Neonatal Abstinence Syndrome is a condition where babies experience withdrawal symptoms following the use of addictive illicit or prescription drugs either by the mother or when these drugs are prescribed for the baby itself. Most commonly, it is due to the use of drugs such as opioids, methadone, barbiturates, fentanyl, diazepam or other narcotics.
There are two types of neonatal abstinence syndrome. The first type is Prenatal, that is, it occurs due to use of drugs by the mother during pregnancy. The foetus becomes drug dependant and experiences withdrawal symptoms after birth, when exposure to the drug is suddenly stopped.
The second category is Postnatal which follows the use of drugs for the baby in situations like emergency mechanical ventilation that requires analgesia. Fentanyl is the most common analgesic used in newborns It can cause neonatal abstinence syndrome if it is suddenly stopped.
Drugs which are frequently implicated in the occurrence of Neonatal Abstinence Syndrome include benzodiazepines, opioids, amphetamines, barbiturates, heroin, methadone, oxycodone, cocaine, marijuana and SSRI’s (Selective Serotonin Reuptake Inhibitors).
It is hard to tell which babies might get Neonatal Abstinence Syndrome. Some babies have Neonatal abstinence syndrome when a mother takes only small amount of drugs while other babies may only have Neonatal abstinence syndrome when a mother takes large amounts of drugs. Most babies born to mothers using drugs develop Neonatal abstinence syndrome and signs are usually seen within the first few days after birth. Some signs of Neonatal abstinence syndrome include:
Diagnosis of Neonatal Abstinence Syndrome
- High pitched cry
- Tremors/jittering/shaking of arms, legs, face
- Hard time sucking during feeding times
- Poor weight gain
- Fast breathing
- Frantic sucking - fists, fingers, thumbs
- Trouble falling asleep and staying asleep
- Fussy - hard to calm
- Sneezing/stuffy nose
- Tense arms, legs and body
- Skin rashes - more so in the diaper area and face
- Warm to touch/sweating
Tests to diagnose Neonatal Abstinence Syndrome include:
- Neonatal Abstinence Syndrome scoring systems: These scoring systems allot point to each symptom the baby presents with depending upon its severity. The overall score decides the necessity for treatment.
- Meconium analysis: Meconium is the first stool passed by the baby. It is the best method for detection of the drug used.
- Urine analysis: Urine analysis is also a widely used method for detection of drug exposure in the newborn, as it contains higher concentrations of the drug in comparison with the blood.
- Hair analysis: This test is not commonly used as it is expensive. But the sample collection is very easy and can be done up to 3 months after birth.
Treatment of Neonatal Abstinence Syndrome depends upon general condition of the infant, severity of the withdrawal symptoms, feeding and weight gain issues and pre-term or full term baby. Steps to treat infants with neonatal abstinence syndrome include:
- Frequent, small portions of high calorie formula feeds are given for children who present with problems of feeding and weight gain. This helps with the nutrition of the baby.
- Intravenous fluids are considered in case of severe vomiting in a dehydrated infant.
Children with neonatal abstinence syndrome are often irritable and fussy. One can follow these steps to calm the baby:
- Switching off the lights and keeping a low noise or calm environment around them
- Minimizing handling the baby and use of pacifiers
- Gentle rocking and swaddling also helps
If these measures do not ease the situation, drug therapy would be required. Morphine
or methadone is commonly used in treating this condition. However, the choice drug to be used depends on the substance used by the mother during her pregnancy.