What Is Neonatal Abstinence Syndrome?

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.

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).

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.

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

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

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.

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

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.

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.

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.

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.

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.

Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.