Neonatal abstinence syndrome

infant crying“The March of Dimes has made it a priority to help and support women and infants affected by opioid use and other substance use disorders,” says Stacey D. Stewart, president of the March of Dimes. “There are few things more tragic than an infant starting out life in drug withdrawal.  We owe it to these babies to do everything in our power to ensure they are treated appropriately and can recover fully from drug exposure.”

Neonatal abstinence syndrome (NAS) happens when newborns go through drug withdrawal shortly after birth because they were exposed to drugs in the womb. In the United States, the number of babies born with NAS has been increasing. The Centers for Disease Control and Prevention (CDC) estimates that the number of babies with NAS has tripled from 1999 to 2013.

What drugs can cause NAS?

One of the most common causes of NAS is maternal use or abuse of opioids during pregnancy. Opioids are painkillers your provider may recommend if you’ve been injured or had surgery. Some common opioids that may be prescribed include:

  • Codeine and hydrocodone (Vicodin®)
  • Morphine (Kadian®, Avinza®)
  • Oxycodone (OxyContin®, Percocet®)

Heroin is also an opioid. Using it during pregnancy can cause your baby to be born with NAS.

In addition to opioids, these drugs can lead to NAS too:

  • Certain antidepressants (prescription drugs used to treat depression)
  • Benzodiazepines (sleeping pills)

What are the signs and symptoms of NAS?

Babies may exhibit different signs of NAS. Most babies will show symptoms within 3 days (72 hours) of birth, but sometimes symptoms will appear soon after birth or a few weeks later. 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 very fast
  • Fever, sweating or blotchy skin
  • Trouble sleeping and lots of yawning
  • Diarrhea or throwing up
  • Stuffy nose or sneezing

NAS can last from 1 week to 6 months after birth.

How is a baby with NAS treated?

Treatment for NAS may include:

  • Taking medicines 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 IV fluids. 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 aren’t growing properly. slow growth.

Most babies with NAS who get treatment get better in 5 to 30 days.

Research

The March of Dimes, together with the CDC, has awarded grants to conduct one-year of surveillance on neonatal abstinence syndrome (NAS) in three states with high rates of NAS:  Vermont, Illinois, and New Mexico. The project will enable each state to conduct enhanced identification of babies born with NAS and evaluate the health services needed by these babies through one year of age.

If you or someone you know is pregnant and struggling with drug use, please share these resources:

Have questions? Text or email AskUs@marchofdimes.org

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