Neonatal abstinence syndrome (NAS)
Neonatal abstinence syndrome (also called NAS) is a group of conditions a newborn can have if he’s exposed to addictive street or prescription drugs in the womb before birth. A baby can get addicted to these drugs and then go through drug withdrawal after birth. Babies with NAS are more likely than other babies to be born with low birthweight (less than 5 pounds, 8 ounces), have breathing and feeding problems and seizures. They also usually have to stay in the hospital longer after birth than babies without NAS.
If you take drugs during pregnancy, they can pass through the placenta to your baby. The placenta grows in your uterus and supplies your baby with food and oxygen through the umbilical cord. Using these drugs during pregnancy can cause NAS:
- Opioids, including the prescription medicines codeine, hydrocodone (Vicodin®), morphine (Kadian®, Avinza®) and oxycodone (Oxycontin®, Percocet®). The street drug heroin also is an opioid.
- Barbiturates, like phennies, yellow jackets and Amytal®
- Benzodiazepines, like sleeping pills, Valium® and Xanax®
In addition to NAS, taking these drugs during pregnancy can cause your baby to be born with birth defects. A birth defect is a health condition that is present at birth. Birth defects can change the shape or function of one or more parts of the body. They can cause problems in overall health, how the body develops, or in how the body works.
Some of these drugs are illegal, like heroin. Others are prescription drugs used to treat severe pain or help you sleep. Prescription drugs are medicines that a health care provider has prescribed for you to treat a certain health condition.
What can you do to help prevent NAS in your baby?
If you’re pregnant and you use any of the drugs that can cause NAS, tell your health care provider right away. But don’t stop taking the drug without getting treatment from your provider first. Quitting suddenly (sometimes called cold turkey) can cause severe problems for your baby, including death. If you need help to stop using these drugs, talk to your provider about treatment to help you quit. Getting treatment can help you stop using drugs and is safer for your baby than getting no treatment at all.
If you’re addicted to opioids, medication-assisted treatment (also called MAT) during pregnancy can help your baby. NAS in babies may be easier to treat for babies whose moms get MAT during pregnancy. Medicines used in MAT include methadone and buprenorphine.
Even if you use a prescription drug exactly as your provider tells you to, it may cause NAS in your baby. During pregnancy, tell your prenatal care provider about any drug or medicine you take. If you go to a health care provider who prescribes medicine to treat a health condition (like sleep problems or severe pain), make sure that provider knows you’re pregnant. You may need to stop taking certain medicines or change to medicine that’s safer for your baby. Ask all your health care providers if the drugs you take—even prescription drugs—can cause NAS in your baby.
If you’re not pregnant and using any of the drugs that can cause NAS, use birth control until you’re ready to get pregnant. Birth control (also called contraception or family planning) is methods you use, like birth control pills or an intrauterine device (also called IUD), to keep from getting pregnant. If you’re pregnant or thinking about getting pregnant, tell your health care provider right away about any drug or medicine you take. She can make sure that what you’re taking is safe for you and your baby. She also can help you get treatment for using street drugs or abusing prescription drugs if you need it. If you abuse prescription drugs, it means you take more than has been prescribed for you, you take someone else’s prescription drug, or you get the drug from someone without a prescription.
If you’re not pregnant, quit using street drugs or abusing prescription drugs before you get pregnant. This is the best way to prevent NAS.
What are signs and symptoms of NAS?
Signs and symptoms can be different for every baby with NAS. Most appear within 3 days (72 hours) of birth, but some can appear right after birth or within a few weeks of birth. Signs and symptoms can include:
- Body shakes (tremors), seizures (convulsions), overactive reflexes (twitching) and tight muscle tone
- Fussiness, excessive crying or having a high-pitched cry
- Poor feeding, poor sucking or slow weight gain
- Breathing really fast
- Fever, sweating or blotchy skin
- Trouble sleeping and lots of yawning
- Diarrhea or throwing up
- Stuffy nose or sneezing
Call your baby’s health care provider if your baby has any of these symptoms. Not all babies with NAS have the same symptoms. Symptoms depend on:
- What drug you used during pregnancy, how much you used and how long you took it
- How your own body breaks down the drug
- If your baby was born prematurely (before 37 weeks of pregnancy)
NAS can last from 1 week to 6 months after birth.
How is your baby tested for NAS?
Your baby’s provider can use these tests to see if he has NAS:
- Neonatal abstinence scoring system. This system gives points for each NAS symptom depending on how severe it is. Your baby’s provider uses the score to decide what kind of treatment your baby needs.
- Test of your baby’s first bowel movements (also called meconium)
- Test of your baby’s urine
How is NAS treated?
Your baby’s treatment may include:
- Taking medicines to treat or manage severe withdrawal symptoms. Your baby’s provider may give her a medicine that’s similar to the drug you used during pregnancy. This can help relieve your baby’s withdrawal symptoms. Once these symptoms are under control, your baby gets smaller doses of the medicine over time so her body can adjust to being off the medicine. Medicines used to treat severe withdrawal symptoms include morphine, methadone and buprenorphine.
