Neonatal abstinence syndrome is what happens when babies are exposed to drugs in the womb before birth. Babies can then go through drug withdrawal after birth. The syndrome most often applies to opioid medicines.
Almost every drug and medicine passes from the mother’s bloodstream through the placenta to her unborn baby. If the mother uses substances that affect her nervous system, they will also affect the baby's. At birth, the baby has become used to getting the drug. But because the drug is no longer available, the baby may have symptoms of withdrawal.
Some drugs and medicines are more likely to cause the syndrome than others. But nearly all have some effect on the baby. When more than one drug has been used, the symptoms are often worse. These include:
Alcohol use can also cause another group of problems called fetal alcohol spectrum disorders.
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.
Symptoms of the syndrome may vary depending on:
Symptoms of withdrawal may start as soon as 24 to 48 hours after birth. Or they may start as late as 5 to 10 days after birth.
The following are the most common symptoms of the syndrome. Symptoms may be slightly different for each baby. Symptoms of withdrawal in full-term babies may include:
Premature babies may have a lower risk for withdrawal symptoms or have less severe symptoms. They may also get better faster because they were exposed to less of the drug than full-term babies.
The symptoms of this problem may look like other health conditions. Make sure your child sees his or her healthcare provider for a diagnosis.
The diagnosis is made based on a history of medicine or substance abuse in the mother. An accurate report of the mother’s drug use is important. This includes the time the last drug was taken. The healthcare provider may use a scoring system to help diagnose and pinpoint how serious the baby’s withdrawal is. Points are assigned for certain signs and symptoms and the seriousness of each. This scoring may also help in planning treatment.
The healthcare provider may check meconium, urine, umbilical cord blood, or all three if the provider suspects that the mother was using drugs. It can also be done if the baby shows symptoms of the syndrome. Some birth centers routinely screen all babies.
Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.
Babies suffering from withdrawal are irritable. They often have a difficult time being comforted. Wrapping the baby snugly in a blanket may help give comfort. Babies also may need extra calories added to their feedings because of their increased activity. They may also need IV fluids if they are dehydrated or have severe vomiting or diarrhea.
Some babies may need medicines to treat severe withdrawal symptoms such as seizures. Medicines may also help relieve the discomfort and problems of withdrawal. If medicine is needed, babies will usually be given a medicine that is in the same family of drugs as the drug the baby was exposed to before birth. Once the signs of withdrawal are controlled, the amount of the medicine is slowly decreased. This helps wean the baby off the drug. Talk with your baby's healthcare provider to learn which treatments might work for your baby.
In addition to the problems of withdrawal after birth, complications in the baby may include:
Even without neonatal abstinence syndrome, prenatal drug exposure can be related to later developmental delay. This may be the result of the environment in which the baby grows up as well.
Specific drugs have been linked to specific problems in the baby. These problems may include:
This syndrome is a potentially preventable problem. But it can only be prevented if the mother stops using drugs before pregnancy or as soon as she learns she is pregnant. In some cases, this is not possible to do safely. In all cases it needs close medical supervision.
Tips to help you get the most from a visit to your child’s healthcare provider: