Neonatal Abstinence Syndrome (NAS) (2023)

What is Neonatal Abstinence Syndrome?

Neonatal Abstinence Syndrome (also called NAS) is a group of conditions caused when a baby withdraws from certain drugs he’s exposed to in the womb before birth. NAS is most often caused when a woman takes drugs called opioids during pregnancy. But it can also be caused by antidepressants (used to treat depression), barbiturates or benzodiazepines (sleeping pills). When you take these drugs during pregnancy, they can pass through the placenta and cause serious problems for your baby. The placenta grows in your uterus (womb) and supplies your baby with food and oxygen through the umbilical cord.

If you’ve been injured or had surgery, your provider may give you a prescription for opioids to help relieve pain. Prescription opioids include:

  • Codeine
  • Hydrocodone (name brand Vicodin®)
  • Morphine (name brands Kadian®, Avinza®)
  • Oxycodone (name brands OxyContin®, Percocet®)
  • Tramadol

The street drug heroin also is an opioid.

You may hear NAS also called NOWS. NOWS stands for neonatal opioid withdrawal syndrome. NOWS is the same as NAS except it’s caused only by opioids.

If you’re pregnant or trying to get pregnant and taking any of these drugs, tell your health care provider right away.

What are signs of NAS?

Signs of a condition are things someone else can see or know about you, like you have a rash or you’re coughing Signs of NAS can be different for every baby. Most happen within 3 days (72 hours) of birth, but some may happen right after birth or not until a few weeks after birth. They can last from 1 week to 6 months after birth.

If your baby has signs of NAS, call her provider right away. Signs may include:

  • Body shakes (tremors), seizures (convulsions), overactive reflexes (twitching) and tight muscle tone
  • Fussiness, excessive crying or having a high-pitched cry
  • Poor feeding or sucking or slow weight gain
  • Breathing problems, including breathing really fast
  • Fever, sweating or blotchy skin
  • Trouble sleeping and lots of yawning
  • Diarrhea or throwing up
  • Stuffy nose or sneezing

Signs of NAS 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
  • Your baby’s gestational age at birth (number of weeks of pregnancy)

What complications can NAS cause for your baby?

Babies with NAS may have health conditions that need treatment in the newborn intensive care unit (also called NICU) after birth. The NICU is the nursery in a hospital where sick newborns get medical care. In addition to having withdrawal signs, babies with NAS are at increased risk of:

  • Low birthweight. This means your baby is born weighing less than 5 pounds, 8 ounces.
  • Jaundice. This is when your baby’s skin and eyes look yellow. It’s caused when your baby’s liver isn’t fully developed or working.
  • Seizures
  • Sudden infant death syndrome (also called SIDS). This is unexplained death of a baby younger than 1 year old. SIDS usually happens when a baby is sleeping.

We don’t know a lot about long-term effects of NAS on a baby. We need more research to see how NAS affects a child in the first few years of life and longer. We think that NAS may cause long-term problems for your baby, like:

  • Developmental delays. Developmental delays are when your child doesn’t reach developmental milestones when expected. Developmental milestones are skills and activities that most children can do at a certain age, like sitting, walking, talking, having social skills and having thinking skills.
  • Motor problems. These are problems with your baby’s bones, muscles and movement.
  • Behavior and learning problems. Babies with NAS are more likely than babies who don’t have NAS to be checked for learning problems and to get special education services in school.
  • Speech and language problems
  • Sleep problems
  • Ear infections
  • Vision problems

How is your baby tested for NAS?

Your baby’s provider can use these tests to see if your baby has NAS:

  • NAS scoring system. With this system, your baby’s provider uses points to grade how severe your baby’s withdrawal is. Your baby’s provider uses the score to decide what kind of treatment your baby needs.
  • Urine and meconium tests to check for drugs. Meconium is your baby’s first bowel movement.

Your baby’s provider also needs to know about what drugs or medicine you’ve used and when you last took them. You may get a urine test.

How is NAS treated?