- Getting fluids through a needle into a vein (also called intravenous or IV). Babies with NAS can get very dehydrated from having diarrhea or throwing up a lot. If a baby’s dehydrated, she doesn’t have enough water in her body. Getting fluids through an IV helps keep your baby from getting dehydrated.
- Drinking higher-calorie baby formula. Some babies with NAS need extra calories to help them grow because they have trouble feeding or slow growth.
Most babies with NAS who get treatment get better in 5 to 30 days.
While your baby’s being treated for NAS, he may be fussy and hard to soothe. Doing these things can help calm him:
For more information
National Council on Alcoholism and Drug Dependence
Substance Abuse Treatment Facility Locator
Organization of Teratology Information Specialists
Last reviewed January 2015
Frequently Asked Questions
Is there any way to prevent RSV?
The season for respiratory syncytial virus (RSV) infection in the United States is usually October to April. It's wise to take precautions to help prevent it. The main thing to do is wash your hands often and thoroughly with soap and water. Make sure everyone who touches your baby has clean hands. Keep your baby away from crowds of people. Do not allow anyone to smoke around your baby. Cover your mouth when you cough or sneeze and don't share cups, spoons and forks with others. RSV is very contagious. Almost all babies get it before the age of 2. Talk to your baby's health care provider about ways to prevent RSV.
What is diphtheria?
Diphtheria is a disease caused by a bacteria. The disease causes a thick coating in the nose, throat and airway. It can lead to breathing problems, heart failure, paralysis or even death.
Diphtheria can be spread by coughing and sneezing. Symptoms may include a slow onset of a sore throat and low-grade fever.
The DTaP (for children) and Tdap (for adults) vaccines can protect against diphtheria, tetanus and pertussis. Your baby gets the DTaP vaccine in four doses: at 2 months, 4 months, 6 months and between 15 and 18 months.
If you’re thinking about getting pregnant, make sure you’re protected against diphtheria. If you need to get vaccinated, get the adult vaccine before pregnancy.
What is Haemophilus influenzae type b?
Hib is a serious disease caused by bacteria. It usually affects young children.
Hib is spread from person to person through coughing or sneezing. Hib can cause meningitis, pneumonia and other serious health problems.
The Hib vaccine protects against this disease. Your baby gets the Hib vaccine in three to four doses: at 2 months, 4 months, 6 months (some brands of the vaccine require a shot at 6 months, but others don’t) and between 12 and 15 months.
What is hepatitis B?
Hepatitis B is caused by the hepatitis B virus. It can lead to serious liver disease. Signs of hepatitis B infection include belly pain, joint pain, dark urine, loss of appetite, nausea, fatigue and jaundice. However, most people who have hepatitis B infection never show any signs.
You can catch hepatitis B if you’re in contact with bodily fluids of someone who has it. For example, you can get the virus from kissing or having sex with an infected person. You also can get it if you share needles with someone who has the virus. During pregnancy, a mom with hepatitis B can pass the infection on to her baby during childbirth. Pregnant women are tested for hepatitis B at a prenatal care visit.
Most people with hepatitis B get better and may not need treatment. However, if you have chronic (long-lasting) hepatitis B infection, you may need treatment with medicines called antivirals that fight the virus. If the liver is badly damaged, you may need a liver transplant. Babies and children are much more likely than adults to get chronic hepatitis B infection.
The hepatitis B vaccine can prevent infection in babies and adults. Your baby gets three doses of hepatitis B vaccine: at birth, 2 months and between 6 and 18 months.
What is measles?
Measles is a disease that is easily spread and causes rash, cough and fever. In some cases, it can lead to diarrhea, ear infection, pneumonia, brain damage or even death. Measles can cause serious health problems in young children. It also can be especially harmful to pregnant women and can cause miscarriage.
The measles, mumps and rubella (MMR) vaccine protects against these three diseases. Your baby gets the MMR vaccine in two doses: the first between 12 and 15 months, the second between 4 and 6 years.
If you’re thinking about getting pregnant, make sure you’re protected against measles. If you need to get vaccinated, get the MMR vaccine before pregnancy. Wait at least 1 month before trying to get pregnant after getting the shot.
What is meningitis?
Meningitis is an infection that causes swelling in the brain and spinal cord. It’s usually caused by a virus or bacteria. The infection can spread from person to person through coughing, sneezing, kissing or sharing drinks.
Most people get meningitis from a virus. If you get this kind of meningitis, you’ll probably get better in a few days without treatment. But the meningitis caused by bacteria can lead to brain damage and even death.
Adults may have symptoms like headache, fever and a stiff neck. These symptoms are sometimes mistaken for the flu. Babies may show different symptoms, like high fever, constant crying or even seizures.
