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Addiction and Neonatal Abstinence Syndrome

Learn about neonatal abstinence syndrome, its symptoms, causes, and treatment options in this informative article.

What Is Neonatal Abstinence Syndrome?

Approximately one baby every nineteen minutes is born with neonatal abstinence syndrome in the U.S., totaling eighty newborns diagnosed every day. Neonatal abstinence syndrome (NAS) is a group of physical and behavioral conditions that babies experience when they withdraw from drugs after birth due to the mother consuming drugs while pregnant. 1

The risk of NAS in unborn babies is primarily linked to narcotics, especially opioids; however, benzodiazepines, barbiturates, cocaine, and antidepressants pose the same risks. Alcohol is another substance that can cause alcohol withdrawal and complications in newborn babies, known as fetal alcohol spectrum disorders (FASDS).

There are two main types of NAS: prenatal and postnatal.

Prenatal NAS

When a baby is diagnosed with prenatal NAS, it means they were exposed to substance use during pregnancy. Between prenatal and postnatal, prenatal NAS is the most prominent, leading to physical, mental, and psychological complications in children and infants.

Maternal opioid use is the primary cause of prenatal NAS. When mothers take opioids, the placenta supplies their unborn child with the drugs. Over time, the unborn baby becomes dependent on the drugs and suffers from withdrawal syndrome after birth. In 2019, approximately 10.1 million people in the U.S. reported misusing opioids, increasing the prevalence of opioid-induced NAS. 2

Postnatal NAS

Most doctors prescribe drugs like morphine and fentanyl for newborns with prenatal NAS who are admitted to NICU (neonatal intensive care unit) during pain therapy. A diagnosis of postnatal NAS occurs when the child stops using these medications, resulting in withdrawal symptoms.

What Are the Symptoms of Neonatal Abstinence Syndrome?

After drug exposure in the womb, most infants may develop neonatal abstinence syndrome symptoms in the first twenty-four to forty-eight hours after birth. However, signs may delay appearing, with the first ones occurring even five to ten days later. Also, note that the severity of the NAS symptoms depends on the last use of the drug, the type of drug used, and the infant’s gestational age.

Doctors closely monitor and grade symptoms of NAS in terms of their severity. These symptoms usually manifest across various physiological functions and organ systems like vasomotor, respiratory system, metabolic, central nervous system, and gastrointestinal issues.

Indicators of Neonatal Abstinence Syndrome

Signs and symptoms of neonatal abstinence syndrome include:

  • High-pitched or excessive crying or fussiness
  • Rapid breathing, tachypnea
  • Increased heart rate, tachycardia
  • Sleep disturbances
  • Fever
  • Blotchy skin
  • Sweating
  • Projectile vomiting
  • Diarrhea
  • Gastric regurgitation
  • Hyper-irritability
  • Muscle jerks, myoclonus
  • Increased muscle tone
  • Tremors
  • Seizures
  • Stuffy nose or sneezing

What Are the Possible Complications of Neonatal Abstinence Syndrome?

Some complications of NAS include:

  • Poor growth in the uterus
  • Being born too soon (preterm or premature)
  • Seizures
  • Yellowing of the skin or eyes, jaundice
  • Congenital disabilities
  • Low birth weight
  • Sudden infant death syndrome (SIDS)
  • Vision problems
  • Problems with behaviors and development
  • Ear infections
  • Motor problems

What Causes Neonatal Abstinence Syndrome?

Between 2010 and 2017, the incidence of mothers with an opioid use disorder upon child delivery increased by 131%, and NAS in babies increased by 82%. 3

Almost any drug moving through the placenta from the mother to the child may cause neonatal abstinence syndrome. For instance, if a mother uses medications that affect the nervous system, the drug will also affect the baby’s nervous system. After birth, the drug is no longer available for the baby, causing drug abstinence side effects.

Substances Linked to NAS

The various substances linked to causing NAS include:

  • Stimulants (e.g., amphetamines, methamphetamine, cocaine)
  • Depressants (e.g., alcohol, barbiturates, benzodiazepines)
  • Antidepressants (e.g., SSRIs, SNRIs)
  • Opioids (e.g., heroin, methadone, hydrocodone, oxycodone, codeine, tramadol, morphine)
  • Other drugs such as marijuana and nicotine

How Is Neonatal Abstinence Syndrome Diagnosed?

Medical professionals use various tests to diagnose NAS. They include:

NAS Scoring System

Many doctors use the NAS scoring system to grade the NAS symptoms. First, the medical team records the infant’s tests and compiles a report. Then, the doctor diagnoses the severity of the baby’s condition and develops a treatment plan. Next, the team creates a follow-up care plan for the mother and child after discharge.

Modified Finnegan Neonatal Abstinence Scoring System
The Modified Finnegan Neonatal Abstinence Scoring System is the most commonly used NAS scoring system. This point-based system records signs and symptoms and tracks them over a week (seven days). The doctor begins scoring the symptoms one day after birth and continues monitoring the symptoms every three to four hours while adjusting the scores whenever possible.


The ESC-NOW, or Eating, Sleeping, Consoling for Neonatal Withdrawal, is a function-based assessment and management approach for babies with neonatal abstinence syndrome. This approach monitors the baby’s body functions before the medical professional prescribes morphine to help with the signs and symptoms.

Umbilical Cord, Urine, and Meconium Screenings

A medical caregiver may run tests on the baby’s umbilical cord, urine, or meconium (first bowel movement) to help diagnose NAS. One study found that maternal urine, maternal interview, and baby meconium samples are equally effective in evaluating drug use. 4

Can You Prevent or Avoid Neonatal Abstinence Syndrome?
People can prevent NAS by avoiding drugs such as opioids, alcohol, and antidepressants during pregnancy. Women who are pregnant or plan to get pregnant should consult with their doctor about the medications and substances they take and if they have an addiction. Doctors can and will help expecting mothers quit and provide medical assistance.  

Neonatal Abstinence Syndrome

Neonatal Abstinence Syndrome

Neonatal Abstinence Syndrome Treatment

NAS withdrawal symptoms range between mild and severe (e.g., seizures that may require medicines like buprenorphine, methadone, or morphine to treat). Doctors administer two standard treatments for NAS side effects in infants. First, they may place the child under medications to help treat or manage severe withdrawal symptoms. Second, doctors administer fluids or higher-calorie baby formula intravenously (directly into the vein) to prevent the baby from getting dehydrated.

How to Alleviate Child Diagnosed With NAS

While medications are crucial for a baby with NAS, the following tips can be used to help calm the baby when agitated:

  • Gentle rocking or swinging
  • Swaddling
  • Skin-on-skin contact
  • Reducing lights and noise
  • Safe breastfeeding
  • Massages
  • Creating a calm and quiet environment 

Most babies may recover from NAS within five to thirty days after treatment. However, neonatal abstinence syndrome’s long-term effects may last for years and affect the child’s growth and development.  

Get Treatment for Neonatal Abstinence Syndrome at Genesis Recovery

We understand the urgency and challenging experience neonatal abstinence syndrome causes. Genesis Recovery goes the extra mile to ensure each mother and baby get quality treatment for their mental, physical, and psychological well-being. Contact us today to schedule an appointment and learn more about our treatment programs.


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