Your baby’s treatment may include:

  • Taking medicines to treat or manage severe withdrawal symptoms. Once withdrawal is 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 include morphine, methadone and buprenorphine.
  • Getting fluids through a needle into a vein (also called intravenous or IV) to prevent your baby from getting dehydrated. Dehydrated means not having enough water in the body. Babies with NAS can get dehydrated from having diarrhea or throwing up a lot.
  • Being fed higher-calorie baby formula. Some babies with NAS need extra calories to help them grow because they have trouble feeding or slow growth.

Most babies with NAS who get treatment get better in 5 to 30 days.

During treatment for NAS, your baby may be fussy and hard to soothe. Doing these things can help calm your baby:

  • Room in with your baby. This means you and your baby stay in the same room together at the hospital before you take your baby home.
  • Give your baby skin-to-skin care (also called kangaroo care). This is when you put your baby, dressed only in a diaper, on your bare chest.
  • Be gentle with your baby. Rock your baby gently. If she’s sleeping, don’t wake her up.
  • Swaddle your baby (wrap him snuggly) in a blanket.
  • Keep your baby’s room quiet and the lights dim.
  • Breastfeed your baby. Feed your baby on demand. This means you feed your baby when he’s hungry.
  • Give your baby a pacifier.

Your baby’s provider checks your baby often in the NICU after birth to make sure he’s getting better and having fewer and less severe withdrawal signs. Your baby can go home from the hospital when she:

  • Is feeding well
  • Is sleeping well
  • Is gaining weight
  • Has a good NAS score

After your baby is home, take her to all of her follow-up and well-baby checkups, even if she’s doing well. Your provider checks your baby at these visits for problems that may be linked to NAS, like:

  • Developmental delays and problems with motor and learning skills and behavior
  • Problems with nutrition and growth
  • Problems with hearing and vision
  • Problems at home, including using harmful substances. This can include misusing prescription drugs and using illegal drugs.

If your baby has developmental delays, talk to her provider about early intervention services. These services can help children from birth through 3 years old learn important skills. Services include therapy to help a child talk, walk, learn self-help skills and interact with others. Getting services as early as possible can help improve your child’s development. The Centers for Disease Control and Preventionhas information to help you get early intervention services for your child and how to find services in your state or territory.

What can you do to help prevent NAS in your baby?

Here’s what you can do:

  • If you’re pregnant and you use any of the drugs that can cause NAS, tell your provider right away, but don’t stop taking the drug without getting treatment from your provider first. Quitting suddenly (sometimes called cold turkey) can cause severe problems for your baby, including death. If you need help to quit using these drugs, talk to your provider about treatment. Getting treatment can help you stop using drugs and is safer for your baby than getting no treatment at all.
  • If you’re pregnant and can’t stop using opioids without problems, ask your provider about medication-assisted treatment (also called MAT). NAS in babies may be easier to treat for babies whose moms get MAT during pregnancy. Medicines used in MAT include methadone and buprenorphine.
  • If you’re pregnant and you go to a provider who prescribes medicine to treat a health condition, make sure that provider knows you’re pregnant. You may need to stop taking certain medicines or change to medicine that’s safer for your baby. Ask all your health care providers if the medicine you take—even prescription drugs—can cause NAS in your baby. Even if you use a prescription drug exactly as your provider tells you to, it may cause NAS in your baby.
  • If you’re pregnant or thinking about getting pregnant, tell your provider about any drugs or medicine you take. Your provider can make sure that what you’re taking is safe for you and your baby. She also can help you get treatment for using street drugs or abusing prescription drugs if you need it. If you abuse prescription drugs, it means you take more than has been prescribed for you, you take someone else’s prescription drug, or you get the drug from someone without a prescription.
  • If you’re not pregnant and you use any drug that can cause NAS: Use birth control until you’re ready to get pregnant. Birth control (also called contraception or family planning) helps keep you from getting pregnant. Examples include intrauterine devices (also called IUDs), implants, the pill and condoms.

More information

See also: Preventing NAS in your baby infographic,Caring for a baby with NAS infographic,Prescription opioids during pregnancy,Prescription medicine during pregnancy

Last reviewed: June, 2019


Neonatal Abstinence Syndrome (NAS)? ›

What is Neonatal Abstinence Syndrome? Neonatal Abstinence Syndrome (also called NAS) is a group of conditions caused when a baby withdraws from certain drugs he's exposed to in the womb before birth. NAS is most often caused when a woman takes drugs called opioids during pregnancy.