If you think anyone if your family has meningitis, see your health care provider right away.
The Hib vaccine can protect against bacteria that cause meningitis. Your baby gets the Hib vaccine in three to four doses: at 2 months, 4 months, 6 months and between 12 and 15 months. Some brands of the vaccine require a shot at 6 months, but others don’t. Ask your provider if you have questions about when your baby gets the vaccine.
What is mumps?
Mumps is a disease that spreads easily from person to person, usually through coughing or sneezing.
It causes fever, headache and swollen glands around the jaw. It can lead to hearing loss, meningitis and painful, swollen testicles in men.
The measles, mumps and rubella (MMR) vaccine prevents against these diseases. Your baby gets the MMR vaccine in two doses: the first between 12 and 15 months, the second between 4 and 6 years.
If you’re thinking about getting pregnant, make sure you’re protected against mumps. If you need to get vaccinated, get the MMR vaccine before pregnancy. Wait 1 month before trying to get pregnant after getting the shot.
What is pertussis?
Pertussis (whooping cough) is a disease caused by bacteria. Pertussis leads to coughing and choking that can last for several weeks. Babies who catch pertussis can get very sick, and some may die. Most deaths from pertussis happen in babies less than 4 months old.
The number of pertussis cases in this country has more than doubled since 2000. This may be because protection from the childhood vaccine fades over time. In the last few years, there have been several large pertussis outbreaks. Outbreaks are common in places like schools and hospitals. The disease spreads easily from person to person, usually by coughing or sneezing. Most infants who get pertussis catch it from someone in their family, often a parent.
The DTaP vaccine for children and the Tdap vaccine for adults can protect you and your children from pertussis, diphtheria and tetanus. Your baby gets the DTaP vaccine in four doses: at 2 months, 4 months, 6 months and between 15 and 18 months. The pertussis part of the vaccine may weaken as your child gets older. So for the best protection, she gets a fifth shot before she starts school, around 4 to 6 years old.
All new parents need the pertussis vaccine. Until your baby gets her first pertussis shot at 2 months, the best way to protect her is for you to get the adult vaccine before pregnancy or soon after you have your baby. The vaccine prevents you from getting pertussis and passing it along to your baby. Caregivers, close friends and relatives who spend time with your baby should get vaccinated, too.
What is pneumonia?
Pneumonia is an infection in the lungs caused by bacteria or viruses.
Pneumonia can cause coughing, shortness of breath and chest pain. You can catch it from another person, even if he doesn’t look or feel sick.
Several vaccines can protect you from pneumonia by preventing infection from certain bacteria or viruses. One vaccine that protects against pneumonia is pneumococcal conjugate vaccine (PCV). Your baby gets the PCV vaccine in four doses: at 2 months, 4 months, 6 months and between 12 and 15 months.
Other vaccines that help protect against pneumonia include:
- Influenza (flu)
- , mumps, rubella (MMR)
- , and (DTaP for children and Tdap for adults)
- Varicella (chickenpox)
If you’re thinking about getting pregnant and are at risk for pneumonia, your provider may recommend that you get vaccinated before pregnancy. Talk to your provider if you think you may be at risk for pneumonia.
What is tetanus?
Tetanus (also called lockjaw) is a disease caused by bacteria that attacks the nervous system (that includes the brain, spinal cord and nerves).
Stiffness in the neck or stomach muscles may be early symptoms of tetanus. Tetanus also can cause the jaw to “lock,” so that a person can’t open his mouth or swallow. It also can cause serious, painful spasms of all muscles. It sometimes causes death.
Tetanus is not passed from one person to another. Instead, the bacteria that causes tetanus can enter your body through a break in your skin and cause infection. For example, if you step on a nail, cut your skin in an accident, or get a splinter, you may be at risk of tetanus infection.
The DTaP (for children) and Tdap (for adults) vaccines can protect you from tetanus, diphtheria and pertussis. Your baby gets the DTaP vaccine in four doses: at 2 months, 4 months, 6 months and between 15 and 18 months.
If you’re thinking about getting pregnant, make sure you’re protected against tetanus. If you need to get vaccinated, get the adult vaccine before pregnancy.
What’s an umbilical hernia?
This common hernia in infants usually appears as a soft lump or bulge beneath the belly button. You may see it most clearly when your baby is crying, pushing her belly outward. It happens when a portion of the intestine bulges through the abdominal wall. This happens when the muscles in the area fail to close around the belly button after the umbilical cord falls off. It's more common in girls, particularly African Americans, or premature babies.
Umbilical hernias usually aren't serious or painful to the baby and they go away without treatment by the fifth birthday - often much sooner. If you suspect your baby has a hernia, call your child's health care provider. It’ll be important to watch it for changes over time. If it enlarges or swells, or if you baby has severe pain, vomiting or weakness, call your child's health provider right away, as a serious complication could exist. If surgery is required, it’s usually a quick fix.