November 13, 2018

Neonatal Abstinence Syndrome: When Babies Experience Withdrawal

neonatal abstinence syndrome - when babies experience withdrawal

By Meg C. Coleman, FNP, PNP

Neonatal abstinence syndrome (also called NAS) refers to symptoms of withdrawal that babies may sometimes develop after birth if their mothers have taken medications or drugs that can be addictive during their pregnancy.

What causes neonatal abstinence syndrome?

Many drugs used by mothers can reach the baby while they are in the womb. Once the baby is born, the baby can no longer receive the drug from their mother’s body, and their own body may begin to react with withdrawal symptoms. Some drugs are more likely to cause NAS than others, but nearly all have some effect on the baby. Opiates, such as heroin and methadone, cause withdrawal in more than half of babies who are exposed prenatally. Cocaine may cause some withdrawal, but the main symptoms in the baby are due to the toxic effects of the drug itself.  Other drugs, such as amphetamines and barbiturates, can also cause withdrawal. Alcohol use causes withdrawal in the baby, as well as a group of problems including birth defects called fetal alcohol spectrum disorders (FASD).

What are the signs and symptoms of neonatal abstinence syndrome?

Signs and symptoms of NAS can be different for every baby. Most happen within three days of birth, but some may happen right after birth or not until a few weeks after birth. They can last from 1 week to 6 months after birth. Signs and symptoms may include:

  • Body shakes (tremors), seizures, overactive reflexes and tight muscle tone
  • Irritability
  • Jitteriness
  • Frequent crying (may be high pitched)
  • Difficulty sleeping
  • Poor feeding or difficulty with sucking
  • Diarrhea or throwing up
  • Stuffy nose or sneezing
  • Fever, sweating or blotchy skin

Why is neonatal abstinence syndrome a concerns?

When a mother uses illicit substances, she places her baby at risk for many problems.

A mother using drugs may be less likely to seek prenatal care, which can increase the risks for her and her baby. The risk of contracting HIV and AIDS is also greater among intravenous drug users. In addition to specific difficulties of withdrawal after birth, problems in the baby may include, but are not limited to: poor intrauterine growth, premature birth, seizures and birth defects.

What is the treatment for neonatal abstinence syndrome?

Specific treatment for NAS will be determined by your baby’s doctor based on:

  • Your baby’s gestational age, overall health and medical history
  • Extent of the disease
  • Your baby’s tolerance for specific medications, procedures or therapies
  • Expectations for the course of the disease

Comfort measures can help your baby cope with withdrawal symptoms, however, some babies need medicine, too. The Finnegan Scoring Tool is used to rate the baby’s symptoms of NAS. The total Finnegan Score helps the providers know whether the baby needs medication to help with the withdrawal symptoms.

Some babies with NAS may be fussy and hard to soothe. Comfort measures can help such as swaddling and decreasing stimulation around the baby.

Can neonatal abstinence syndrome be prevented?

Neonatal abstinence syndrome is totally preventable. However, it requires that a mother stop using drugs before pregnancy, or as soon as she learns she is pregnant if her doctor believes it is safe to do so.


Meg C. Coleman, FNP, PNP, is a nurse practitioner.

For more information about the services at Mission Children’s Hospital, visit missionchildrens.org.