What is Neonatal Withdrawal Syndrome?

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What is Neonatal Abstinence Syndrome (NAS)?

Neonatal withdrawal syndrome or neonatal abstinence syndrome (NAS) is a group of conditions caused when a baby has been exposed to drugs in the womb before birth, and then experiences withdrawal symptoms after birth. NAS most commonly applies to opioid medications, but it can also be caused by antidepressants, benzodiazepines, barbiturates, and stimulants.

Causes of Neonatal Abstinence Syndrome & Neonatal Withdrawal Syndrome

Any medications or drugs that the mother uses during her pregnancy that affect her, will also affect her baby. These substances pass from the mother’s bloodstream through the placenta. For instance, if a mother uses something that affects her nervous system, it will also affect the baby’s nervous system. Much like the mother, the baby gets used to getting these drugs, so when they are born the drug is no longer available to them. This then causes the baby to start experiencing symptoms of withdrawal.

Some substances are more likely to cause neonatal abstinence syndrome than others, but nearly all drugs or medications have some kind of effect on the baby. If the mother uses more than one drug during pregnancy, then the symptoms are usually far worse.

What are the Symptoms of Neonatal Withdrawal Syndrome?

Symptoms of neonatal abstinence syndrome can be different for every baby, but most happen within 72 hours of birth. Some symptoms can start as soon as 24 to 48 hours after birth, and some may not appear until 5 to 10 days up to a few weeks after. Symptoms of neonatal abstinence syndrome can last anywhere from 1 week up to 6 months after birth.

Here are the most common symptoms of a neonatal withdrawal syndrome in full-term babies:

  • Too much crying or high-pitched crying
  • Sleep issues
  • Trembling
  • Seizures
  • Tight muscle tone
  • Yawning, sneezing, stuffy nose
  • Overactive reflexes
  • Poor feeding and sucking
  • Tight muscle tone
  • Sweating
  • Vomiting and diarrhea
  • Fever or unstable temperature
  • Irritability
  • Difficulty comforting baby

Premature babies can have less severe symptoms and a lower risk of even developing withdrawal symptoms due to being exposed to less of the drug. They may also get better faster than full-term babies.

How is Neonatal Abstinence Syndrome Diagnosed?

Neonatal abstinence syndrome can be diagnosed based on a history of the mother’s substance abuse. The medical provider can also use a scoring system to help pinpoint and diagnose the seriousness of the withdrawal. The healthcare provider can also check the baby’s urine, meconium, umbilical cord blood, or all three if they suspect the mother was using drugs. Some places now routinely screen all babies due to the epidemic we are in.

How is Neonatal Abstinence Syndrome Treated?

Neonatal abstinence syndrome can be treated in different ways. Some babies need medications in the same family of drugs that the mother was taking. Once the symptoms of withdrawal are controlled, the baby is slowly weaned off of the medication.

Babies born with neonatal withdrawal syndrome are usually irritable and have trouble being comforted. Swaddling or wrapping the baby snuggly in a blanket can help provide comfort. Babies may also need extra nutrition added to their feedings due to their increased activity. IV fluids may also be needed in severe cases with diarrhea, vomiting, or dehydration.

Complications From Neonatal Withdrawal Syndrome

A lot of babies born with NAS are placed in the NICU or neonatal intensive care unit after birth. This way they can be monitored more closely for any potential complications of the syndrome.

Babies born with neonatal abstinence syndrome are at an increased risk of low birth weight, jaundice or yellowing of the skin, seizures, birth defects, and even SIDS (sudden infant death syndrome). Some children may experience long-term effects like developmental delays, motor problems, behavior and learning problems, sleep, vision, or speech and language problems along with having more ear infections.

Treatment for Addiction During Pregnancy

Neonatal Abstinence Syndrome can be devastating for a new mom and baby. It’s important for new expecting mothers to be educated on the detrimental effects of using drugs while pregnant. Getting treatment for substance abuse during the early months of pregnancy will improve the health and well-being of both the child and the mother.

New Jersey Addiction and Intervention provides addiction recovery and family intervention services for drug and alcohol problems for residents across New Jersey that are struggling along with support services for loved ones affected by substance abuse. If you have a friend or loved one that needs help with substance abuse, give us a call. We can even stage an intervention if necessary.

Medically Reviewed: October 13, 2022

Dr Ashley

Medical Reviewer

Chief Editor


All of the information on this page has been reviewed and verified by a certified addiction professional.

Dr Ashley Murray obtained her MBBCh Cum Laude in 2016. She currently practices in the public domain in South Africa. She has an interest in medical writing and has a keen interest in evidence-based medicine.

All of the information on this page has been reviewed and verified by a certified addiction professional.

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