How long can NAS symptoms last? ›

NAS can last from one week to a few months. It is difficult to know how long it will last. The length of the withdrawal symptoms depends on what medicines or drugs the baby was exposed to. It also depends on how much of these the baby got while you were pregnant.

When do NAS symptoms start? ›

Symptoms of NAS can happen within 24 to 48 hours of life or as late as one week after birth. So it is necessary to look out for such symptoms even after discharge from the hospital. Management during hospital stay includes supportive care for the baby, and the mother should be actively involved in their baby's care.

What drugs cause NAS in babies? ›

Causes. NAS may occur when a pregnant woman takes drugs such as heroin, codeine, oxycodone (Oxycontin), methadone, or buprenorphine. These and other substances pass through the placenta that connects the baby to its mother in the womb. The baby becomes dependent on the drug along with the mother.

Is NAS painful for babies? ›

And after they are born, they may start to show signs of withdrawal when they are no longer getting these drugs. This withdrawal is called neonatal abstinence syndrome (NAS). We care about NAS because withdrawal can be painful for babies and even cause medical and other problems.

What are the behavior issues with NAS babies? ›

If your baby has signs of NAS, call her provider right away. Signs may include: Body shakes (tremors), seizures (convulsions), overactive reflexes (twitching) and tight muscle tone. Fussiness, excessive crying or having a high-pitched cry.

What are signs of withdrawal in baby? ›

Withdrawal symptoms in your baby can include:
  • high pitched cry.
  • irritability.
  • tremors (shaking) and jittering.
  • difficulty sleeping or settling.
  • stuffy nose.
  • sneezing.
  • difficulty feeding due to sucking problems.
  • tense (tight) arms, legs and back.

How common is NAS in babies? ›

Neonatal Abstinence Syndrome

That is approximately one baby diagnosed with NAS every 24 minutes in the United States, or more than 59 newborns diagnosed every day.

How long do babies with NAS stay in the hospital? ›

Babies who do not need medicine to control NAS may stay in the hospital for up to a week. Many babies who need medicine for NAS stay in the hospital up to three to four weeks and rarely some may stay longer. It all depends on how your baby responds to treatment.

What are risk factors for NAS babies? ›

Who is at risk for neonatal abstinence syndrome? Pregnant women who use drugs, smoke, or drink alcohol put their unborn babies at risk for neonatal abstinence syndrome and other problems. Women who use drugs also may be less likely to get prenatal care. This can also increase the risks for both mother and baby.

How do you treat NAS in newborns? ›

Infants with NAS and NOWS are treated through non-pharmacological methods (such as rooming-in with mothers after birth, breastfeeding, swaddling, skin-to-skin time, and minimizing stimuli in the environment), as well as pharmacologic methods (medication) when warranted.

How do you prevent NAS in babies? ›

How can NAS be prevented? The most promising approach for treatment of NAS is the evidence-based Eat, Sleep, Console (ESC) model of family-centered care. The ESC model emphasizes the mother's ability to provide care for their infant to reduce NAS symptoms through breastfeeding, swaddling, and skin to skin contact.

What is early intervention for NAS babies? ›

Early Intervention works with families with children birth to age 3 who have NAS/NOWS so they have the best possible start in life. If your baby has been diagnosed with NAS/NOWS, they should be referred to Early Intervention right away. You or your healthcare provider can refer your baby for EI.

Do NAS babies cry a lot? ›

They usually start to show signs of withdrawal a few days after birth. They may be fussy, irritable, or cry a lot, usually with a high-pitched cry. Many babies have trouble sleeping, eating, and gaining weight.

Can NAS babies be breastfed? ›

Breastfeeding is generally recommended for mothers of infants with neonatal abstinence syndrome (NAS) unless some associated risk outweighs the benefits. Evidence indicates that infants with NAS who receive human milk require less pharmacologic treatment and have shorter hospital lengths of stay.

What is the mortality rate of NAS? ›

Infant mortality was 1.00% in the any NAS cohort and 0.29% in the unexposed cohort, as shown in Table 2.

What is a pearl in a baby mouth? ›

Epstein pearls are whitish-yellow cysts. These form on the gums and roof of the mouth in a newborn baby. Milia are a similar type of skin problem in babies.

Does NAS lead to ADHD? ›

Current evidence-based research estimates the rate of ADHD among babies with NAS to be anywhere from 30-40%, much higher than the 3.6% estimated in this study.

How do you soothe a withdrawing baby? ›

If you baby is experiencing withdrawal he or she may be more unsettled when you take them home and may need more care and comforting. Decrease loud noises, bright lights, and don't handle your baby too much. Humming and gentle rocking may help.

How long does infant withdrawal last? ›

You may hear newborn withdrawal referred to as neonatal abstinence syndrome or NAS. Symptoms usually appear 1 to 7 days after birth. Symptoms can be mild or severe, but they usually go away by the time a baby is 6 months old.

Can neonatal abstinence syndrome be fatal? ›

Infants exposed to maternal drugs in fetal life develop signs of drug withdrawal during early neonatal life. This group of withdrawal signs is known as neonatal abstinence syndrome (NAS). Although NAS is not a fatal condition, it results in significant illness and prolonged hospitalization.

Do all babies experience NAS? ›

No, not all babies who have been exposed to medicine or drugs, either before or after birth, have NAS. It depends on what type the baby was exposed to, for how long, and how much was taken. If the NAS is due to exposure while in the womb, it depends when during the pregnancy the baby was born.

What is the most common cause of neonatal distress syndrome? ›

Neonatal respiratory distress syndrome (RDS) occurs from a deficiency of surfactant, due to either inadequate surfactant production, or surfactant inactivation in the context of immature lungs. Prematurity affects both these factors, thereby directly contributing to RDS.

How do you feed a baby NAS? ›

Keeping the infant calm was crucial to being successful, as well as maintaining good control of withdrawal signs. Feeding the infant facing away from them to avoid eye contact was used, as well as vertical rocking, continuous butt patting, bundling, “shhing” sound, and a novel feeding position.

Which newborn babies have the highest risk of complications? ›

Infants born at the lower limit of viability have the highest mortality rates and the highest rates of all complications.

Who is at risk for neonatal abstinence syndrome? ›

Who is at risk for neonatal abstinence syndrome? Pregnant women who use psychoactive drugs, smoke, or drink alcohol put their unborn babies at risk for NAS and other problems. Women who use drugs also may be less likely to get prenatal care. This can also increase the risks for both mother and baby.

What are 6 predisposing factors to infection in the neonate? ›

Summary of risk factors:
  • Preterm labor.
  • Prolonged rupture of membranes > 12-18 hours (the loss of intact membranes allows vaginal bacterial direct access to the fetus)
  • Maternal fever – chorioamnionitis, maternal septicemia transient bacteremia.
  • Multiple gestations.
  • Previously infected infant.
  • Prematurity.
Jun 10, 2022

What is the first line treatment for neonatal abstinence syndrome? ›

For opioid related neonatal abstinence syndrome, morphine and methadone are given as substitutes. Nonmorphine treatments (eg, phenobarbital, chlorpromazine, diazepam, clonidine) provide symptomatic relief. Opioids are currently considered the first-line therapy.

Why is my baby tensing up and shaking? ›

Infantile spasms are a form of epilepsy that affect babies typically under 12 months old. They look like brief spells of tensing or jerking and often happen in a cluster or series. If you think your baby is having spasms, it's important to talk to their pediatrician as soon as possible.

What are 3 interventions for neonatal substance withdrawal? ›

Standard of care interventions include decreasing external stimulation, holding, nonnutritive sucking, swaddling, pressure/rubbing, and rocking. These interventions meet the goals of nonpharmacologic interventions, which are to facilitate parental attachment and decrease external stimuli.

Why don't nicu babies cry? ›

Your preemie may cry softly or not at all, at first, since their breathing system isn't fully developed. They may also have breathing problems. They may have trouble feeding because they don't have reflexes for sucking and swallowing.

What are the long term emotional effects of NICU on babies? ›

The risk of separation anxiety disorder, specific phobia, attention deficit hyperactivity disorder, or oppositional defiant disorder also increased.

