Neonatal Abstinence Syndrome (NAS): How to Care for Your Baby

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Pregnant person holding their belly

During pregnancy, drugs and medicines can get into your baby's blood. Babies can get used to these drugs while they are still growing in your body. And after they are born, they may start to show signs of withdrawal when they are no longer getting these drugs. This withdrawal is called neonatal abstinence syndrome (NAS). We care about NAS because withdrawal can be painful for babies and even cause medical and other problems.

Neonatal Abstinence Syndrome (NAS) Risks

Your baby may be at risk for neonatal abstinence syndrome if you have opioid use disorder. Babies with NAS need medical care and extra care from you.

We know this can be a hard time for you and your baby. At Penn Medicine, we are here to help you, answer your questions and give your baby the best care possible.

You are your baby's best medicine

Your love and care are an important part of your baby's health.

If your baby has signs of withdrawal, you and your support person can help by comforting your baby. We will teach you things you can do to help your baby stay safe and calm. You can also help your medical team by looking for new signs of withdrawal or telling them if the signs are getting worse.

Be there for your baby as much as you can

Every day is a new day for you and your baby. If your baby has NAS, there are things you can do to help them cope with their symptoms, including:

  • Swaddle your baby
  • Hold your baby skin to skin
  • Gently rock your baby to help soothe them

If you have any questions or concerns, please reach out to your medical care team.

Frequently Asked Questions about NAS

What drugs and medicines can cause NAS?

Babies may withdraw from drugs like OxyContin, Percocet, methadone, buprenorphine, or Subutex, and street drugs like cocaine, crack, ecstasy, heroin, oxy, or speed.

They may also withdraw from some medicines used to treat anxiety and depression.

It is very important to tell your baby's nurses and doctors about all the medicines and drugs you took when you were pregnant. This will help them give your baby the best care.

Going through withdrawal when you are pregnant can be dangerous for you and your baby. Do not stop taking medications without talking to your doctor first.

If you are in a program for methadone or buprenorphine, your doctor will work closely with you before and after birth.

Will my baby have neonatal abstinence syndrome?

Every baby is different, so it's hard to know which babies will have NAS.

Some babies will show signs of NAS even if you took only small doses of drugs when you were pregnant. Others will show mild signs even if you took large doses of drugs when you were pregnant.

Most babies will start to show signs of withdrawal within five days after birth.

When does withdrawal start and how long will it last?

For babies with NAS, when withdrawal starts and how long it lasts depends on:

  • What drugs or medicines a baby was exposed to during pregnancy.
  • How close to the time of birth the drugs or medicines were taken.

What will happen after my baby is born?

We want you to be a part of your baby’s care as much as you can.

After your baby is born, they will stay with you in your room as long as they are doing well. However, they may need to stay in the hospital longer than you do to watch for signs of withdrawal.

What are the signs of neonatal abstinence syndrome (NAS)?

We will watch your baby closely for signs of withdrawal every few hours. Let your nurse know when you have finished feeding your baby as this is a good time to check for signs. You can also help us watch your baby by keeping track of these signs of NAS:

  • High-pitched cries or being very fussy
  • Stiff arms, legs and back
  • Trouble sleeping
  • Being extra sensitive to light, sounds, and touch
  • Shaking, jitters, or lots of sucking
  • Not eating well or having problems with feedings
  • Throwing up
  • Fast breathing or stuffy nose
  • Fever or sweating
  • Sneezing or yawning more than usual
  • Diaper rash due to loose or watery poop
  • Redness on the face, back of head, and/or legs due to jitters or moving around a lot
  • Trouble gaining weight
  • Seizures

What if my baby needs more help?

Babies who have many or strong signs of withdrawal may need to go to the Intensive Care Nursery (ICN) or pediatrics to be watched more closely. They may need medicine to help keep them safe and comfortable as they work through withdrawal.

How can I comfort my baby if they have NAS?

If your baby has NAS or is experiencing signs of withdrawal, you can comfort them in the following ways:

  • Hold your baby skin to skin.
  • Keep the lights low and the room quiet.
  • Don't wake the baby up when they are sleeping unless they need to eat.
  • Wrap the baby tight using a blanket or sleep sack so they feel safe.
  • If the baby is fussy, rock them and talk to them in a soft voice.
  • Make feeding time quiet and burp your baby often.
  • Limit your visitors to keep the room quiet.
  • Keep track of how well your baby eats and sleeps and what things help your baby stay calm.
  • Learn the signs that your baby is upset (yawning, sneezing, shaking, crying or frowning).
  • Learn the signs that your baby is happy, hungry or relaxed.

Can I breastfeed if my baby has NAS?

Breastfeeding has many health benefits and can help you and your baby bond.

For a baby with NAS, breastfeeding can also help decrease the signs of withdrawal. If you want to breastfeed, your medical team will help you decide if it is safe to give your baby breastmilk.

In general, those in programs taking methadone or buprenorphine are encouraged to breastfeed.

If my baby has NAS, when can they go home?

After your baby is born, their medical team will watch and decide when it is safe for your baby to go home.

Some babies can go home after a few days, but some babies may need to stay for weeks or months. Your baby will be ready to go home when they:

  • Do not need medicine
  • Are eating and sleeping well
  • Are gaining weight
  • Have a normal temperature, heart rate, and breathing pattern
  • Are easy to calm

If you have any questions about opioid use disorder or neonatal abstinence syndrome, talk to your care team.

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