Neonatal abstinence Fox Valley (1724)

Fox Valley

What is Neonatal abstinence syndrome (NAS)?

When a woman is pregnant, everything she eats, drinks, inhales or takes passes to her baby.  This all stops when the baby is born.  If the mother was taking medicines or drugs, the baby may show signs of withdrawal after birth.  Babies may show different symptoms as they withdraw.  The group of symptoms the baby may go through is called neonatal abstinence syndrome (NAS).  Neonatal Opioid Withdrawal syndrome (NOWS) is when a baby is withdrawing from opioids or narcotic medicines.

What drugs can cause withdrawal?

This list has examples but is not all-inclusive:

• Opioids: codeine, hydrocodone (Vicodin), morphine (Kadian, Avinza), methadone, buprenorphine (Suboxone, Subutex), oxycodone (Oxycontin, Percocet), and fentanyl. 
• Barbiturates: Amytal and Fioricet.
• Benzodiazepines: sleeping pills, Valium, Ativan, Klonopin and Xanax.
• Street drugs:  heroin, cocaine, amphetamines and marijuana.
• Common substances: tobacco, caffeine, and alcohol.
• Amphetamines: Adderall and Ritalin.
• Selective Serotonin Reuptake Inhibitors (SSRI’s) and antidepressants: Prozac, Zoloft, Celexa and Lexapro.
• Products of a plant called kratom.  This plan has opioid-like effects.

What are the symptoms of NAS?

• Extreme or high pitched crying.
• Problems sleeping between feedings.
• Difficult to calm.
• Body shakes (tremors or jitters.)
• Trouble sucking on a pacifier or finger 
  or suck excessively.
• Increased muscle tone (stiff muscles).
• Jerky movements during sleep.
• Stuffy nose, sneezing, yawning a lot.
• Fever.
• Sweating.
• Feeding problems.
• Vomiting.
• Diarrhea, which can lead to severe skin    breakdown on the butt.
• Poor weight gain.
• Rashes on face, elbows or heals.
• Breathing fast.
• Patchy color of skin (mottling.)

When might I see symptoms?

Babies usually show signs anywhere from 2 to 7 days after birth. The time it takes for the signs to show depends on the medicine or drug used.  Babies withdraw from tobacco, caffeine and SSRI’s within the first days after birth.  Symptoms may be milder and improve withina  couple of days. The signs from other substances can appear later, sometimes not until 3 to 6 days after birth.

Other things may affect when you will see symptoms:

• What substance was taken during pregnancy.
• When it was last taken.
• The dose of the drug. 
• If the baby is breastfed.

How is NAS treated?

Your baby will be watched in the hospital for at least 4 days.  The total  number of days  depends on the type of substance that was taken and how your baby is doing. 

Testing may also be done on the baby to look for other causes of the symptoms.  Some things we may look for are low blood sugar, infection, brain problems, or electrolyte imbalances. All of these are important for body function.

The main treatment for withdrawal is constant care from caregivers.  You are the primary treatment for your baby.  Staff will try to keep you and your baby together so you can provide the best care for your baby.  This means hugs, cuddles, and on-demand feedings.  Your baby will stay in the hospital, even after you are discharged to go home.  You will keep caring for your baby in the hospital room.  If you need to leave for medical appointments or other duties, have a family member or other person come to care for your baby.  Hospital staff will also care for your baby, if needed.   

All babies born to mothers with a history of illicit drug use will have tests done to look for drug exposure during the pregnancy. These tests can be done on the baby’s urine, stool or umbilical cord. The hospital is required by law to inform the Wisconsin Department of Health and Human Services of maternal use of illegal substances. 

What will the staff be watching?

Your baby will be watched to see how they are doing. If your baby cannot eat, sleep or be calmed (consoled), treatment with medicine may be considered. 

• Eat:  Staff will watch your baby eat to be sure they can suck and swallow without choking of coughing. We encourage all mothers to breastfeed when they are able to do so safely.  You may also pump your breast milk and feed it with a bottle, or use formula.  While weight loss in the first few days of life is normal, babies that are having withdrawal are at risk for losing too much weight. They might need more calories which means they will be given richer feedings. 
• Sleep: The baby should be able to sleep for at least 1 hour. Sleeping can be in someone’s arms or in the crib.  
• Calm (console): The baby should be able to be calmed in 10 minutes or less. Parents have the unique ability to calm their infant with just their presence. Babies can recognize the smell and sound of their parents, and will calm much quicker than with other caregivers. 

How can I help my baby?

• Provide skin-to-skin care.
• Swaddle your baby and hold them close.  Be careful not to over-dress them.
• Feed your baby as often as they seem hungry (at least every 3 hours, if breastfeeding.)
• Avoid loud noises and bright lights.  Turn off the TV.
• Respond quickly to crying.
• Some babies like to be patted or rocked, others do not. Listen to your baby’s cues.
• Allow your baby to rest between feedings.
• Limit visitors.
• Take good care of their skin.  Use butt creams on the diaper area starting from birth. Aquaphor can be used on elbows and chins if they appear to be red or irritated.

How can I take care of myself?

Caring for babies who have NAS/NOWS is very tiring. You will already be tired from your labor and delivery and your baby will need constant care.  Ask family and friends for help. Ask for support from the hospital staff. Tell someone when you need a break or nap. Safe sleep is very important for the health of your baby. Safe sleep means the baby should sleep alone, on their back and in their crib. If your baby is not sleeping in their crib, they need to be watched by an awake and alert person

The hospital staff understands that this is a very stressful time for you and your family. We are here to support you and your baby through this difficult time. Think of us as your coaches to being the best parents you can be. Our goal is to prepare you for a safe discharge home. 

Keep your appointments with your doctors. If you have a substance use or other mental health disorder, please talk to your provider to get help.

Before your baby goes home, we will help you:

• Schedule the first appointment with your baby’s primary care provider (PCP).  Your baby will need visits more often in the first weeks home.
• Set up a home nurse visit from the public health department.
• Refer your baby in the birth to 3 program. 

We highly suggest that moms and babies enroll in the Women, Infants and Children program (WIC), if they are eligible.  

What happens at home?

Most symptoms are gone by 1 month.  Some can last up to 6 months. Your baby may still have problems with sleeping, colic and slow weight gain. It is very important to keep all your appointments with your baby’s doctor. 

For other health and wellness information, check out this resource: https://kidshealth.org/ChildrensWi/en/parents