Neonatal Abstinence Syndrome

Author: 
Adoptive Families Association of BC
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Definition
Neonatal Abstinence Syndrome (NAS) is a medical diagnosis given to a child who shows medical and behavioural signs of withdrawal from opiates such as heroin and methadone that are manifested between birth and 14 days of life.

Causes
Almost every drug passes from the mother's blood stream through the placenta to the fetus. Illicit substances that cause drug dependence and addiction in the mother also cause the fetus to become addicted. At birth, the baby's dependence on the substance continues. However, since the drug is no longer available, the baby's central nervous system becomes overstimulated causing the symptoms of withdrawal.

Characteristics
Symptoms of NAS may vary depending on the type of substance used, the last time it was used, and whether the baby is full-term or premature. Symptoms of withdrawal may begin as early as 24 to 48 hours after birth, or as late as fine to ten days. Alcohol withdrawal may begin a few hours after birth. Each baby may experience symptoms differently. Symptoms of withdrawal in full-term babies may include:

  • Tremors (trembling)
  • Irritability (excessive crying)
  • Sleep problems
  • High-pitched crying
  • Tight muscle tone
  • Hyperactive reflexes
  • Seizures
  • Stuffy nose and sneezing
  • Poor feeding and suck
  • Vomiting
  • Diarrhea
  • Dehydration
  • Sweating
  • Fever or unstable temperature

Premature babies may not have the classic signs of withdrawal but more often experience the following symptoms:

  • Tremors (trembling)
  • High-pitched crying
  • Rapid breathing
  • Poor feeding

Prematurity is defined as birth at less than 37 weeks gestational age. The majority of pre-term babies suffer from low-birth weight (they weigh less than 2500 grams). Acute medical complications associated with pre-term birth include:

  • Intracranial hemorrhages: refers to bleeding into the brain tissue. It is known to be a risk factor for future physical, sensory (hearing and vision) or intellectual problems
  • Bronchopulmonary dysplasia (most well-recognized complication of prematurity): affects lung tissue and interferes with normal breathing functions. Children with this condition may continue to require oxygen, have complex medication regimens and need special home-monitoring of their heart and respiratory rates
  • Retinopathy of prematurity: a disease that involves the blood vessels in the eye
  • Interferences with normal feeding ability: several conditions including low birth weight in the absence of additional medical complications may interfere with an infant's ability to feed. Moreover, the presence of medical complications may further impair an infant's ability to take nutrition by mouth.
  • Cleft lip and palate

Treatment
Babies suffering from withdrawal are irritable and often have a difficult time being comforted. They need extra calories because of their increased activity and may need a higher calorie formula. Some babies may need medications to treat severe withdrawal symptoms, especially for seizures. Other drugs are also being used to help relieve the discomfort and problems of withdrawal. The treatment drug is usually in the same class as the substance the baby is withdrawing from.

Complications
In addition to the specific difficulties of withdrawal after birth, problems in the baby include:

  • Poor intrauterine growth
  • Premature birth
  • Seizures
  • Birth defects

Specific drugs often cause specific problems in the baby:

  • Heroin and other opiates, including methadone, can cause significant withdrawal in the baby.
  • Prenatal use of amphetamines is associated with low birth weight and premature birth.
  • A mother's prenatal cocaine use may related to an increased risk of sudden infant death syndrome (SIDS).
  • Marijuana use is linked to lower birth weight and size of the baby.
  • Alcohol use in pregnancy has significant effects on the fetus (FAS / FAE).
  • Cigarette smoking has long been known for its effects on the fetus. Generally, smokers have smaller babies than non-smokers. Babies of smokers may also be at increased risk for premature birth and stillbirth.

Complications in older childhood due to opiates are:

  • Motor skills difficulties
  • Learning difficulties
  • Delayed speech and language development
  • Difficulties understanding and using information
  • Poor impulse control
  • Hyperactivity
  • Attachment problems
  • Vision problems
  • Difficulty with stress

This resource is by no means intended as a substitute for a doctor's advice or diagnosis. Any concerns you may have with regard to your child's health and development should be discussed with a professional in an appropriate field.