Neonatal Abstinence Syndrome (NAS)

What Is NAS?

If a woman uses drugs called opioids (OPE-ee-oydz) when she is pregnant, her baby can be born with neonatal abstinence syndrome (nee-oh-NAY-tul AB-stuh-nents SIN-drome). This is called NAS for short.

When mothers use opioids during pregnancy, their babies become dependent on the drug. NAS happens when babies no longer get the drugs from the mom's bloodstream. After they're born and no longer getting the drugs, the babies go through withdrawal.

It can take a few weeks for all of the drug to leave a baby's body. If your baby has NAS, you can help keep your baby comfortable at home.

What Are Opioids?

Opioids are drugs prescribed for pain. They are also called narcotics. They include:

• codeine
• hydrocodone
• morphine
• oxycodone
• meperidine
• fentanyl

The drug heroin is also an opioid. So is methadone. Methadone is a drug that helps people quit using drugs like heroin.

If a woman takes any of these drugs while pregnant, it can cause problems for her baby. That's true even when the drugs are prescribed by a health care professional. Babies might be born too early (premature) or with NAS.

What Happens When a Baby Has NAS?

Babies born with NAS are often smaller than most babies. They can have more health problems.

A baby with NAS may be fussy, irritable, or cry a lot, usually with a high-pitched cry. Many babies have trouble sleeping, eating, and gaining weight. Babies also may:

• shake, tremble, or move in a jerky way
• have stiff arms and legs
• have a big startle reflex
• have a fever and/or sweat a lot
• throw up or have diarrhea
• have trouble breathing
• have blotchy skin
• yawn a lot
• have a stuffy nose or sneeze a lot
• have seizures

Not every baby will have all of these symptoms. It depends on what drugs the mother used, how long and how often she used them, and how soon before birth she took them.

How Can I Help My Baby?

Babies born with NAS need tender loving care. Here's what you can do:

Comfort your baby. Keep your baby away from bright lights and loud noises. Always place your baby to sleep on his or her back. Don't bundle your baby up too much.

Other ways to comfort your baby:

• skin-to-skin contact (putting baby bare-chested on your chest) or holding the baby close to your body
• gently rock and cuddle often, but avoid patting or stroking your baby
• swaddle and give a pacifier
• play soothing music, hum, or sing softly

Feed your baby when he or she is hungry in a calm, quiet place. Feeding can take a lot of your baby's energy, so allow time for resting during a feeding.

Talk to the doctor about the best way to feed your baby. Mothers who use drugs like heroin should not breastfeed their babies. If you're giving formula, make sure you give it as directed by your doctor and in the right amounts.

Change your baby's diaper after a feeding and keep the diaper area clean and dry.

What to do if your baby sucks his or her fists often. Offer a pacifier. Keep your baby's hands clean, but don't apply lotions or creams. Cover your baby's hands with mittens to protect the skin and prevent your baby from scratching his or her face.

What to do if your baby has a runny or stuffy nose. Wipe mucus away with a clean cloth. To help your baby breathe better when awake, hold your baby upright and support the chest with your hand.

Never shake your baby. If you feel overwhelmed, put your baby in a safe place like a crib or bassinet and go into another room to take a break. Or ask a family member or friend to take over for a while.

Does My Baby Need Medical Treatment?

Some babies may need small amounts of a medicine that is like the drug the mother took during pregnancy. As time goes on, the baby will get smaller and smaller amounts until he or she can stop taking the medicine without having withdrawal symptoms.

Moms who are addicted to drugs will need treatment. Doctors, drug counselors, and social workers can help moms and their babies.

Can NAS Be Prevented?

If you're pregnant or thinking about getting pregnant, the best way to prevent NAS is to not use drugs.

If you take drugs and are planning to get pregnant, use birth control during sex until you quit the drug. This will help give you time to get off of any drugs that could harm a baby.

If you take drugs and are pregnant, talk to your health care professional about the best way to stop. Quitting drugs all at once can cause serious problems for you and your growing baby. Your doctor may suggest medication-assisted treatment (MAT) or another method to help you quit.