February 4, 2022
By Leah Fendrick, Drexel University College of Medicine
During pregnancy, certain drugs and medications can cross the placenta and get into a baby’s blood. After a baby is born, when they are no longer exposed to these drugs or medications, they may show signs of withdrawal. Drugs that babies may experience withdrawal from include: OxyContin, Percocet, methadone, buprenorphine or Subutex and street drugs such as cocaine, crack, ecstasy, heroin, or speed. Babies may also experience withdrawal from some mediations used to treat anxiety and depression.
From 2004 to 2014, the incidence of neonatal abstinence syndrome (NAS) in the United States increased 433% from 1.5 to 8.0 per 1,000 hospital births. For babies that have NAS, when withdrawal starts and how long it will last depends on what drugs a baby was exposed to during pregnancy and how close to the time of birth the medications were taken. Most symptoms begin within one to three days after birth. The signs of neonatal abstinence syndrome include a high-pitched cry or being very fussy; trouble sleeping; stiff arms, legs and back; being extra sensitive to light, sounds and touch; shaking, jitters or lots of sucking; not eating well or having problems with feeding; throwing up; fast breathing or stuffy nose; fever or sweating; sneezing or yawning more than usual; diaper rash due to loose or watery stool; redness on the face, back of head and/or legs due to jitters or moving around a lot; trouble gaining weight and seizures.
Babies may have to go to the neonatal ICU to be watched more closely and receive medications to help keep them safe and comfortable as they work through withdrawal. Tests that may be done to help diagnose withdrawal in a newborn include the NAS scoring system, which assigns points based on each symptom and its severity; the Eat, Sleep, Console evaluation; and a drug screen of urine and meconium. Ways to comfort a baby with NAS include holding a baby skin to skin, keeping the lights low and the room quiet, not waking the baby when they are sleeping unless they need to eat, wrapping the baby tight using a blanket or sleep sack so they feel safe, rocking the baby and talking to them in a soft voice when they are fussy, and keeping track of how well they are eating.
Treatment will depend on the drug involved, the infant’s overall health, abstinent scores and whether the baby was born full term or prematurely. Some babies with severe symptoms need medicines such as methadone or morphine to treat withdrawal symptoms and help them be able to eat, sleep and relax. If the symptoms are severe, clonidine may be added. Treatment will help relieve symptoms of withdrawal. Babies may need extra tender loving care for weeks or months. To prevent NAS, pregnant people should discuss all medicine, drugs, alcohol and tobacco use with a health care provider.
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