Babies Born into Addiction: Neonatal Abstinence Syndrome (NAS)

Welcoming a newborn into the world should be a joyous occasion filled with hope and excitement for the future. However, for some infants, their first days and weeks of life are marked by a very different reality – one of withdrawal, discomfort, and a complex medical journey. These are the babies born dependent on substances, a consequence of their mother’s struggles with addiction during pregnancy.

While the statistics are sobering – an estimated 10,000 infants per year are born addicted to opioids in the United States alone – a growing understanding and compassion is surrounding this issue. Addiction is a complex disease that does not discriminate, and the impact it can have on the tiniest members of our society is both heartbreaking and eye-opening. As healthcare providers, loved ones, and community members, we must educate ourselves, provide support, and ensure babies born into addiction receive the care and resources they need to thrive.

Understanding Neonatal Abstinence Syndrome (NAS)

Neonatal abstinence syndrome (NAS), formerly known as neonatal opioid withdrawal syndrome (NOWS), is the term used to describe the withdrawal symptoms experienced by infants who were exposed to addictive substances in utero. This condition can arise when a mother uses opioids, prescription medications¹, or even illicit drugs during her pregnancy.

What Are the Causes of NAS?

The root cause of NAS is the transfer of substances from the mother’s bloodstream to the developing fetus through the placenta. As the fetus becomes dependent on these substances, it begins to rely on their presence to function normally. When the infant is born and suddenly deprived of the substances, their central nervous system becomes overstimulated, leading to a range of withdrawal symptoms.

Substances that are most commonly associated with NAS include:

• Opioids (heroin, prescription painkillers like oxycodone, methadone, buprenorphine)
• Benzodiazepines (diazepam, alprazolam)
• Barbiturates
• Selective serotonin reuptake inhibitors (SSRIs) and other antidepressants
• Alcohol

It’s important to note that the risk of NAS is not limited to illicit drug use; even the appropriate use of certain prescription medications during pregnancy can lead to the condition in the newborn¹.

What Are the Symptoms of NAS?

The specific symptoms and severity of NAS can vary depending on the type of substance, the timing, and frequency of exposure, and whether the infant was born full-term or prematurely. However, some of the most common withdrawal symptoms include:

• Irritability and excessive crying
• Tremors and stiff limbs
• Feeding difficulties and poor weight gain
• Diarrhea, vomiting, and dehydration
• Fever, sweating, and temperature instability
• Sneezing, stuffy nose, and yawning
• Seizures (in severe cases)

These symptoms typically appear within the first 24 to 48 hours after birth, but in some cases, they may not manifest until several days or weeks later.

Diagnosing and Treating NAS

Diagnosing NAS is a critical first step in ensuring these infants receive the appropriate care and support they need. Neonatal abstinence syndrome scoring is typically performed using a system, such as the Finnegan Neonatal Abstinence Scoring System, to assess the severity of an infant’s withdrawal symptoms and guide treatment decisions.

What Is the Diagnostic Approach for NAS?

To accurately diagnose NAS, healthcare providers will gather a comprehensive medical history, including details about the mother’s substance use during pregnancy. They may also conduct various tests, such as:

• Urine, meconium, or umbilical cord toxicology screens to detect the presence of substances
• Blood tests to monitor the infant’s electrolyte levels, liver function, and other vital indicators
• Neurological assessments to evaluate the infant’s reflexes, muscle tone, and overall neurological status

Gathering this information allows the healthcare team to develop a tailored treatment plan to address the infant’s specific needs.

NAS Treatment Strategies

The primary goal of NAS treatment is to manage the infant’s withdrawal symptoms and ensure their physical and emotional well-being. This often involves a multidisciplinary approach, with input from neonatologists, nurses, social workers, and other specialists.

Some neonatal abstinence syndrome nursing interventions include the following:

1. Pharmacological interventions:
   • Administration of medications, such as morphine or methadone, to gradually wean the infant off the substances they were dependent on
   • Careful titration and gradual reduction of these medications to minimize withdrawal symptoms
2. Non-pharmacological interventions:
   • Swaddling and skin-to-skin contact to provide comfort and soothe the infant
   • Maintaining a quiet, low-stimulation environment to minimize sensory overload
   • Breastfeeding, when possible, can help reduce the severity of withdrawal symptoms
   • Increased caloric intake to support the infant’s heightened metabolic needs
3. Supportive care:
   • Monitoring for signs of dehydration, electrolyte imbalances, and other medical complications
   • Providing fluids and nutrition through intravenous (IV) lines or feeding tubes, if necessary
   • Addressing any respiratory or seizure-related issues that may arise

The duration of treatment can vary significantly, ranging from a few weeks to several months, depending on the severity of the infant’s withdrawal symptoms and their response to the interventions. However, all infants diagnosed with NAS should have a neonatal abstinence syndrome care plan in place.

What Are the Long-Term Implications of NAS?

While the immediate challenges of NAS are significant, the long-term impact on these infants can be equally profound. Children born with NAS may face a range of developmental, behavioral, and cognitive challenges as they grow older.

Developmental and Behavioral Consequences

Infants exposed to substances in utero are at an increased risk of experiencing:

• Feeding difficulties and growth problems
• Respiratory issues and other medical complications
• Developmental delays in areas such as motor skills, language, and cognition
• Behavioral problems, including hyperactivity, attention deficits, and impaired impulse control

These challenges can persist well into childhood and adolescence, requiring ongoing support and intervention from healthcare providers, educators, and caregivers.

Cognitive and Academic Impacts

In addition to the physical and behavioral consequences, children with a history of NAS may also struggle with:

• Lower IQ scores and intellectual disabilities
• Learning disabilities and difficulties in school
• Challenges with memory, problem-solving, and executive function

These cognitive and academic challenges can have far-reaching implications, potentially affecting the child’s educational attainment, employment prospects, and overall quality of life.

Supporting Families Affected by NAS

Addressing the needs of infants with NAS requires a comprehensive, compassionate, and collaborative approach that extends beyond the healthcare system. Families, communities, and policymakers all have crucial roles in ensuring these vulnerable children receive the support they need to thrive.

Empowering and Educating Mothers

One of the most critical aspects of supporting infants with NAS is addressing the underlying substance use disorder in their mothers. This often involves a multifaceted approach, including:

• Providing access to evidence-based addiction treatment and recovery resources
• Offering non-judgmental, trauma-informed care and support services
• Educating mothers on the risks of substance use during pregnancy and the importance of seeking help
• Advocating for policies and programs that reduce the stigma associated with addiction and promote maternal-child health

By empowering and supporting mothers in their recovery journey, we can help break the cycle of addiction and ensure a brighter future for both the parent and child.

Babies born into addiction face an uphill battle, but with the proper support and resources, they can overcome the challenges of neonatal abstinence syndrome and go on to lead healthy, fulfilling lives. By fostering a compassionate, multidisciplinary approach to care, empowering mothers in recovery, and advocating for systemic change, we can create a brighter future for these vulnerable infants and their families.