Neonatal Abstinence Syndrome: Understanding Infant Withdrawal

Medically Reviewed

Addiction is a significant public health issue in the United States. Substance use disorders can affect anyone, regardless of demographics, financial status, or location. Plus, substance use problems don’t just affect adults.

Neonatal abstinence syndrome is a disorder that affects newborn babies born to mothers struggling with substance use disorders. It is especially associated with opioid use, but it can also occur with depressants like alcohol and benzodiazepines.

Learn more about this serious problem and how it can be treated.

What is Neonatal Abstinence Syndrome?

Neonatal abstinence syndrome (NAS) refers to a disorder in newborn infants that happens when exposed to certain drugs in the womb. As a mother uses a substance, she and the baby will become chemically dependent on it, leading to uncomfortable withdrawal symptoms when drug use is stopped. When the baby is born, they will no longer be getting the drug through their mother, which means they will experience withdrawal symptoms.

Opioids like heroin, oxycodone, codeine, and methadone are the most common drugs that can cause NAS. However, other substances like alcohol, benzodiazepines, and antidepressants can cause symptoms, as well.

This heartbreaking condition occurs for several reasons. The most common is when the mother has a substance use disorder during pregnancy. Addiction is a disease of the reward center of the brain that causes powerful compulsions to repeatedly use a particular drug. In many cases, addictive compulsions are so powerful, they’re irresistible, even for pregnant mothers.

NAS can also happen when women going through an addiction treatment program use prescription drugs like buprenorphine or methadone, which are opioids used to treat opioid addiction. These treatment programs can last several months to a year, and if a woman becomes pregnant during treatment, it could lead to NAS.

Should Addicted Mothers Quit While Pregnant?

Addiction can significantly complicate pregnancy. In some cases, going through withdrawal can put stress on a pregnant woman that could threaten her health and that of her baby. On the other hand, substance misuse during pregnancy is associated with psychiatric and medical issues for both mothers and babies.

Addiction treatment is a highly personalized process, and the need for tailored medical and clinical care is even greater for pregnant women with substance use disorders. If you have an SUD while pregnant, it’s important to seek medical care before quitting cold turkey, but addressing a substance use disorder as soon as possible is important.

Because addiction so severely complicates pregnancy, it can be challenging for pregnant women with substance use disorders to find treatment. They might also face other barriers to treatment related to transportation, childcare, financial instability, other medical and psychiatric conditions, and a general lack of resources. Still, the need for effective treatment is extremely important.

A paper published in Neuropsychiatry (London) reported that early multidisciplinary treatment might lead to better clinical outcomes, and it may even save overall lifetime healthcare costs.

Is Neonatal Abstinence Syndrome Deadly?

Neonatal abstinence syndrome is a complicated and dangerous problem. NAS is potentially life-threatening, especially in newborns not treated for the disorder. However, with treatment, the prognosis for the disorder is much better. Still, NAS treatment requires long-term treatment in a hospital setting.

Depending on the treatment plan, it could take up to a month of hospitalization. The severity of NAS also depends on the drug that caused it. Opioids are the most common, but alcohol and depressant withdrawal are more life-threatening. Mothers and children in alcohol withdrawal may experience tonic-clonic seizures. However, like opioid withdrawal, alcohol withdrawal is treatable.

How is Neonatal Abstinence Syndrome Diagnosed?

Neonatal abstinence syndrome can complicate pregnancy, delivery, and postnatal care. It’s important for medical professionals to be ready to treat the problem as soon as possible. NAS is often diagnosed based on a pregnant mother’s recent substance use history.

A pregnant mother may go through an intake and assessment process similar to anyone who is seeking substance use treatment. This assessment may involve the use of the ASAM Criteria, a set of important factors in addiction treatment that was made by the American Society of Addiction Medicine.

This assessment first looks at current and recent drug use to determine withdrawal potential. After a period of consistent drug use, your body adapts to the presence of the chemical in your brain. As your brain compensates for this, it will come to integrate the drug into its chemical balance.

If you stop using the substance suddenly, you’ll likely experience uncomfortable withdrawal symptoms. Drugs like opioids and stimulants cause uncomfortable symptoms, but they aren’t life-threatening in otherwise healthy adults. Depressants like alcohol and benzodiazepines can cause more dangerous withdrawal symptoms like seizures.

In newborns, NAS can be observed through symptoms like tremors, irritability, poor feeding habits, and loose stools. These symptoms may vary depending on the drug that’s caused chemical dependence. For instance, opioids cause loose stools and diarrhea during withdrawal, but other drugs may not. However, the drug use history of a newborn’s mother is a better indicator of a baby’s likelihood to have NAS.

Mothers are often afraid to tell doctors they have a substance use disorder for fear they might be separated from their child. However, it is vital for medical professionals to have all the information they need to deliver the best diagnosis and treatment.

What is the Scope of Neonatal Abstinence Syndrome?

The opioid epidemic in the United States has led to various public health consequences related to substance use issues. NAS is one complication that comes with a spike in substance use problems, along with effects on crime, accidents, and injuries, and the spread of infectious diseases like hepatitis. Communities impacted by opioid use issues have a higher risk of experiencing NAS-related issues.

Prescription opioid use is common among women during their child-bearing years. The Centers for Disease Control and Prevention (CDC) reports that a third of women of reproductive age filled an opioid prescription between 2008 and 2012. According to data from 2016, seven out of every 1,000 newborns in hospitals were diagnosed with NAS. That accounts for about 80 newborns diagnosed with NAS each day.

NAS can be costly to hospitals and patients. The cost of a hospital stay for a newborn with NAS was $9,500 in 2016, nearly nine times the cost of a newborn without NAS.

How is Neonatal Abstinence Syndrome Treated?

Babies going through treatment for NAS that is related to opioids are likely to be treated by tapering with opioid medication. Morphine is the most commonly prescribed medication, but treating a baby with an opioid is a delicate process that requires hospitalization and long periods of treatment. Morphine tapering in NAS cases can take up to nearly a month.

However, infants with NAS are now being treated with buprenorphine, a partial opioid agonist that has weaker effects than morphine, while blocking withdrawal. Buprenorphine may be effective in treating NAS with shorter treatment durations. Ideally, shorter hospitalizations for newborns means a lower risk of exposure to infection and lower treatment costs for the patients and healthcare systems involved.

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