Do neonatal nurses take care of healthy babies? ›

A Neonatal Nurse will care for the infant from birth to when they can finally go home as healthy babies.

Does breastmilk help NICU babies? ›

What does your baby eat in the NICU? Breast milk is the best food for your baby, even if she's in the newborn intensive care unit (also called NICU). Breast milk has antibodies that help keep your baby from getting sick. It also contains nutrients that help your baby grow and develop.

Can a mom breastfeed if child is in NICU? ›

If you have a baby in the NICU, it might take a little longer to get them to feed, and in some cases, babies don't feed orally. But with the help of NICU lactation consultants and qualified nurses, many babies with complex medical conditions can successfully breastfeed in the NICU.

Why does NAS cause seizures? ›

The underlying cause of seizures in NAS is not known, although the threshold for seizure activity may be decreased due to upregulation of sodium channels as a result of receptor instability (9).

What are the comorbidities of NAS? ›

Complications of NAS

Other complications and comorbidities include: Low birth weight and preterm birth. Poor feeding and weight loss. Transient tachypnea of the newborn (TTN) and other respiratory complications.

What is a high NAS score? ›

The individual NAS symptoms are weighted (numerically scoring 1–5) depending on the symptom, and the severity of the symptom expressed. Infants scoring an 8 or greater are recommended to receive pharmacologic therapy.

How long does withdrawal irritability last? ›

Studies have found that the most common negative feelings associated with quitting are feelings of anger, frustration, and irritability. These negative feelings peak within 1 week of quitting and may last 2 to 4 weeks (1).

How long does antipsychotic withdrawal syndrome last? ›

The studies in our review (8, 23–26) reported that most withdrawal symptoms started within 4 weeks after abrupt antipsychotic discontinuation and subsided after up to 4 weeks even though certain symptoms such as hyperkinesia may last for months (23).

What are the long term effects of drug exposure in utero? ›

Babies exposed to drugs in utero may experience developmental consequences including impaired growth, birth defects, and altered brain development. Prenatal drug exposure may impact the child's behavior, language, cognition, and achievement long term.

What are finish withdrawal symptoms? ›

FINISH: remembering the discontinuation syndrome. Flu-like symptoms, Insomnia, Nausea, Imbalance, Sensory disturbances, and Hyperarousal (anxiety/agitation)

How long does it take for brain chemistry to return to normal after quitting smoking? ›

3 months – According to research, your dopamine levels will return to normal3 at this point, and the reward part of your brain no longer requires nicotine.

What emotions are withdrawal symptoms? ›

The Notion of Psychological Withdrawal Symptoms

These symptoms include depression, anxiety, reduced motivation, difficulties experiencing pleasure, apathy, and even more serious symptoms, such as the development of hallucinations and delusions.

How long does it take for the brain to heal after antipsychotics? ›

"Studies have found that the volume of brain regions changes over a number of days, but this is in one to two hours, and in half that time it bounces back." Within a day, volunteers' brains returned to almost their original size as the effects of the single haloperidol dose subsided.

What helps antipsychotic withdrawal? ›

To mitigate the symptoms of antipsychotic withdrawal, the dose is gradually reduced or tapered to the minimum effective dose. Gradual tapering involves a slow tapering in dose to allow drug-induced neuroadaptations to return to baseline.

Is brain shrinkage from antipsychotics reversible? ›

Meyer-Lindberg himself published a study last year showing that antipsychotics cause quickly reversible changes in brain volume that do not reflect permanent loss of neurons (see 'Antipsychotic deflates the brain')7.

In which stage of pregnancy is a fetus most susceptible to drugs? ›

Transplacental transfer of drugs increases in the third trimester due to increased maternal and placental blood flow, decreased thickness and increased surface area of the placenta[9].

What are the lifetime effect of substance abuse during pregnancy? ›

Opioid use disorder during pregnancy has been linked with serious negative health outcomes for pregnant women and developing babies, including preterm birth, stillbirth, maternal mortality, and neonatal abstinence syndrome (NAS).

What is lightening in pregnancy? ›

At the end of the third trimester, the baby settles, or drops lower, into the mother's pelvis. This is known as dropping or lightening.


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