What Is Neonatal Abstinence Syndrome?

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What Is Neonatal Abstinence Syndrome?

Neonatal Abstinence Syndrome

Neonatal abstinence syndrome (NAS) is a condition that causes babies to develop withdrawal symptoms to certain drugs even before they’ve been born. It develops when they’ve been exposed to these drugs, most commonly opioids, in the womb.

When NAS occurs, a newborn is likely to exhibit symptoms just days after being born such as:

  • Fever
  • Diarrhea
  • Difficulty feeding   

With the proper treatment and management, most babies with this condition will recover in a few days or weeks, depending on the severity of their symptoms.

NAS could lead to medical complications such as sudden infant death syndrome (SIDS), developmental delays, or behavioral problems in severe cases.

The condition is sometimes referred to as neonatal opioid withdrawal syndrome (NOWS); however, this term only accounts for opioids and not other drugs that can cause the same symptoms.

Some research shows that every 25 minutes, a case of NAS is diagnosed in the United States.

Symptoms of Neonatal Abstinence Syndrome

Symptoms of NAS typically vary from child to child, depending on a myriad of factors. All of the types of drugs the mother used, how long they used it, the number of drugs consumed, and whether the child was born prematurely or not come into play. However, common symptoms of the condition include:

  • Diarrhea 
  • Crying excessively 
  • Persistent fever 
  • Excessive sweating 
  • Tremors 
  • Seizures 
  • Difficulty sleeping
  • Breathing rapidly 
  • Difficulty feeding 
  • Gaining weight slowly 
  • Blotchy skin 
  • Excessive fussiness 
  • Sneezing 

If your baby has NAS, they are likely to begin exhibiting symptoms one to three days after birth. It can sometimes take up to a week to notice and identify the signs.

Watch for Symptoms

If these symptoms weren’t seen at the hospital and you notice them after taking your baby home, you should contact your healthcare provider immediately.

Identifying Neonatal Abstinence Syndrome 

Diagnosing NAS can be complex. Its symptoms are similar to various conditions a newborn is likely to develop.

Drug Use History Is Assessed

The easiest way to diagnose the condition is to obtain a detailed history of the mother’s drug use. Questions such as if the mother took any drugs during pregnancy, the duration of the drug use, and the quantities consumed will be asked. If the healthcare provider suspects NAS and the mother isn’t forthcoming with answers to these questions, a drug panel might be ordered to screen for drug use.

Tests that can be done on your baby include: 

  • NAS scoring system: A point-based system to determine how severe your baby’s withdrawal symptoms are. 
  • Other tests: Urine and stool tests of your baby to check for drugs 

Causes of Neonatal Abstinence Syndrome

Neonatal abstinence syndrome is caused by drug use during pregnancy. If you are pregnant and keep taking drugs such as codeine, heroin, methadone, oxycodone, or other opioids, you put your baby at the risk of developing NAS.

Continued use of these drugs could cause the drugs to pass to your baby through your placenta. The placenta is responsible for passing nutrients, oxygen, and everything your baby needs from you to your baby during pregnancy. It can also pass these drugs and cause your baby to depend on these types of drugs even before they are born. 

After you give birth to your baby, your baby stops getting access to these drugs, which leads to withdrawal symptoms.

While opioids are the most common culprit for causing NAS, drugs like alcohol, barbiturates, some antidepressants, and benzodiazepines could also cause NAS.

Neonatal Abstinence Syndrome Treatment

There is no blanket treatment for NAS. Before treatment commences, the healthcare provider must first identify what drugs are responsible for the baby’s symptoms and the severity of their symptoms. A week after symptoms are first noticed, the baby will typically be kept in the hospital for observation.

In most cases, you should see improvement within days or a few weeks after treatment has commenced. If the baby’s symptoms are severe, they might be kept for even longer.

Feeding 

Babies with NAS have difficulty feeding. It’s crucial to feed them with higher-calorie baby formula throughout their recovery to ensure they get the most out of each meal. Regular feeding also aids their recovery.

Your baby might also be given fluids and nutrients intravenously to prevent dehydration, especially if vomiting and diarrhea are some of the symptoms they are exhibiting. 

Medication 

In severe cases of NAS, medication might be prescribed to help combat withdrawal symptoms. Methadone, buprenorphine, and morphine are most commonly prescribed to treat withdrawal symptoms in NAS cases caused by opioid use.

This aims to slowly wean the baby off the drugs that are causing the withdrawal symptoms. Smaller and smaller doses will continue to be given until the baby has fully weaned off of them. In these cases, the baby will need to be kept in the hospital for several weeks as they recover. 

Coping With Neonatal Abstinence Syndrome 

Babies with NAS often need more hands-on care than the average newborn. Doctors often recommend that parents engage in activities known as 'tender loving care' (TLC) with their babies who have NAS. Activities that fall into this category include: 

  • Minimizing your baby’s exposure to bright lights and loud noises 
  • Gently holding and rocking your child in your arms
  • Breastfeeding if the mother is drug-free. In some instances, breastfeeding is encouraged even if the mother isn’t drug-free, as drugs are typically found in minute quantities in breast milk.
  • Engaging in skin-to-skin contact with the mom or swaddling in a blanket 

If you’ve been in the hospital, you and your baby will be discharged when your healthcare provider has ascertained that they are feeding well, sleeping well, and eating well. They’ll also use the NAS scoring system to determine how much your baby’s symptoms have improved. If your baby has a good NAS score, you will likely be discharged.

However, it’s essential to closely monitor your baby after you’ve been sent home for signs of any medical complications resulting from NAS.

A Word From Verywell

If you have a child with NAS, they can make a full recovery with proper treatment and symptom management, Early symptoms of the condition such as slow weight gain and fussiness can be easy to miss, so it's essential to keep a close eye on your child if you have a history of drug use. It's highly advisable for people who have children with NAS also to consider enrolling in a drug treatment program.

7 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Anbalagan S, Mendez MD. Neonatal abstinence syndrome. In: StatPearls. StatPearls Publishing; 2022.

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  5. Wiles JR, Isemann B, Ward LP, Vinks AA, Akinbi H. Current management of neonatal abstinence syndrome secondary to intrauterine opioid exposure. The Journal of Pediatrics. 2014;165(3):440-446.

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By Toketemu Ohwovoriole
Toketemu has been multimedia storyteller for the last four years. Her expertise focuses primarily on mental wellness and women’s health topics.