Neonatal Abstinence Syndrome (NAS)

Also Known as Neonatal Opioid Withdrawal Syndrome (NOWS)

Neonatal abstinence syndrome (NAS), or neonatal opioid withdrawal syndrome (NOWS), is a condition that starts at birth after a baby was exposed to drugs, legal or illegal, during pregnancy.

When the baby is born, their drug supply stops and they go through a time of withdrawal. Until the drugs have left the baby’s system, they feel discomfort. This is like when an adult suddenly stops using drugs.

Signs and Symptoms

The withdrawal signs a baby has depends on what drugs are in their system, how much they were exposed to and how they were used during pregnancy.

Some typical signs of withdrawal may be:

• high-pitched cry
• shaky (tremors)
• cranky, restless
• hard to get or keep asleep
• stiff body
• fever
• throwing up (vomiting)
• little weight gain
• feeding problems
• diarrhea or frequent stools
• sweating
• severe diaper rash
• stuffy nose or repeated sneezing
• dehydrated
• forceful sucking
• skin irritation
• frequent yawning
• seizures (rare)

Treatment

Some babies have mild signs of withdrawal and need only normal, newborn baby care. Non-medical treatment is preferred. However, some babies have severe withdrawal and need medical treatment. Treatment may include being admitted to a special care nursery. There, your baby can get medicine to help ease their distress. If your baby is in a special care nursery, providers will be watching them to decide what care they need.

Things You Can Do

You can do these things at the hospital, or at home:

• Give your baby a pacifier.
• Pat or rock your baby.
• Hold your baby close. You might try using a skin-to-skin method called kangaroo care (Picture 2).
• Learn the signs of withdrawal so you will know if your baby is getting worse.
• Change your baby’s diaper often. Clean their skin with warm water.
• Give smaller, more frequent feedings.
• Spend a lot of time with your baby, in the nursery or at home. Your baby will be comforted by your contact.
• Keep the setting calm and quiet. Keep lights dim, TV and radio off and use soft, quiet voices. Babies that have NOWS/NAS, are sensitive to stimulation, like bright light, loud sounds and being moved or held often.
• Use a blanket to wrap your baby, but be careful not to overheat them.
• Keep in contact with your child’s health care provider.

Diet

• Breastfeeding is encouraged. However, if you are not breastfeeding, your baby’s health care provider will tell you what formula is best.
• To help with digestion, your baby may need a special formula.
• Often, babies will need to suck but not eat. In that case, you can give them a pacifier.
• During the first week of life, a baby will eat 1/2 to 1 ounce of milk per feeding. After that, they will usually eat 2 to 3 ounces of milk per feeding. Feeding more than this can lead to vomiting and diarrhea.

Medicine

Your baby’s health care provider may prescribe medicine to help with their withdrawal.

• Give your baby the exact dose of medicine prescribed. Give only the amount of medicine that the health care provider prescribes.
• If you forget a dose of medicine, but remember within about an hour, give it right away. Then, go back to your regular dosing schedule.
• If you do not remember until later, do not give the missed dose at all. Do not double the next one. Instead, go back to your regular dosing schedule.

Follow-up

It is important to watch your baby’s development as they grow. Talk to your baby’s health care provider about any questions or concerns you have. Children who have been treated for NOWS/NAS in a special care or intensive care nursery may be referred to the Neonatal Developmental Clinic for more specialized care. A health care provider will screen your baby to make sure they are developing normally.

When to Call Your Health Care Provider

Call your baby’s health care provider if they:

• have worse signs of withdrawal
• are not eating
• have diarrhea or vomiting
• cannot be calmed down

When to Call 911

Call 911 for emergency help if your baby:

• has a seizure
• turns blue
• stops breathing

Neonatal Abstinence Syndrome (PDF)

HH-I-320 ©2009, Revised 2021, Nationwide Children’s Hospital