Neonatal abstinence syndrome (NAS) refers to the withdrawal symptoms that happen in newborns of mothers who used substances during pregnancy. The features and management vary for each substance.
Substances that can cause neonatal abstinence syndrome when consumed during pregnancy include:
- Opiates (most commonly)
- Methadone
- Benzodiazepines
- Alcohol
- Cocaine
- Amphetamines
Poor Neonatal Adaptation Syndrome (PNAS) is used to describe the withdrawal features in the newborn associated with maternal use of antidepressants, particularly SSRIs.
Signs and Symptoms
Withdrawal symptoms from opiates, diazepam, SSRIs and alcohol occur between 3-72 hours after birth. Withdrawal symptoms from methadone and other benzodiazepines occur between 24 hours and 21 days.
Central nervous system symptoms include:
- Irritability
- Increased tone
- High pitched cry
- Not settling
- Tremors
- Seizures
Vasomotor and respiratory symptoms include:
- Nasal stuffiness
- Sneezing
- Yawning
- Sweating
- Unstable temperature and pyrexia
- Tachypnoea (fast breathing)
Metabolic and gastrointestinal symptoms include:
- Poor feeding
- Regurgitation or vomiting
- Hypoglycaemia
- Loose stools with a sore nappy area
Management
Mothers who are known to use substances should have an alert on their notes so the newborn receives additional monitoring and management.
Newborns are kept in hospital with monitoring on a NAS chart for at least 3 days (48 hours for SSRI antidepressants). They are supported in a quiet and dim environment with gentle handling.
Sending a newborn urine sample for toxicology is an option if there is doubt about maternal substance use.
Medical treatment options for moderate to severe symptoms are:
- Oral morphine sulphate for opiate withdrawal (methadone and clonidine are other options)
- Oral phenobarbitone for non-opiate withdrawal (e.g., benzodiazepines or alcohol)
Oral treatment is gradually weaned as tolerated.
SSRI withdrawal does not typically require or benefit from medical treatment.
Additional considerations in newborns with neonatal abstinence syndrome:
- Testing for hepatitis B and C and HIV
- Safeguarding and social service involvement
- Safety-net advice for readmission if withdrawal signs and symptoms occur
- Follow-up from paediatrics, social services, health visitors and the GP
- Support for the mother to stop using substances
- Check the suitability for breastfeeding in mothers with substance use
Last updated May 2025
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