Neonatal Abstinence Syndrome

Neonatal abstinence syndrome (NAS) refers to the withdrawal symptoms that happens in neonates of mothers that used substances in pregnancy. The symptoms and management is slightly different for each substance used in pregnancy. Mothers should be encouraged and supported with cutting back, and if possible stopping, substances that can affect the pregnancy.

 

Substances That Cause Neonatal Abstinence Syndrome

  • Opiates
  • Methadone
  • Benzodiazepines
  • Cocaine
  • Amphetamines
  • Nicotine or cannabis
  • Alcohol
  • SSRI antidepressants

 

Signs and Symptoms

Withdrawal from most opiates, diazepam, SSRIs and alcohol occurs between 3 – 72 hours after birth. Withdrawal from methadone and other benzodiazepines occurs between 24 hours and 21 days.

CNS:

  • Irritability
  • Increased tone
  • High pitched cry
  • Not settling
  • Tremors
  • Seizures

Vasomotor and respiratory:

  • Yawning
  • Sweating
  • Unstable temperature and pyrexia
  • Tachypnoea (fast breathing)

Metabolic and gastrointestinal:

  • Poor feeding
  • Regurgitation or vomiting
  • Hypoglycaemia
  • Loose stools with a sore nappy area

 

Management

Mothers that are known to use substances should have an alert on their notes so that when they give birth the neonate can have extra monitoring and management of NAS.

Babies are kept in hospital with monitoring on a NAS chart for at least 3 days (48 hours for SSRI antidepressants) to monitor for withdrawal symptoms. A urine sample can be collected from the neonate to test for substances. The neonate should be supported in a quiet and dim environment with gentle handling and comforting.

Medical treatment options for moderate to severe symptoms are:

  • Oral morphine sulphate for opiate withdrawal
  • Oral phenobarbitone for non-opiate withdrawal

Neonates should be gradually weaned off oral treatment. SSRI withdrawal does not typically require or benefit from medical treatment.

Additional considerations:

  • 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 January 2020
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