Each year, our Neonatal Intensive Care Unit (NICU) treats an increasing number of babies diagnosed with neonatal abstinence syndrome (NAS), a term for a group of problems a baby experiences when withdrawing from exposure to narcotics.
NAS most often is caused when a woman takes opioids during pregnancy. Opioids are painkillers (used to relieve pain) a provider may prescribe if you’ve been injured or had surgery. Prescription opioids include:
- Codeine and hydrocodone (Vicodin®)
- Morphine (Kadian®, Avinza®)
- Oxycodone (OxyContin®, Percocet®)
The street drug heroin also is an opioid. When taken during pregnancy, they can pass through the placenta and cause serious problems for a baby. Infants with NAS have higher rates of neonatal complications and prolonged lengths of hospital stay.
Overland Park Regional Medical Center is a Center of Excellence in Education and Training for Substance-exposed Infants and Their Families by the Vermont Oxford Network (VON). VON is a nonprofit voluntary collaboration of healthcare professionals working together as an interdisciplinary community to change the landscape of neonatal care.
“We are proud to lead the effort at Overland Park Regional Medical Center in training our healthcare team to improve the quality, safety and value of care for substance-exposed infants and their families,” says Kathleen Weatherstone, M.D., board-certified Neonatologist and Medical Director, NICU, at Overland Park Regional Medical Center. “We are known for our commitment to and passion for serving the vulnerable neonatal patient and their families and continue to expand our reach and scope by impacting the health and well-being of these particularly fragile neonates.”
Almost every drug passes from the mother's blood stream through the placenta to the fetus. Illicit substances that cause drug dependence and addiction in the mother also cause the fetus to become addicted. At birth, the baby's dependence on the substance continues. However, since the drug is no longer available, the baby's central nervous system becomes overstimulated causing the symptoms of withdrawal.
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 over half of babies 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 (FASDs).
Questions and Answers
Neonatal abstinence syndrome (also called NAS) happens when a baby is exposed to drugs in the womb before birth. A baby can then go through drug withdrawal after birth. NAS most often is caused when a woman takes opioids during pregnancy. Opioids are painkillers (like codeine, hydrocodone, morphine and oxycodone) your provider may prescribe if you’ve been injured or had surgery. The street drug heroin is also an opioid. Babies with NAS are more likely than other babies to be born with low birthweight (less than 5 pounds, 8 ounces), have breathing and feeding problems and seizures
At birth, your baby no longer gets the drug(s) he or she was used to getting from your blood during pregnancy. When the effects of the drug(s) suddenly stop, your baby may develop symptoms called withdrawal. Not all babies go through withdrawal in the same way. It is not possible to predict which babies will have withdrawal or how long it will last. Your baby may need to stay in the hospital for a few days to several weeks, depending on the treatment he or she needs for withdrawal.
Signs and symptoms can be different for every baby with NAS. Most appear within 3 days (72 hours) of birth, but some can appear right after birth or within a few weeks of birth. Signs and symptoms can include:
- Body shakes (tremors), seizures(convulsions), overactive reflexes (twitching) and tight muscle tone
- Fussiness, excessive cryingor having a high-pitched cry
- Poor feeding, poor sucking or slow weight gain
- Breathing really fast
- Fever, sweating or blotchy skin
- Trouble sleeping and lots of yawning
- Diarrhea or throwing up
- Stuffy nose or sneezing
Call your baby’s health care provider if your baby has any of these symptoms. Not all babies with NAS have the same symptoms. Symptoms depend on:
- What drug you used during pregnancy, how much you used and how long you took it
- How your own body breaks down the drug
- If your baby was born prematurely(before 37 weeks of pregnancy)
NAS can last from 1 week to 6 months after birth.
Your baby’s provider can use these tests to diagnose NAS:
- Neonatal abstinence scoring system. This system gives points for each NAS symptom depending on how severe it is. Your baby’s provider uses the score to decide what kind of treatment your baby needs.
- Test of your baby’s first bowel movements (also called meconium)
- Test of your baby’s urine
As a parent, you have a very special role.
- Your love and care are most important to your baby at this time.
- As you care for your baby, you can closely watch your baby’s behavior. If you notice any symptoms, tell your nurse or another member of the health care team. We want to know your concerns and what you have observed.
- You can provide comfort to your baby in many ways. This can reduce your baby’s symptoms of withdrawal. Comfort measures are an important part of your baby’s care.
Your baby’s treatment 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 fluids through a needle into a vein (also called intravenous or IV). 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 slow growth.
If you have cared for a newborn before, you will know some ways to calm a baby. However, it may not be easy to settle or soothe your baby because of the effects of withdrawal. You may have to try different comfort measures to find out what helps your baby. Your health care providers will help you with this.
While your baby’s being treated for NAS, he may be fussy and hard to soothe. Doing these things can help calm him:
- Swaddle your baby in a blanket.
- Give your baby skin-to-skin care (also called kangaroo care). It’s when you put your baby, dressed only in a diaper, on your bare chest.
- Keep your baby in a quiet, dimly lit room.
- Breastfeed your baby.
Watch your baby’s cues and body language.
- Your baby will give signs or cues that let you know what he or she likes, and what makes him or her uncomfortable.
- Learning to read your baby’s “body language” will make you feel more confident.
Provide a quiet and calm environment.
- Your baby may be very sensitive to light, sounds and touch.
- Try to keep the lights and sounds low.
- Use a gentle touch and speak softly. Your baby will love the smell of your skin and the sound of your soft voice.
- Care for your baby without “handling” him or her too much. Try not to wake your baby when he or she is sleeping. Quiet time helps your baby grow and develop.
- Limit the number of people who visit your baby.
Hold and cuddle your baby “skin-to-skin”.
- Gently hold and cuddle your baby when he or she is fussy or crying. This soothes your baby and makes him or her feel safe and secure.
- The best way to cuddle is to hold your undressed baby against your chest, or “skin-to-skin”. This is also called “Kangaroo care”. If this does not calm your baby, try bundling your baby.
- Bundle your baby
- Wrap your baby firmly in a soft baby blanket. The blanket should be snug, but not too tight. Some babies feel more comfortable when they are fed and put to sleep this way.
- Bundle your baby with his or her hands close to his or her chest or mouth. Your baby may suck on his or her fingers for comfort.
- Do not over-dress your baby or let your baby get too warm when he or she is bundled in the blanket. Your nurse will check your baby’s temperature regularly.
Breastfeeding is healthy and can be very comforting for your baby.
- Talk to your health care provider or lactation consultant about breastfeeding your baby with special needs. A lactation consultant is a person with special training in helping women breastfeed.