NAS is a serious condition for newborns, but there is an extensive medical support system to help you and your baby through this tough time.

Anyone who has ever been pregnant knows that this stage in a person’s life comes with a wide range of restrictions.

Lesser known factors, like avoiding hibiscus tea or not consuming deli meats, can seem like pregnancy traps that can make mealtime a frustrating experience. But some medications also come with serious complications for your baby.

If you are looking to get pregnant, it’s important to talk with your doctor about your medications and stop any substance use, including caffeine and alcohol.

If you are already pregnant and using substances medically or otherwise, it’s important to act quickly to reduce any harm to your little one.

This article discusses what medications or drugs can cause neonatal abstinence syndrome (NAS) as well as how to treat this condition and where to get support as a caregiver.

Everything from prescribed pain relievers to mental health medications can affect a baby in the womb. This is because the substance passes through the placenta to the fetus, causing a dependency to develop in the baby.

Once the baby is born and stops receiving the substance, they experience withdrawal symptoms. This is what’s known as NAS.

While most people think that NAS is from illegal drug use, the reality is that some prescription drugs can have the same effect.

To be clear, while pregnant people are encouraged to steer clear of illegal drug use, not all prescription drugs are considered dangerous. And anyone currently taking prescription medication who is considering getting pregnant should speak with a doctor to determine whether their current medications are safe or if alternatives are available.

The following drugs are commonly known to lead to NAS:

Babies may also experience NAS if their birthing parent drank alcohol, smoked cigarettes, or frequently used other products that contained nicotine during pregnancy.

Symptoms can vary depending on the type of drug used during pregnancy. Additionally, the amount consumed, the frequency, how the body metabolizes the drug, and even whether the baby was born prematurely or full term will all determine the type of symptoms that are present.

In most cases, symptoms will begin to appear within 1 to 3 days of birth but may not present for up to a week. Common symptoms include:

Long-term symptoms in infants with neonatal abstinence syndrome

Again, the severity or potential for long-term symptoms will depend on the extent of the pregnant parent’s substance use. However, complications can occur for babies born with NAS. In most cases, these babies will need time in the newborn intensive care unit (NICU) to receive treatment and monitoring.

Infants with NAS have a higher risk of sudden infant death syndrome (SIDS). And while more research is needed, experts believe that NAS can be linked to developmental delays that slow progression through key milestones, such as rolling over, sitting, and walking.

Likewise, issues with motor skills, speech delays, difficulty sleeping, and even vision problems are all possible. And in some cases, children with NAS may be more likely to develop recurrent ear infections.

How long does neonatal abstinence withdrawal last?

Like with symptoms, the withdrawal timeline will depend on the severity of drug exposure. Symptoms will usually first appear within 24 to 72 hours of birth. But sometimes initial symptoms may not be present until a baby is 2 weeks old.

While most babies can be treated for NAS withdrawal within 5 to 30 days, individual cases will vary. Severe NAS may take as long as 6 months to complete the withdrawal process.

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Before determining treatment, both you and your baby may be tested to confirm a diagnosis of NAS and to understand the substance that’s causing withdrawal.

The baby’s urine or meconium (the first bowel movement) will be tested for substances. Doctors will ask questions about which substances were consumed during pregnancy. They may order a urine sample from you, too.

Treatment solutions will vary depending on the severity of NAS. For more severe cases, babies may be given medications to control withdrawal symptoms. The goal will be to continue reducing the dose until it’s no longer needed. Common medications used for this purpose include:

Dehydration is a serious concern during withdrawal because of the constant vomiting and diarrhea. So, your baby may also need intravenous (IV) fluids to replenish them. And because slow growth is often a symptom associated with NAS, your baby might be switched to a higher-calorie baby formula.

Preliminary evidence also suggests that babies with NAS who stay with their parents in the same room tend to require shorter hospital stays than babies who stay in the hospital nursery away from their parents.

Always be honest with doctors and hospital staff

There are a lot of variables when it comes to the treatment for NAS. To make sure your baby gets the best treatment, always be honest about any substances used during pregnancy, and how much. The confidentiality of this information is protected by law.

How can I quiet my baby with neonatal abstinence syndrome?

Babies with NAS can be very fussy during withdrawal, but there’s plenty you can do to reduce stress on your little one and make them as comfortable as possible:

  • Keep them calm: Experts usually recommend creating a calming environment that’s free from stimulation while also encouraging bonding. This means reducing exposure to lights and noise as well as providing comfort items, like pacifiers or rockers.
  • Hold them close: Parents are encouraged to engage in skin-to-skin contact, swaddling, and holding the infant to calm them. If you can do so safely, breastfeeding is strongly encouraged as well.
  • Keep them clean: Make sure to clean dirty diapers promptly. Use gentle and non-scented soaps, and moisturize after bathtime.
  • Feed them frequently: It may be easier for your baby if you do smaller and more frequent feedings. Closely monitor their weight gain. Use any supplements or formulas your doctor recommends.
  • Take care of yourself: Caring for a newborn is never easy, but caring for newborns with NAS can include even more challenges. Your baby will be taking emotional cues from you, so make sure to ask your support system for help when you need it. Get plenty of rest and proper nutrition for yourself, too.

When to call your doctor

Infants with NAS have a higher risk of SIDS and need close monitoring to stay in their best health. Make sure to contact your doctor or seek emergency care if your baby:

  • is unable to keep down formula or milk
  • is running a fever of 100.4°F (38°C) or higher
  • is displaying symptoms of a seizure
  • has decreased wet diapers
  • has breathing difficulties (faster or slower than usual)
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Getting proper treatment for NAS can be expensive. And even if you have insurance, the costs may not be fully covered by your plan.

According to a 2019 research letter, the average cost of NAS treatments per infant was $22,552 in 2016. The average stay for NAS-related treatment for infants was 15.9 days.

However, Medicaid largely covered treatment: The network was responsible for 83% of all charges for NAS-related in-hospital births.

Getting support

The best form of treatment for NAS is prevention. This means people who want to become pregnant can focus on seeking support to stop using substances before conceiving.

If you’re already pregnant, be sure to maintain proper prenatal care. You can also receive drug-cessation support if you need it.

There are many organizations that can support you and your baby on your recovery journey:

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Not all neonatal abstinence syndrome (NAS) cases are caused by illegal drug use. Many prescription medications can also create substance dependencies for fetuses that manifest as NAS once a baby is born.

While prevention is the best treatment, there are proven methods that can treat NAS in babies. Depending on the severity of the substance used during pregnancy, NAS withdrawal and subsequent long-term symptoms can vary widely.

Keeping up with routine well visits with your child’s pediatrician is important for all children, and that goes double for children with NAS. If you need extra support, there are many groups that can help you and baby get the help you need.