Neonatal Abstinence Syndrome (NAS): How to Care for Your Baby

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Dr. Manu Lakshmi

24 Dec 2021

Neonatal Abstinence Syndrome – symptoms and treatment

Neonatal Abstinence Syndrome (NAS) is a condition that occurs in a newborn baby from a mother who has been abusing opioid drugs during pregnancy. The drugs could include heroin, codeine, oxycodone, methadone, buprenorphine, etc.,

When a pregnant woman abuses drugs, certain drugs pass through the placenta and reach the baby. As a result, even the growing baby gets addicted to those drugs. After the baby’s delivery, he/she won’t receive the drugs anymore and he/she craves the drugs and shows certain symptoms such as loud crying, hyperactivity, etc until the drugs wane off from the body eventually. Such as state is called Neonatal Abstinence Syndrome (NAS).

Neonatal Abstinence Syndrome – Symptoms

The symptoms and severity of NAS depend on certain factors such as:

  1. The type of drug (or drugs) the mother has used.
  2. The duration of use and till when (during pregnancy) she has consumed the drugs.
  3. How the body breaks down the consumed drugs – this depends on the genetics of the person and the baby
  4. How the baby is born – at right term or premature.

Symptoms of NAS include:

  1. Blotchy skin coloring
  2. Diarrhea
  3. Loud crying
  4. Excessive sucking
  5. Hyperactivity
  6. Fever
  7. Getting easily irritated
  8. Increased muscle tone
  9. Poor feeding
  10. Rapid breathing
  11. Problems sleeping
  12. Shivering or trembling
  13. Vomiting etc.

Diagnosis of NAS

Diagnosis of NAS starts from the mother and typically with a set of questions regarding the type of drug(s) she has been using, the quantity and duration of consumption. What is most important is, till which week of pregnancy she has been using the drugs because babies whose mothers consumed the drugs until the last week have shown severe symptoms of NAS.

The mother’s urine will be screened for the presence of drugs and then NAS scoring will be done on the baby depending on the symptoms and the severity.  The eating and sleeping of the baby will be examined and evaluated. The Baby’s urine may also be sent for screening to look for the presence of drugs.

Treatment of Neonatal Abstinence Syndrome

Treatment depends on the symptoms, severity of the symptoms, and the drugs that are found in the baby’s body. Babies with NAS are closely watched for a week as that is the time when the drugs are removed from the body naturally. In babies with severe symptoms, doctors have found feeding problems, weight gain and in those who vomit, severe dehydration may take place.  In such cases, fluids will be given to the baby intravenously.

Along with administering certain medicines based on the drugs used, babies are to be loved and cared for during the treatment period. This is called giving TLC – Tender Loving Care to the baby. Certain activities such as rocking the baby (in a cradle), letting the baby sleep in a quiet and little darker place, making skin-to-skin contact with the baby, and breastfeeding are also be recommended.

In some babies with severe symptoms, the same drugs will be given to the baby and over a period of time, the dosage will be reduced eventually to wane off the baby from the drugs.

Complications in babies that can occur due to drug abuse by pregnant mother

Every gynecologist or a doctor will advise his/her pregnant patients not to smoke or consume alcohol or abuse drugs at least until the delivery of the baby. It is not just for the health of the woman but also to prevent many unwanted possible medical conditions that the baby might have post-birth. Such complications include:

  1. Birth defects
  2. Underweight
  3. Premature birth of the baby
  4. Small head circumference
  5. Sudden Infant Death Syndrome (SIDS), this happens with no warning.
  6. Difficulties with physical and mental development of the baby as he/she grows up.

Time taken by babies to come out of NAS usually ranges from 1 week to 6 months and some babies may have to have a longer stay than those with mild NAS symptoms.

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