Neonatal Abstinence Syndrome:

What is it?
Neonatal abstinence syndrome is a withdrawal response that occurs in
newborns. Infants are withdrawing from maternal addictive substances
they were exposed to in utero. NAS has both medical and
developmental consequences for the newborn.
Pathophysiology? How?
Drugs are transferred from the mother to the fetus via the placenta.
During birth the passage of drug is discontinued which causes the
neonates CNS to become over stimulated and thus causing the
symptoms of withdrawal.
Symptoms?
NAS occurs in 55-94% of neonates that were exposed to opiates in
utero.
The presentation of symptoms and the length of withdrawal are
dependent upon the amount and type of drug that was used in
pregnancy, duration of addiction and time of last maternal dose prior
to delivery. Symptoms begin anywhere from 48 hours to 72 hours after
birth. NAS can last from one week to six months

Withdrawal Symptoms:
Central Nervous
System
Tremors
Irritability
High-pitched cry
Abnormal or
excessive suck
Seizures
Autonomic System
Sneezing
Yawning
Gastrointestinal
Symptoms
Diarrhea
Loose/Watery Stools
Vomiting
Pulmonary Symptoms
Tachypnea
Respiratory Distress

NASS:

When a neonate is suspected to be experiencing withdrawal, there are

several tools used to assess the newborn. For example A neonatal
abstinence scoring system is used to determine the severity.

Treatments
Pharm:
Newborns with symptoms of diarrhea, vomiting, seizures and
excessive weightloss, insomnia or fever will require drug therapy.
Common medications prescribed to decrease the babys
symptoms of NAS include morphine, paregoric, phenobarbital,
methadone, clonidine, chlorpromazine and diazepam.
Oral morphine is most commonly used in Canada for newborn
withdrawal.
Nonpharm:
Comfort:
o Infant comfort measures are import than minimize
physiologic effects of withdrawal caused by the central
and autonomic system.
o Keep a quiet dark environment. Tight swaddling is used to
decrease irritability behaviours, gentle rocking, pacifiers
are useful to help infants soothe themselves, (Non-nutritive

sucking helps to decrease the stress in the infant and have

less erratic, uncoordinated movements.)
o Providing comfort also improves feeding which can lead to
weight gain, and promotes mother-newborn interactions.
Nutrition
o Since neonates with NAS have impaired feeding habits it
may be difficult for the infant to gain weight therefore high
calorie formulas used to facilitate weight gain.
o Small, frequent meals encouraged because NAS have
frequent gi upsets and this will improve digestion
o Breastfeeding is encouraged unless the mother is still
using drugs.

Barriers to seeking/preventing treatment:

-

References
Lall, A. (2008). Neonatal abstinence syndrome. British Journal of Midwifery,16(4), 220-223.
Nelson, M. M. (2013). Neonatal Abstinence. Childbirth Education, 28(1), 38.
Bass III, P. F. (2015). Neonatal abstinence syndrome.

Ashraf, H. (2014, August 11). Neonatal Abstinence Syndrome Treatment & Managemen.
Retrieved from http://emedicine.medscape.com/article/978763-treatment
Chow, J., Scott, S., Kyle, T., Ateah, C., & Ricci, S. (2013). Nursing management of the
newborn at risk: Acquired and congenital newborn conditions. In Canadian Maternity and
Pediatric Nursing (pp. 779-783). Philadelphia, PA: Wolters Kluwer Health.
Preventing fasd and fas. (2013, May 2). Retrieved from http://fasd.alberta.ca/

It's safe for a pregnant woman to take tranquilizers, sleeping pills, or amphetamines.?
The correct answer is B. False .
Babies born to mothers who take these medications can have trouble breathing, poor muscle tone, and
other developmental problems.

Aspirin and ibuprofen are safe to take while pregnant? No they are not.
Over-the-counter (OTC) medicines, such as aspirin, ibuprofen, laxatives, or cold or allergy medicines, may
be harmful to an unborn child. Always talk with your obstetrician (pregnancy doctor) before taking OTC
medications or medicines prescribed by a different doctor.

What can we do?

Encourage nonopiod pharmacologic management of pain in
pregnany women such as physical therapy, and massage
therapy.
Educate the mother about NAS and plan for the babys needs
Connect the mother we community resources.

Why do women use substances during pregnancy?

There are several different reasons. In the early stages of pregnancy
the woman may not be aware that she is pregnant, she may not be
aware of the effects of drunking, smoking and other drugs have on the
fetus, or maybe given inaccurate information . Threfore she may
continue to use, some may not be able to stop even if they want to.
Want to quit or cut down their use when they discover they are pregnant. However, these women face many
barriers in seeking treatment for their substance use.

Barriers to Seeking & Receiving treatment?

Stigma,guiltWomendonotseektreatmentbecausetheyareawareofthestigmathatis
attachedtomotherswhousesubstances.Theyfeelguiltyorashamedandthisstigma
preventsthemfromseekinghelpfromhealthprofessionalsandsocialservices.Theremay
alsobestigmafromprofessionalsprovidingcareastheymayhavenegativeattitudes
towardswomenwhousedrugswhilepregnant.Fearfulofloosingcustodyofthechildfearful
ofdisclosingthattheyhaveasubstanceuseproblemandseekingtreatment.

SocialSupportisthereresistancefromthepeopleinherlife?aretheirfriendsandfamily
supportiveofhereffortstochange.

Accessandavailabilitymanyfactorsthatcometoplaydoesshehavephysicalaccessto
treatmentservices?Doesshehavetransportation,financialissues?Unemployed?
Lowincome?Distanceofoutpatientprogrammes?