What is Neonatal Abstinence Syndrome (NAS)?
The purpose of this leaflet is to give you information, as a parent, about Neonatal Abstinence Syndrome (NAS).
Any medications (either prescribed by your doctor or not) you have taken during pregnancy will have also been absorbed by your baby through the placenta.
Once delivered, the baby is no longer receiving the doses of medication that had been coming from the placenta, therefore, they may begin to withdraw from these medications. This process is known as Neonatal Abstinence Syndrome (NAS).
This withdrawal process is similar to the affects you would feel if you suddenly stopped taking your medications.
Will my baby stay with me?
Most babies will remain with their mothers on the postnatal ward (this depends on the type and number of medications which you have taken during pregnancy) where a midwife will observe for the signs and symptoms of NAS. If your baby starts to show signs of withdrawal they may need to be admitted to the neonatal unit for treatment.
Will my baby need any treatment?
Many babies do not need any treatment for NAS although they may be slightly distressed, feed frequently and only sleep for short periods. This depends on the medication(s) taken and the dose.
Symptoms of withdrawal may include:
- A continuous high pitched cry
- Sneezing and nasal stuffiness
- Feeding difficulties, poor suck, vomiting and loose stools
- Tremors or shaking of your baby’s limbs (known as ‘Jitteriness’)
- Awake a lot, even after a good feed, where your baby will not settle
- Irritability and scratching of their face
- Increased muscle tone where your baby’s limbs feel very stiff
- Jerking of either their arms and legs or both (similar to a fit)
How will you monitor my baby?
Monitoring will ideally continue for a period of at least 24 to 48 hours, up to a maximum of 7 days. This depends on the type and number of medications which you have taken during pregnancy.
Your midwife will assess your baby, at least every 4 hours, using an observation chart which will give a score. If your baby shows poor adaptation outside the womb, they will be admitted to transitional care or to the neonatal baby unit, where a different observation chart will be used, which will give a score. If the score is above a certain cut-off number, he/she will need admission to the neonatal unit.
What will happen on the Neonatal Unit (NNU)?
Once admitted to the neonatal unit, your baby will usually start a medication to help them manage the symptoms of withdrawal. The nurses will continue to observe your baby using the observation chart.
You are an important and valuable part of your baby’s care. It can be a very difficult and frustrating time as your baby may be very irritable. Don’t be afraid to ask for help or to take a break away from the ward.
As your baby improves, the dose of medication will be reduced. Occasionally babies require an increase in medication in order to control their symptoms, but again, as your baby improves, the dose of medication will decrease and later be discontinued.
Remember: Each baby is different and the length of the withdrawal process varies from baby to baby.
Discharge home from the Neonatal unit (NNU)
Once your baby’s medication has been discontinued, your baby will need to be observed for another 4 days in order to make sure that they are stable. Your baby’s discharge can then be planned.
However, some babies will continue to have mild symptoms of withdrawal for up to 4 to 6 months after discharge home. These symptoms are usually milder than the initial symptoms such as irritability, disturbed sleep patterns and continuous crying.
These secondary symptoms will gradually improve with time, however, if the symptoms become worse or you are worried about your baby please seek medical advice.
Support at home
When it is time to go home, if necessary, your baby will be given an appointment to see a Paediatrician as an outpatient. Once home your baby will be seen by your Health Visitor. Please ensure you attend this appointment as any concerns that you may have about your baby’s progress and development can be discussed.
For more information visit nice.org.uk
How to contact us
Neonatal unit Pilgrim Telephone 01205 445404
NICU Lincoln County Telephone 01522 573604
Health visitors single point of access
Telephone 01522 843000
NHS 111 Service Telephone 111