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Neonatal Abstinence Syndrome (NAS): How the Opioid Crisis Affects Babies

For most mothers, holding a newborn baby for the first time is an experience like no other. The immediate bonding as baby lies close to mom’s heart is typically the beginning of life outside the womb.

But for new mothers struggling with opioid addiction, these precious first moments may be very different. Babies born addicted to a mother’s drug of choice experience their first withdrawal symptoms shortly after coming into the world. The condition is called neonatal abstinence syndrome, and the diagnosis can be dire. Those in the most danger are quickly whisked away from mothers’ arms and taken by ambulance to hospitals sometimes hours away for treatment in neonatal intensive care units.1
Doctor holding newbornBoth mother and child feel the separation immediately, as the addicted baby struggles to settle, eat and sleep, and the mother, battling separation anxiety, fights the strong urge to use again to cope with the intense loss. But with the recent success of new treatment methods, there is more hope than ever before for these smallest victims of America’s current opioid epidemic and the mothers who love them.

Neonatal Abstinence Syndrome Basics

Neonatal abstinence syndrome (NAS) happens when babies are exposed to addictive substances while in the womb. The condition is marked by a variety of symptoms caused by the withdrawal of the substance after birth.

There are two recognized types of NAS:

  1. NAS caused by maternal substance use resulting in withdrawal symptoms in newborns
  2. NAS that is secondary to the discontinuation of medications such as morphine or fentanyl used to control pain in newborns2


The symptoms of NAS may include the following:

  • High-pitched cry
  • Jitteriness
  • Tremors
  • Generalized convulsions
  • Sweating
  • Fever
  • Mottled skin
  • Excessive sucking or rooting
  • Poor feeding
  • Vomiting
  • Diarrhea2

The appearance of opioid withdrawal symptoms is the most obvious indicator of the presence of NAS. However, doctors may also use blood, urine and umbilical cord tests, as well as hair analysis, to determine a diagnosis.

Symtoms Of Neonatal Abstinence Syndrome
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No matter the drug of choice, addiction can lead to serious health complications for anyone who abuses a substance. The same is true for your unborn baby.

According to the March of Dimes, NAS can increase your baby’s risk of the following:

  • Low birth weight: Babies born with NAS often weigh less than five pounds and eight ounces.
  • Jaundice: Jaundice is caused by an underdeveloped or compromised liver. When a baby has jaundice, the whites of her eyes and skin appear yellow.
  • Lack of bonding time: Because most babies born with NAS are separated from their mothers during the first few hours of life for intensive care treatment, the bonding time essential for proper infant development is dangerously low.
  • Medication: NAS babies may need morphine or other medicines to help with addiction withdrawal. These medications can lead to secondary addiction and more time spent in the NICU.3

According to the most recent statistics, the number of babies born addicted to some type of drug grew more than five times between 2003 and 2012. In states with highly rural areas like Kentucky, 15 of every 1,000 babies born are addicted to prescription or illegal opioids. And with the average length of stay in the hospital for babies with NAS at 23 days, the cost to treat these tiny patients is astronomical.4

If you are pregnant and addicted to opioid painkillers or take any other medications, tell your doctor right away. Do not stop any medicines you are using, as quitting on your own could cause great harm to you and your baby. Talk to your doctor about treatment programs that can get you off of drugs in a way that is safe for your unborn child.

Promising NAS Treatment

Much like newborns with other serious health problems, babies with NAS are typically taken to a newborn intensive care unit (NICU) not long after birth. Treatment in a NICU usually involves bright lights, the noise of monitors, the use of medications and time spent away from the birth mother. But recent clinical trials have shown that a new approach may be better for addicted babies.

Mother with crying babyStudies show that the practice of separating babies from their mothers while they are going through withdrawal can actually slow the recovery process. Babies who stay with their mothers require less medication and fewer days in NICU units than babies who are taken from their mothers within the first few hours of birth. New “rooming-in” practices where the mother is the primary caregiver allow mom and baby to stay together rather than be separated by hundreds of miles in some cases.

In one example, staff members at Children’s Hospital in Dartmouth-Hitchcock in Lebanon, New Hampshire, prepare mothers struggling with opioid addiction to care for their newborns. When parents weren’t available, volunteer baby “cuddlers” were enlisted. Nurses began the care, and once baby was stable, the birth mother or “cuddler” took over. This program reduced hospital time for infants treated with morphine for their withdrawals from 17 days to 12, saving the hospital nearly $10,000 per baby.1

The most promising if not surprising revelation to come from these studies is that for opioid-addicted infants, a mother’s care may be the best first-line treatment.

By Patti Richards, Contributing Writer


1 Saint Louis, Catherine. “A Tide of Opioid-Dependent Newborns Forces Doctors to Rethink Treatment.The New York Times, July 13, 2017.

2 Hamdan, Ashraf H. “Neonatal Abstinence Syndrome: Practice Essentials, Background and Pathophysiology.” Medscape, August 4, 2017.

3Neonatal abstinence syndrome (NAS).” March of Dimes, June 2017.

4 McQueen, Karen, RN, PhD, and Jodie Murphy-Oikonen, MSW, PhD. “Neonatal Abstinence Syndrome.” New England Journal of Medicine, December 22, 2016.