02Apr2017 Neonatal Abstinence Syndrome
Neonatal abstinence syndrome, or NAS, occurs in newborns exposed to opiate drugs while in the mother’s womb and can cause withdrawal symptoms after birth. This is not a new problem of course, but it is increasingly common. As the problem of opiate addiction grows in this country, so does NAS.
NAS was first defined in the 1970’s. Recently there has been a dramatic increase in the number of cases. In 2012, the syndrome was diagnosed in 21,732 infants in the United States. Every 25 minutes, 1 baby is born suffering from opiate withdrawal.
The graph below shows the spike in recent years.
In Wisconsin, the state Department of Health Services says that in 2015 598 babies were born addicted and suffering from NAS compared to 142 in 2006.
The most common abused opiates (also known as opioids) resulting in NAS are hydrocodone (Vicodin) and oxycodone (Percocet, OxyContin), the most common illicit substance is, of course, heroin.
Babies with NAS are more likely than other babies to be born with low birthweight (less than 5 pounds, 8 ounces) and they usually have to stay in the hospital longer after birth. Symptoms show up 48-72 hours after birth and vary depending on the level of abuse in the mother and the drug abused. Symptoms can include the following…
- Preterm labor
- Fetal death
- Small head circumference
- Visual disturbances
- 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
- IV fluids for babies that can’t feed adequately
- Medication similar to the drug used during pregnancy, most commonly with either oral morphine solution, methadone or buprenorphine
- Phenobarbital for seizures
- Higher calorie formula because these babies need more calories to grow
- Things to help soothe the baby such as, swaddling, keeping the room dim and quiet, holding the baby with skin to skin contact (kangaroo care)
The average length of stay for most babies that get treatment is 17-23 days.
In 2012 10% of women filled an opioid medication prescription during pregnancy. Detecting opiate use or abuse during pregnancy and treating it before delivery improves the treatment course for the newborn. When women were treated during pregnancy, their newborns required 89% less morphine and had a 43% shorter hospital stay. But to detect it requires women to report their use or submit to a drug screen. Those with a serious problem would of course be reluctant to do that. Are we at a point that we require all pregnant women to have drug testing? Should we make it a standard test for pregnant women? Maybe. But if we do that, some women may instead decline to get prenatal care at all which could make the problem worse.
Prevention is key. Education for women of childbearing age and prescribers on the risks of NAS is of the utmost importance. If we can decrease the incidence of opiate abuse in the general public, we will decrease the incidence of NAS.
So when we fight against this addiction, either as individual addicts or as the public, we are not only fighting for people with addictions, we are helping those innocent babies. The smallest of victims. Those that can’t help themselves.