, an expectant mother’s substance use disorder can develop from unresolved trauma or a mental illness which could have developed in their own childhood. 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 discovering their pregnancy.

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 like partial hospitalization and outpatient care allow mothers to focus on their own healing so they can better care for their children. For new mothers and their babies, ending the drug use that caused neonatal abstinence syndrome 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. Call  352.771.2700 today to get started.

What Is Neonatal Abstinence Syndrome?
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