Summary about Disease
Neonatal Abstinence Syndrome (NAS) is a group of problems that occur in a newborn who was exposed to addictive substances (primarily opioids) while in the mother's womb. The baby is essentially going through withdrawal after birth because they are no longer receiving the drug they were dependent on. NAS can affect multiple systems in the baby's body.
Symptoms
Symptoms of NAS can vary in severity and may include:
Tremors (shaking)
Irritability (excessive crying)
Sleep problems
High-pitched cry
Tight muscle tone
Hyperactive reflexes
Seizures
Sweating
Sneezing
Yawning
Poor feeding or sucking
Vomiting
Diarrhea
Dehydration
Stuffy nose
Causes
NAS is caused by the abrupt cessation of exposure to drugs that the baby was exposed to in utero, after birth. Most commonly, this involves opioid medications, but other substances like barbiturates, benzodiazepines, alcohol, and nicotine can also cause NAS. The severity of NAS often depends on the specific substance, the amount used, how long the mother used it, and how quickly the baby's body metabolizes the drug.
Medicine Used
Medications used to treat NAS often include:
Morphine: A common opioid medication used to wean the baby off of opioid dependence.
Methadone: Another opioid medication used for weaning.
Buprenorphine: A partial opioid agonist sometimes used.
Phenobarbital: A barbiturate sometimes used to manage seizures and other symptoms. Other supportive care measures are also critical, such as providing a quiet, dark environment, swaddling, gentle rocking, and frequent, small feedings.
Is Communicable
No, Neonatal Abstinence Syndrome is not communicable. It is a withdrawal syndrome caused by in utero exposure to substances and is not infectious.
Precautions
Prevention of NAS focuses on preventing substance use during pregnancy. This includes:
Comprehensive prenatal care, including screening for substance use.
Providing education and support for women with substance use disorders.
Offering medication-assisted treatment (MAT) for opioid use disorder during pregnancy.
Avoiding the use of non-essential medications during pregnancy.
Safe tapering of medications under medical supervision, if needed.
How long does an outbreak last?
NAS is not an "outbreak". The duration of symptoms varies significantly, typically lasting from several days to several weeks. The length of time depends on the substance involved, the severity of dependence, and how quickly the baby is weaned off any medications used to treat the withdrawal symptoms.
How is it diagnosed?
NAS is diagnosed based on:
History: Maternal history of substance use, including prescription and illicit drugs, alcohol, and nicotine.
Physical Examination: Observing the newborn for characteristic signs and symptoms.
Scoring Systems: Using standardized scoring systems (e.g., Finnegan Neonatal Abstinence Scoring Tool) to assess the severity of symptoms and guide treatment.
Urine or Meconium Drug Testing: Testing the baby's urine or meconium (first stool) to confirm exposure to specific substances.
Timeline of Symptoms
The timeline of NAS symptoms can vary:
Onset: Symptoms typically begin within 1-3 days after birth but can be delayed up to 5-7 days, depending on the substance.
Peak: Symptoms usually peak within 3-5 days.
Resolution: Symptoms gradually resolve over several days to weeks as the baby's body adjusts and eliminates the substance.
Important Considerations
NAS requires a multidisciplinary approach involving neonatologists, pediatricians, nurses, social workers, and addiction specialists.
Breastfeeding is generally encouraged if the mother is in a stable treatment program and not using illicit substances. Discuss benefits and risks with your physician.
Non-pharmacological interventions (e.g., swaddling, skin-to-skin contact) play a critical role in managing NAS.
Long-term developmental follow-up is important to monitor for any potential effects of prenatal substance exposure.
Maternal support and treatment are essential for the well-being of both the mother and the baby.